转移性激素敏感性前列腺癌患者的PSMA放射性配体治疗：一项回顾性研究
PSMA-RLT in Patients with Metastatic Hormone-Sensitive Prostate Cancer: A Retrospective Study.
作者信息
Banda Amina, Privé Bastiaan M, Allach Youssra, Uijen Maike J M, Peters Steffie M B, Loeff Cato C, Gotthardt Martin, Muselaers Constantijn H J, Witjes J Alfred, van Oort Inge M, Sedelaar J P Michiel, Westdorp Harm, Mehra Niven, Khreish Fadi, Ezziddin Samer, Sabet Amir, Kreissl Michael C, Winkens Thomas, Seifert Philipp, Janssen Marcel J R, van Gemert Willemijn A M, Nagarajah James
机构信息
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands.
Department of Medical Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands.
出版信息
Cancers (Basel). 2022 Dec 31;15(1):297. doi: 10.3390/cancers15010297.
BACKGROUND
Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT) is a novel treatment for patients with castration-resistant prostate cancer (CRPC). Given the mode of action, patients in an earlier disease stage, such as hormone-sensitive prostate cancer (HSPC), are also likely to benefit from [Lu]Lu-PSMA- (Lu-PSMA) or [Ac]Ac-PSMA-radioligand treatment (Ac-PSMA). In this retrospective study, we analyzed the safety and efficacy of PSMA-RLT in early-stage and hormone-sensitive metastatic prostate cancer patients.
METHODS
A retrospective study was performed in patients who received Lu-PSMA and/or Ac-PSMA with early-stage metastatic prostate cancer. The primary outcome parameter evaluated in this study was the progression-free survival (PFS) after PSMA-RLT and toxicity according to the Common Terminology Criteria for Adverse Events. Secondary outcome parameters were prostate-specific antigen (PSA) response and the date of onset of CRPC state.
RESULTS
In total, 20 patients were included of which 18 patients received Lu-PSMA radioligand and two patients received tandem treatment with both Lu-PSMA and Ac-PSMA radioligands. Patients received a median of 2 treatment cycles (range 1-6) and a median activity of 6.2 GBq Lu-PSMA per cycle (interquartile range (IQR) 5.2-7.4 GBq). PSMA-RLT was overall well-tolerated. The most common grade 1-2 side effects were xerostomia ( = 6) and fatigue ( = 8), which were only temporarily reported. One patient that received Ac-PSMA developed grade 3-4 bone marrow toxicity. The median PFS was 12 months (95% confidence interval (CI), 4.09-19.9 months). Seventeen (85%) patients had a ≥50% PSA response following PSMA-RLT. One patient developed CRPC 9 months following PSMA-RLT.
CONCLUSIONS
In this small cohort study, PSMA-RLT appeared safe and showed encouraging efficacy for (metastasized) early-stage and hormone-sensitive prostate cancer patients. Prospective studies are awaited and should include long-term follow-up.
背景
前列腺特异性膜抗原（PSMA）导向的放射性配体疗法（RLT）是去势抵抗性前列腺癌（CRPC）患者的一种新型治疗方法。鉴于其作用方式，处于疾病早期阶段的患者，如激素敏感性前列腺癌（HSPC），也可能从[镥]镥 - PSMA - （镥 - PSMA）或[锕]锕 - PSMA放射性配体治疗（锕 - PSMA）中获益。在这项回顾性研究中，我们分析了PSMA - RLT在早期和激素敏感性转移性前列腺癌患者中的安全性和疗效。
方法
对接受镥 - PSMA和/或锕 - PSMA治疗的早期转移性前列腺癌患者进行了一项回顾性研究。本研究评估的主要结局参数是PSMA - RLT后的无进展生存期（PFS）以及根据不良事件通用术语标准评估的毒性。次要结局参数是前列腺特异性抗原（PSA）反应和CRPC状态的发病日期。
结果
总共纳入了20例患者，其中18例患者接受了镥 - PSMA放射性配体治疗，2例患者接受了镥 - PSMA和锕 - PSMA放射性配体的联合治疗。患者接受的中位治疗周期数为2个周期（范围1 - 6个周期），每个周期镥 - PSMA的中位活性为6.2 GBq（四分位间距（IQR）5.2 - 7.4 GBq）。PSMA - RLT总体耐受性良好。最常见的1 - 2级副作用是口干（n = 6）和疲劳（n = 8），这些仅为临时报告。1例接受锕 - PSMA治疗的患者出现了3 - 4级骨髓毒性。中位PFS为12个月（95%置信区间（CI），4.09 - 19.9个月）。17例（85%）患者在PSMA - RLT后PSA反应≥50%。1例患者在PSMA - RLT后9个月出现CRPC。
结论
在这项小型队列研究中，PSMA - RLT对（转移性）早期和激素敏感性前列腺癌患者似乎是安全的，并且显示出令人鼓舞的疗效。期待开展前瞻性研究，且应包括长期随访。
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