Kınıkoğlu Oğuzcan, Öven Bala Başak, Çelik Serkan, Alan Selçuk Nalan, Beydağı Gamze, Akçay Kaan, Kabasakal Levent
Department of Medical Oncology, Health Science University, Kartal Dr. Lütfi Kirdar City Hospital, İstanbul 34865, Türkiye.
Department of Medical Oncology, Yeditepe University Medical Faculty, İstanbul 34718, Türkiye.
J Clin Med. 2024 Aug 6;13(16):4585. doi: 10.3390/jcm13164585.
The combination of Lutetium-177 (Lu-177) PSMA-617 radioligand therapy (RLT) with androgen receptor pathway inhibitors (ARPIs) has shown promise in metastatic castration-resistant prostate cancer (mCRPC). However, real-world data on the efficacy and safety of this combination are limited. This study aimed to evaluate the impact of combination therapy with Lu-177 PSMA-617 RLT and ARPIs on progression-free survival (PFS) and overall survival (OS) in patients with mCRPC. In this retrospective study, 104 mCRPC patients receiving Lu-177 PSMA-617 RLT at our institution between December 2017 and January 2024 were divided into the following two groups those receiving Lu-177 PSMA-617 RLT plus ARPI (n = 34) and those receiving Lu-177 PSMA-617 RLT alone (n = 70). Patients received 150 to 200 millicuries Lu-177 PSMA-617 RLT in each cycle. PFS and zOS were assessed using Kaplan-Meier analysis and Cox proportional hazard models. The combination therapy significantly prolonged median PFS compared to Lu-177 PSMA-617 RLT alone (11 vs. 5.6 months; HR, 0.47; 95% CI, 0.28-0.79; < 0.01). A trend towards improved OS was also observed in the combination group (20.3 vs. 15.9 months; HR, 0.58; 95% CI, 0.33-1.02; = 0.06). Age was a significant predictor of OS (21.2 vs. 12.4 months for younger vs. older patients; < 0.01), while Gleason score and visceral involvement did not significantly impact PFS. The safety profile indicated that adverse effects were generally comparable between the two groups, with no statistically significant differences in the incidence of anemia, neutropenia, thrombocytopenia, nephrotoxicity, or hepatotoxicity. This study provides evidence that combining Lu-177 PSMA-617 RLT with ARPIs may significantly improve PFS in mCRPC patients. The potential OS benefit warrants further investigation in larger prospective trials. Age should be considered when making treatment decisions for mCRPC patients.
镥-177（Lu-177）PSMA-617放射性配体疗法（RLT）与雄激素受体通路抑制剂（ARPIs）联合应用在转移性去势抵抗性前列腺癌（mCRPC）中显示出前景。然而，关于这种联合疗法疗效和安全性的真实世界数据有限。本研究旨在评估Lu-177 PSMA-617 RLT与ARPIs联合治疗对mCRPC患者无进展生存期（PFS）和总生存期（OS）的影响。在这项回顾性研究中，2017年12月至2024年1月期间在我们机构接受Lu-177 PSMA-617 RLT的104例mCRPC患者被分为以下两组：接受Lu-177 PSMA-617 RLT加ARPI的患者（n = 34）和仅接受Lu-177 PSMA-617 RLT的患者（n = 70）。患者在每个周期接受150至200毫居里的Lu-177 PSMA-617 RLT。使用Kaplan-Meier分析和Cox比例风险模型评估PFS和OS。与单独使用Lu-177 PSMA-617 RLT相比，联合治疗显著延长了中位PFS（11个月对5.6个月；HR，0.47；95%CI，0.28 - 0.79；P<0.01）。联合治疗组也观察到OS有改善的趋势（20.3个月对15.9个月；HR，0.58；95%CI，0.33 - 1.02；P = 传值0.06）。年龄是OS的显著预测因素（年轻患者与老年患者分别为21.2个月对12.4个月；P<0.01），而Gleason评分和内脏受累对PFS无显著影响。安全性表明两组的不良反应总体相当，贫血、中性粒细胞减少、血小板减少、肾毒性或肝毒性的发生率无统计学显著差异。本研究提供了证据表明Lu-177 PSMA-617 RLT与ARPIs联合应用可能显著改善mCRPC患者的PFS。潜在的OS获益值得在更大规模的前瞻性试验中进一步研究。在为mCRPC患者做出治疗决策时应考虑年龄。
