Bu Ting, Zhang Lulu, Yu Fei, Yao Xiaochen, Wu Wenyu, Zhang Pengjun, Shi Liang, Zang Shiming, Meng Qingle, Ni Yudan, Shao Guoqiang, Qiu Xuefeng, Ai Shuyue, Jia Ruipeng, Guo Hongqian, Wang Feng
Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Urology, Nanjing Drum Hospital, Nanjing University, Nanjing, China.
Front Oncol. 2022 Mar 24;12:835956. doi: 10.3389/fonc.2022.835956. eCollection 2022.
There is increasing evidence for convincing efficacy and safety of Lu-labled prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (PRLT) for metastatic castration-resistant prostate cancer (mCRPC). However, data are not available regarding the feasibility of Lu-labled PSMA-targeted RLT in East Asians. The present study summarized the first experience with Lu-PSMA-I&T therapy for mCRPC in China.
Forty consecutive patients with mCRPC were enrolled from December 2019 to September 2021. Eligible patients received Lu-PSMA-I&T RLT at intervals of 8-12 weeks. Toxicity was assessed based on standardized physicians' reports and the Common Toxicity Criteria for Adverse Events criteria. Response to PRLT was evaluated according to the changes of prostate specific antigen (PSA) response and imaging response. Quality of life (QOL), Karnofsky performance status (KPS) and pain (visual analogue scale, VAS) were also evaluated. The impacts of baseline parameters on the therapeutic effects were explored by univariate and multivariate logistic regression analyses.
All patients underwent a total of 86 cycles of Lu-PSMA-I&T (range: 1-5 cycles) with dosages of 3.70-14.43GBq per cycle, with a median of 8 months followed up. Six patients (15%) developed mild reversible xerostomia during follow-up, and 28 patients (70%) experienced grade 1-4 bone marrow dysfunction. Changes in PSA were assessed after therapy, accompanied by the partial response (PR) in 25 patients (62.5%), the stable disease (SD) in 5 patients (12.5%), and the progressive disease (PD) in 10 patients (25%), respectively. QOL, KPS (%) and VAS scores were improved significantly due to treatment (<0.05). Overweight and elevated AST, ALP, and LDH were associated with poor outcomes.
Lu-PSMA-I&T achieves the favourable response and well tolerance in mCRPC, which associates with not only PSA decline but also with tumor remission including lymphadenopathy and bone metastasis. We also find that patients with overweight and high AST, ALP, and LDH should be cautious to undergo the PRLT. Large-cohort studies are warranted to confirm the initial findings and elucidate the survival benefit of the treatment.
越来越多的证据表明，镥标记的前列腺特异性膜抗原（PSMA）靶向放射性配体疗法（PRLT）对转移性去势抵抗性前列腺癌（mCRPC）具有令人信服的疗效和安全性。然而，关于镥标记的PSMA靶向RLT在东亚人群中的可行性数据尚不可用。本研究总结了中国首例mCRPC患者接受镥-PSMA-I&T治疗的经验。
2019年12月至2021年9月，连续纳入40例mCRPC患者。符合条件的患者每8-12周接受一次镥-PSMA-I&T RLT治疗。根据标准化医生报告和不良事件通用毒性标准评估毒性。根据前列腺特异性抗原（PSA）反应和影像学反应的变化评估PRLT的疗效。还评估了生活质量（QOL）、卡诺夫斯基表现状态（KPS）和疼痛（视觉模拟评分，VAS）。通过单因素和多因素逻辑回归分析探讨基线参数对治疗效果的影响。
所有患者共接受了86个周期的镥-PSMA-I&T治疗（范围：1-5个周期），每个周期剂量为3.70-14.43GBq，中位随访时间为8个月。6例患者（15%）在随访期间出现轻度可逆性口干，28例患者（70%）出现1-4级骨髓功能障碍。治疗后评估PSA变化，分别有25例患者（62.5%）出现部分缓解（PR），5例患者（12.5%）病情稳定（SD），10例患者（25%）病情进展（PD）。治疗后QOL、KPS（%）和VAS评分显著改善（<0.05）。超重以及AST、ALP和LDH升高与不良预后相关。
镥-PSMA-I&T在mCRPC中取得了良好的反应和耐受性，这不仅与PSA下降有关，还与包括淋巴结病和骨转移在内的肿瘤缓解有关。我们还发现，超重以及AST、ALP和LDH升高的患者应谨慎接受PRLT治疗。需要进行大规模队列研究以证实初步发现并阐明该治疗的生存获益。
