Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.
Hell J Nucl Med. 2020 Sep-Dec;23(3):312-320. doi: 10.1967/s002449912219.
We analyzed the clinical outcome of lutetium-177 prostate-specific membrane antigen (Lu-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) patients with visceral metastasis.
Ten patients of mCRPC with visceral metastasis were enrolled for one cycle of Lu-PSMA therapy. Number of efficacy and safety parameters, e.g., prostate-specific antigen (PSA), visual analog scale (VAS) and analgesic quantification scale (AQS), hemoglobin (Hb), total leukocytes counts (TLC), platelets, creatinine, & total bilirubin, were assessed and compared with Wilcoxon signed-rank test. The progression-free survival (PFS) curve was computed by the Kaplan-Meier method. The receiver operating characteristic curve (ROC) was also plotted for Lu-PSMA dose. P≤0.05 was considered significant.
Liver (80%), lung (30%), adrenal (10%), and peritoneum (10%) were the sites of visceral metastasis in our study. On PSA response assessment, 10%, 60%, and 30% of the patients had partial response, stable disease, and progressive disease, respectively. Forty percent of the patients had improvement in the VAS, while 50% had improvement in the AQS score. Median PFS was 24 weeks in our study. A cut-off of 4.88GBq of Lu-PSMA was the best-predicted progression with 66.67% sensitivity and 100% specificity on ROC analysis. Thirty percent of the patients showed grade 3 anemia. No other significant toxicity was seen.
Lutetium-177-PSMA was a reasonable palliative treatment option with limited toxicity for these end-stage mCRPC patients with visceral metastasis with adequate PSA stabilization. A synergistic drug amalgamation may be an ideal way to boost the outcome in the future.
我们分析了镥-177 前列腺特异性膜抗原（Lu-PSMA）在伴有内脏转移的转移性去势抵抗性前列腺癌（mCRPC）患者中的临床疗效。
10 例伴有内脏转移的 mCRPC 患者接受了一个周期的 Lu-PSMA 治疗。我们评估了疗效和安全性参数，如前列腺特异性抗原（PSA）、视觉模拟量表（VAS）和镇痛量化量表（AQS）、血红蛋白（Hb）、总白细胞计数（TLC）、血小板、肌酐和总胆红素，并采用 Wilcoxon 符号秩检验进行比较。通过 Kaplan-Meier 方法计算无进展生存期（PFS）曲线。还绘制了 Lu-PSMA 剂量的受试者工作特征曲线（ROC）。P≤0.05 为差异有统计学意义。
在我们的研究中，内脏转移的部位为肝脏（80%）、肺（30%）、肾上腺（10%）和腹膜（10%）。在 PSA 反应评估中，分别有 10%、60%和 30%的患者出现部分缓解、疾病稳定和疾病进展。40%的患者 VAS 评分改善，50%的患者 AQS 评分改善。我们的研究中中位 PFS 为 24 周。ROC 分析显示，Lu-PSMA 剂量为 4.88GBq 是预测进展的最佳截断值，其敏感性为 66.67%，特异性为 100%。30%的患者出现 3 级贫血。未观察到其他明显毒性。
对于伴有内脏转移的晚期 mCRPC 患者，Lu-177-PSMA 是一种合理的姑息治疗选择，毒性有限，可使 PSA 得到充分稳定。未来联合用药可能是提高疗效的理想方法。
