Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.
Prostate Cancer Prostatic Dis. 2020 Mar;23(1):38-52. doi: 10.1038/s41391-019-0174-x. Epub 2019 Oct 8.
Theranostic principles utilize a molecular biomarker specific for a tumor target, initially for imaging to assess target expression and, if deemed suitable, for targeted therapy. This presents an exciting opportunity for a highly personalized treatment strategy in the era of precision medicine. Prostate-specific membrane antigen (PSMA) theranostics has attracted increasing attention as a promising targeted treatment in metastatic prostate cancer (PC). Lu-DOTA-PSMA-617 (Lu-PSMA-617) is a PSMA-targeted small molecule with favorable properties and is the most extensively investigated PSMA radioligand for radionuclide therapy (RNT) in PC. Since 2014 multiple retrospective studies and more recently a phase II prospective study demonstrated safety and impressive efficacy of Lu-PSMA RNT. The evidence generated by these trials led to two currently underway randomized trials in metastatic castrate-resistant PC: TheraP (NCT03392428) and VISION (NCT03511664). While we wait for these pivotal trials to read out, nuclear medicine physicians, medical oncologists, radiation oncologists, and urologists are facing a steep learning curve to master the intricacies and nuances of this novel therapeutic strategy. This review article aims to share and discuss the evolving experience in practical aspects of PSMA theranostics.
治疗诊断学原则利用针对肿瘤靶标的分子生物标志物，最初用于成像以评估靶标表达，并且如果认为合适，则用于靶向治疗。这为精准医学时代的高度个性化治疗策略提供了一个令人兴奋的机会。前列腺特异性膜抗原（PSMA）治疗诊断学作为转移性前列腺癌（PC）的一种有前途的靶向治疗方法，越来越受到关注。Lu-DOTA-PSMA-617（Lu-PSMA-617）是一种具有良好特性的 PSMA 靶向小分子，是 PC 中放射性核素治疗（RNT）研究最广泛的 PSMA 放射性配体。自 2014 年以来，多项回顾性研究和最近的一项 II 期前瞻性研究证明了 Lu-PSMA RNT 的安全性和令人印象深刻的疗效。这些试验产生的证据导致了两项目前正在进行的转移性去势抵抗性 PC 随机试验：TheraP（NCT03392428）和 VISION（NCT03511664）。在我们等待这些关键试验得出结果的同时，核医学医师、肿瘤内科医师、放射肿瘤学家和泌尿科医师正在面临陡峭的学习曲线，以掌握这种新治疗策略的复杂性和细微差别。这篇综述文章旨在分享和讨论 PSMA 治疗诊断学的实际方面的不断发展的经验。
