Wong Chris Ho-Ming, Nicoletti Rossella, Mazzone Elio, Eapen Renu S
S.H. Ho Urology Centre, Department of Surgery, The Chinese University Hong Kong, Hong Kong SAR, China.
Department of Experimental and Clinical Biomedical Science, University of Florence, Florence.
Curr Opin Urol. 2025 Jan 1;35(1):46-52. doi: 10.1097/MOU.0000000000001234. Epub 2024 Oct 16.
Lutetium-177-prostate-specific membrane antigen (Lu 177-PSMA) radioligand therapy has emerged as a promising novel strategy for advanced prostate cancer. With its increasing importance alongside with a plethora of exciting results from latest trials, we would like to summarize current evidence and advancements in Lu 177-PSMA therapy across different stages of prostate cancer.
In metastatic castration-resistant prostate cancer (mCRPC), early studies like the LuPSMA trial and TheraP trial demonstrated promising PSA response rates. The landmark VISION trial had established the oncological efficacy of Lu 177-PSMA as salvage therapy and demonstrated its benefit on survival outcomes. Explorations into earlier treatment settings have also been encouraging. Studies like that the PSMAfore trial, Enza-P trial and the UpFrontPSMA trial explored an earlier role of Lu 177-PSMA in mCRPC, and showed benefits when used in solitary or in junction with Docetaxel or androgen receptor pathway inhibitor. Finally, the potential use of Lu 177-PSMA as neoadjuvant therapy in localized prostate cancer is also under consideration, whose safety was demonstrated in the recent LuTectomy trial.
Lu 177-PSMA therapy represents a significant advancement in prostate cancer treatment, offering selective and targeted delivery of radiation to prostate cancer cells in patients across various disease stages. Ongoing research and collaborative efforts are essential to overcome existing challenges, optimize patient selection and integrate this therapy into standard clinical practice, ultimately improving outcomes for patients with advanced prostate cancer.
镥-177-前列腺特异性膜抗原（Lu 177-PSMA）放射性配体疗法已成为晚期前列腺癌一种有前景的新策略。随着其重要性日益增加以及来自最新试验的大量令人振奋的结果，我们想总结Lu 177-PSMA疗法在前列腺癌不同阶段的当前证据和进展。
在转移性去势抵抗性前列腺癌（mCRPC）中，早期研究如LuPSMA试验和TheraP试验显示出有前景的前列腺特异性抗原（PSA）反应率。具有里程碑意义的VISION试验确立了Lu 177-PSMA作为挽救疗法的肿瘤学疗效，并证明了其对生存结果的益处。对更早治疗阶段的探索也令人鼓舞。诸如PSMAfore试验、Enza-P试验和UpFrontPSMA试验等研究探索了Lu 177-PSMA在mCRPC中更早的作用，并显示出单独使用或与多西他赛或雄激素受体通路抑制剂联合使用时的益处。最后，Lu 177-PSMA作为局限性前列腺癌新辅助治疗的潜在用途也在考虑之中，其安全性在最近的LuTectomy试验中得到了证明。
Lu 177-PSMA疗法代表了前列腺癌治疗的一项重大进展，为处于各种疾病阶段的患者的前列腺癌细胞提供了选择性和靶向性的辐射递送。持续的研究和合作努力对于克服现有挑战、优化患者选择并将这种疗法纳入标准临床实践至关重要，最终改善晚期前列腺癌患者的治疗结果。
