Nuklearmedizin 2019; 58(02): 194
DOI: 10.1055/s-0039-1683740
Poster
Theranostik
Georg Thieme Verlag KG Stuttgart · New York

Lu-177-PSMA-617 radioligand therapy in mCRPC patients with a single functioning kidney

J Zhang
1   Zentralklinik Bad Berka, THERANOSTICS Center for Molecular Radiotherapy & Molecular Imaging, Bad Berka
,
HR Kulkarni
1   Zentralklinik Bad Berka, THERANOSTICS Center for Molecular Radiotherapy & Molecular Imaging, Bad Berka
,
A Singh
1   Zentralklinik Bad Berka, THERANOSTICS Center for Molecular Radiotherapy & Molecular Imaging, Bad Berka
,
C Schuchardt
1   Zentralklinik Bad Berka, THERANOSTICS Center for Molecular Radiotherapy & Molecular Imaging, Bad Berka
,
K Niepsch
1   Zentralklinik Bad Berka, THERANOSTICS Center for Molecular Radiotherapy & Molecular Imaging, Bad Berka
,
T Langbein
1   Zentralklinik Bad Berka, THERANOSTICS Center for Molecular Radiotherapy & Molecular Imaging, Bad Berka
,
RP Baum
1   Zentralklinik Bad Berka, THERANOSTICS Center for Molecular Radiotherapy & Molecular Imaging, Bad Berka
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2019 (online)

 
 

    Ziel/Aim:

    The aim of this study was to assess the safety, tolerability and renal toxicity profile of PRLT using Lu-177-PSMA-617 in patients with mCRPC and a single functioning kidney.

    Methodik/Methods:

    16 patients (age 53 – 78 y, mean age 64.7 ± 6.5 y) with a single functioning kidney received PRLT with Lu-177-PSMA-617. All parameters of renal function (for example, serum creatinine, blood urea nitrogen and electrolytes) prospectively documented in a structured database and analyzed along with the patient characteristics and tumor load prior to each PRLT cycle and in follow-up. Renal function was further quantified by measuring the TER. AEs were graded according to the CTCAE. Treatment response was evaluated by measuring PSA and on imaging (Ga-68-PSMA PET/CT with/without MRI) according to RECIST 1.1 as well as by EORTC.

    Ergebnisse/Results:

    The median administered activity was 22.1 GBq (range 15.4 – 33.8 GBq) in 2 – 6 cycles. Calculated radiation-absorbed doses of kidney were 0.81 ± 0.32 Gy/GBq. Renal function was already impaired at baseline in 43.7% patients, according to CTCAE G1 in 25.0% and G2 in 18.8%. G1 and G2 renal functional impairment, respectively, were present in 37.5% and 6.3% of the patients after the first PRLT cycle and in 31.3% and 12.5% after the second cycle. No G3 or 4 nephrotoxicity was observed during or after treatment. The ratio of TER to lower limit TER (TER/TERLoLi) changed from 0.82 ± 0.30 to 0.78 ± 0.29, declining in 10/16 (62.5%) and by more than 10% in 4 (25%) of the patients. The renal function (both TER as well as TER/TERLoLi ratio) improved in 6/16 (37.5%) patients after treatment. Any PSA decline 2 months after the first cycle was noted in 9 patients (56.3%) with 7 patients (43.8%) demonstrating a PSA decline of more than 50%. Based on EORTC, disease control rate (DCR) at 2 months (2.1 ± 0.3 months) post-PRLT was 68.8%, encompassing PR in 43.8% and SD in 25.0%, and by RECIST, PR in 43.8%, and SD in 31.3%.

    Schlussfolgerungen/Conclusions:

    With highly individualized interdisciplinary treatment, the use of Lu-177-PSMA-617 RLT in mCRPC patients with a single functioning kidney is feasible and shows no significant subacute nephrotoxicity. Further investigation with long-term follow-up is warranted.


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