Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California;
J Nucl Med. 2023 Nov;64(11):1737-1743. doi: 10.2967/jnumed.122.265155. Epub 2023 Sep 7.
Our objective was to evaluate the prognostic value of end-of-treatment prostate-specific membrane antigen (PSMA) PET/CT (PSMA-PET) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with Lu-PSMA radioligand therapy (PSMA-RLT). This was a single-center retrospective study. mCRPC patients who underwent PSMA-RLT with available baseline PSMA-PET (bPET) and end-of-treatment PSMA-PET (ePET) within 6 mo of the last PSMA-RLT cycle were eligible. Overall survival (OS) and prostate-specific antigen (PSA) progression status at the time of ePET (by Prostate Cancer Clinical Trials Working Group 3 criteria) were collected. PSMA-PET tumor segmentation was performed to obtain whole-body PSMA tumor volume (PSMA-VOL) and define progressive (≥20% increase) versus nonprogressive disease. Pairs of bPET and ePET were interpreted for appearance of new lesions. Response Evaluation Criteria in PSMA-PET/CT (RECIP) 1.0 were also applied to define progressive versus nonprogressive disease. The associations between changes in PSMA-VOL, new lesions, RECIP 1.0, and PSA progression status at the time of ePET with OS were evaluated by Kaplan-Meier analysis. Twenty mCRPC patients were included. The median number of treatment cycles was 3.5 (interquartile range [IQR], 2-4). The median time between bPET and cycle 1 of PSMA-RLT was 1.0 mo (IQR, 0.7-1.8 mo). The median time between the last cycle of PSMA-RLT and ePET was 1.9 mo (IQR, 1.2-3.5 mo). Twelve of 20 patients (60%) had died at the last follow-up. The median follow-up time from ePET for survivors was 31.2 mo (IQR, 6.8-40.7 mo). The median OS from ePET was 11.4 mo (IQR, 6.8-30.7 mo). Patients with new lesions on ePET had shorter OS than those without new lesions (median OS, 10.7 mo [95% CI, 9.2-12.2] vs. not reached; = 0.002). Patients with progressive PSMA-VOL had shorter OS than those with nonprogressive PSMA-VOL (median OS, 10.7 mo [95% CI: 9.7-11.7 mo] vs. not reached; = 0.007). Patients with progressive RECIP had shorter OS than those with nonprogressive RECIP (median OS, 10.7 mo [95% CI, 9.7-11.7 mo] vs. not reached; = 0.007). PSA progression at the time of ePET was associated with shorter OS (median, 10.9 mo [95% CI, 9.4-12.4 mo] vs. not reached; = 0.028). In this retrospective study of 20 mCRPC patients treated with PSMA-RLT, progression on ePET by the appearance of new lesions, changes in PSMA-VOL, and RECIP 1.0 was prognostic for OS. Validation in larger, prospective multicentric clinical trials is warranted.
我们的目标是评估治疗转移性去势抵抗性前列腺癌（mCRPC）患者的治疗结束时前列腺特异性膜抗原（PSMA）PET/CT（PSMA-PET）的预后价值，这些患者接受了 Lu-PSMA 放射性配体治疗（PSMA-RLT）。这是一项单中心回顾性研究。符合条件的患者为在最后一次 PSMA-RLT 周期后 6 个月内接受基线 PSMA-PET（bPET）和治疗结束时 PSMA-PET（ePET）的 mCRPC 患者。收集 ePET 时的总生存期（OS）和前列腺特异性抗原（PSA）进展状态（根据前列腺癌临床试验工作组 3 标准）。进行 PSMA-PET 肿瘤分割以获得全身 PSMA 肿瘤体积（PSMA-VOL），并定义进展性（≥20%增加）与非进展性疾病。对 bPET 和 ePET 进行解读以观察新病灶的出现。还应用 PSMA-PET/CT 中的反应评估标准（RECIP）1.0 来定义进展性与非进展性疾病。通过 Kaplan-Meier 分析评估 PSMA-VOL、新病灶、RECIP 1.0 和 ePET 时 PSA 进展状态的变化与 OS 的相关性。 该研究纳入了 20 例 mCRPC 患者。中位治疗周期数为 3.5 个（四分位距 [IQR]，2-4）。bPET 与 PSMA-RLT 第 1 周期之间的中位时间为 1.0 个月（IQR，0.7-1.8 个月）。最后一次 PSMA-RLT 与 ePET 之间的中位时间为 1.9 个月（IQR，1.2-3.5 个月）。20 例患者中有 12 例（60%）在最后一次随访时死亡。幸存者从 ePET 开始的中位随访时间为 31.2 个月（IQR，6.8-40.7 个月）。ePET 后的中位 OS 为 11.4 个月（IQR，6.8-30.7 个月）。ePET 出现新病灶的患者 OS 短于无新病灶的患者（中位 OS，10.7 个月 [95%CI，9.2-12.2]与未达到； = 0.002）。PSMA-VOL 进展的患者 OS 短于 PSMA-VOL 非进展的患者（中位 OS，10.7 个月 [95%CI：9.7-11.7 个月]与未达到； = 0.007）。RECIP 进展的患者 OS 短于 RECIP 非进展的患者（中位 OS，10.7 个月 [95%CI，9.7-11.7 个月]与未达到； = 0.007）。ePET 时 PSA 进展与 OS 较短相关（中位，10.9 个月 [95%CI，9.4-12.4 个月]与未达到； = 0.028）。 在这项接受 PSMA-RLT 治疗的 20 例 mCRPC 患者的回顾性研究中，ePET 上通过新病灶的出现、PSMA-VOL 的变化和 RECIP 1.0 的进展与 OS 相关。需要在更大的、前瞻性多中心临床试验中进行验证。
