Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India; and.
Department of Medical Oncology, B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
J Nucl Med. 2023 Aug;64(8):1266-1271. doi: 10.2967/jnumed.123.265414. Epub 2023 May 11.
Radioligand therapy (RLT) with Lu-prostate-specific membrane antigen (PSMA) inhibitors ([Lu]Lu-PSMA) is currently approved for patients with metastatic castration-resistant prostate cancer (mCRPC) after progression with at least 1 taxane and 1 androgen-receptor-pathway inhibitor. However, the impact of prior chemotherapy on [Lu]Lu-PSMA-RLT outcomes is debatable, with various studies showing inconsistent results. This study was conducted to precisely evaluate the impact of prior taxane chemotherapy on response and survival outcomes in mCRPC patients after [Lu]Lu-PSMA-RLT. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches in PubMed, Scopus, and Embase were made using relevant key words, and articles up to December 2022 were included. The endpoints included prostate-specific antigen (PSA) response rate (RR), progression-free survival, and overall survival (OS). Individual patient data were pooled when feasible. Univariate odds ratios (ORs) and hazard ratios (HRs) were extracted from the individual articles, and pooled estimates and 95% CIs were generated using metaanalysis. Thirteen articles comprising 2,068 patients were included. In 6 articles (553 patients), taxane-naïve patients had significantly better odds of biochemical response after [Lu]Lu-PSMA-RLT (pooled OR, 1.82; 95% CI, 1.21-2.71). Individual patient data metaanalysis for PSA RRs in 3 articles revealed a significantly higher PSA RR in the taxane-naïve versus taxane-treated patients (57.1% vs. 39.5%; difference, 17.6%; 95% CI, 5.6%-28.9%). Further, taxane-naïve status was also a predictor of significantly better progression-free survival (5 articles; 1,027 patients; pooled HR, 0.60; 95% CI, 0.51-0.69) and OS (8 articles; 1,594 patients; pooled HR, 0.54; 95% CI, 0.43-0.68) after [Lu]Lu-PSMA-RLT. There was no evidence of publication bias. mCRPC patients with no prior taxanes had significantly better outcomes after [Lu]Lu-PSMA-RLT than did taxane-treated patients. Further trials evaluating [Lu]Lu-PSMA-RLT in the taxane-naïve setting are now required.
放射性配体疗法 (RLT) 联合 Lu-前列腺特异性膜抗原 (PSMA) 抑制剂 ([Lu]Lu-PSMA) 目前已获批用于至少接受过 1 种紫杉烷类药物和 1 种雄激素受体通路抑制剂治疗后进展的转移性去势抵抗性前列腺癌 (mCRPC) 患者。然而，先前化疗对 [Lu]Lu-PSMA-RLT 疗效的影响存在争议，不同的研究结果不一致。本研究旨在精确评估 mCRPC 患者在接受 [Lu]Lu-PSMA-RLT 治疗前接受紫杉烷化疗对反应和生存结局的影响。本综述遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 指南。在 PubMed、Scopus 和 Embase 中使用相关关键词进行了检索，并纳入截至 2022 年 12 月的文章。终点包括前列腺特异性抗原 (PSA) 缓解率 (RR)、无进展生存期和总生存期 (OS)。当可行时，对个体患者数据进行了汇总。从各篇文章中提取单变量比值比 (OR) 和风险比 (HR)，使用荟萃分析生成汇总估计值和 95%置信区间。纳入了 13 篇包含 2068 例患者的文章。在 6 篇文章 (553 例患者) 中，[Lu]Lu-PSMA-RLT 后，紫杉烷初治患者的生化缓解的可能性显著更高 (汇总 OR，1.82；95%CI，1.21-2.71)。3 篇文章的个体患者数据荟萃分析显示，与紫杉烷治疗患者相比，紫杉烷初治患者的 PSA RR 显著更高 (57.1%比 39.5%；差异，17.6%；95%CI，5.6%-28.9%)。此外，紫杉烷初治状态也是无进展生存期 (5 篇文章；1027 例患者；汇总 HR，0.60；95%CI，0.51-0.69) 和 OS (8 篇文章；1594 例患者；汇总 HR，0.54；95%CI，0.43-0.68) 显著改善的预测因素。没有发现发表偏倚的证据。与接受紫杉烷治疗的患者相比，未接受过紫杉烷治疗的 mCRPC 患者在接受 [Lu]Lu-PSMA-RLT 后具有显著更好的结局。现在需要进一步的试验来评估 [Lu]Lu-PSMA-RLT 在紫杉烷初治患者中的应用。
