Department of Nuclear Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Department of Radiology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
J Nucl Med. 2024 Jan 2;65(1):79-84. doi: 10.2967/jnumed.123.265986.
β-emitting Lu targeting prostate-specific membrane antigen (PSMA) is an approved treatment option for metastatic castration-resistant prostate cancer. Data on its long-term nephrotoxicity are sparse. This study aimed to retrospectively evaluate post-Lu-PSMA estimated glomerular filtration rate (eGFR) dynamics for at least 12 mo in a cohort of metastatic castration-resistant prostate cancer patients. The institutional databases of 3 German tertiary referral centers identified 106 patients who underwent at least 4 cycles of Lu-PSMA and had at least 12 mo of eGFR follow-up data. eGFR (by the Chronic Kidney Disease Epidemiology Collaboration formula) at 3, 6, and 12 mo after Lu-PSMA radioligand therapy was estimated using monoexponentially fitted curves through available eGFR data. eGFR changes were grouped (≥15%-<30%, moderate; ≥30%-<40%, severe; and ≥40%, very severe). Associations between eGFR changes (%) and nephrotoxic risk factors, prior treatment lines, and number of Lu-PSMA cycles were analyzed using multivariable linear regression. At least moderate eGFR decreases were present in 45% (48/106) of patients; of those, nearly half (23/48) had a severe or very severe eGFR decrease. A higher number of risk factors at baseline (-4.51, = 0.03) was associated with a greater eGFR decrease. Limitations of the study were the retrospective design, lack of a control group, and limited number of patients with a follow-up longer than 1 y. A considerable proportion of patients may experience moderate or severe decreases in eGFR 1 y from initiation of Lu-PSMA. A higher number of risk factors at baseline seems to aggravate loss of renal function. Further prospective trials are warranted to estimate the nephrotoxic potential of Lu-PSMA.
β发射体 Lu 靶向前列腺特异性膜抗原（PSMA）是转移性去势抵抗性前列腺癌的一种批准的治疗选择。关于其长期肾毒性的数据很少。本研究旨在回顾性评估至少 12 个月内转移性去势抵抗性前列腺癌患者队列中 Lu-PSMA 后估算肾小球滤过率（eGFR）的动态变化。3 家德国三级转诊中心的机构数据库共确定了 106 名至少接受 4 个 Lu-PSMA 周期且至少有 12 个月 eGFR 随访数据的患者。通过现有 eGFR 数据，使用单指数拟合曲线估算 Lu-PSMA 放射性配体治疗后 3、6 和 12 个月的 eGFR（通过慢性肾脏病流行病学合作公式）。根据 eGFR 变化（≥15%-<30%，中度；≥30%-<40%，重度；≥40%，非常严重）对患者进行分组。使用多变量线性回归分析 eGFR 变化（%）与肾毒性危险因素、既往治疗线数和 Lu-PSMA 周期数之间的关系。至少有 45%（48/106）的患者出现中度或更严重的 eGFR 下降；其中近一半（23/48）的患者出现严重或非常严重的 eGFR 下降。基线时危险因素数量较高（-4.51， = 0.03）与 eGFR 下降更大相关。研究的局限性为回顾性设计、缺乏对照组以及随访时间超过 1 年的患者数量有限。从 Lu-PSMA 开始治疗 1 年后，相当一部分患者可能会出现中度或重度 eGFR 下降。基线时危险因素数量较多似乎会加重肾功能丧失。需要进一步的前瞻性试验来评估 Lu-PSMA 的肾毒性潜力。
