Download PDF
Nuklearmedizin 2020; 59(06): 409-414
DOI: 10.1055/a-1234-5891
Original Article

Improving quality of life in patients with metastatic prostate cancer following one cycle of 177Lu-PSMA-617 radioligand therapy: a pilot study

Verbesserung der Lebensqualität bei Patienten mit metastasiertem Prostatakrebs nach einem Zyklus der 177Lu-PSMA-Radioligandentherapie: eine Pilotstudie
Milka Marinova   *
1   Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
,
Reza Alamdar   *
2   Department of Nuclear Medicine, University Hospital Bonn, Germany
,
Hojjat Ahmadzadehfar
2   Department of Nuclear Medicine, University Hospital Bonn, Germany
3   Department of Nuclear Medicine, Klinikum Westfalen, Dortmund, Germany
,
Markus Essler
2   Department of Nuclear Medicine, University Hospital Bonn, Germany
,
Ulrike Attenberger
1   Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
,
Martin Mücke   §
4   Center for Rare Diseases Bonn (ZSEB), University Hospital of Bonn, Germany
,
Rupert Conrad   §
5   Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Bonn, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Introduction To evaluate the clinical therapeutic response of PSMA targeted radioligand therapy with 177Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer. The current study analyzed disease-related quality of life (QoL) in patients undergoing PSMA therapy with a special focus on the association with simultaneous PSA response.

Methods Thirty patients (age range 50–87 years, median 73.5 years) undergoing 177Lu-PSMA-617 therapy from 2014 to 2016 at our institution were included in this pilot study. Health-related QoL was assessed by EORTC QLQ-C30 questionnaire filled in at baseline and two months after initializing the PSMA-therapy. The treatment response was evaluated under three categories with regard to changes in (a) global health status and other functional scales, (b) disease-related symptoms, and (c) effects of PSA values.

Results Most patients underwent three treatment cycles (n = 12); at least 2 cycles (n = 6) or at most 8 cycles (n = 1) were performed. Out of 30 cases, PSA response after the first cycle was observed in 73 % (n = 22). Compared to baseline, QoL was significantly improved at 2-month follow-up revealing increase in global health status (p = 0.025), role functioning (p = 0.017) and emotional functioning (0.010), and decrease in pain (p = 0.033). Global health status variation can be explained up to 20.5 % by response in PSA (p = 0.012), this improved with PSA reduction.

Conclusion PSMA radioligand therapy seems to be an effective treatment option of metastatic castration-resistant prostate cancer patients as it improves their QoL in terms of increasing global health and mitigation of disease-related pain.

Key words

metastatic prostate cancer - 177Lu-PSMA-617 - radioligand therapy - quality of life - EORTC QLQ-C30

Schlüsselwörter

Metastasiertes Prostatakarzinom - 177Lu-PSMA-617 - Radioliganden Therapie - Lebensqualität - EORTC QLQ-C30

* shared first authorship.


§ shared last authorship.




Publication History

Received: 11 June 2020

Accepted: 05 August 2020

Article published online:
21 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ahmadzadehfar H, Rahbar K, Essler M. et al PSMA-Based Theranostics: A Step-by-Step Practical Approach to Diagnosis and Therapy for mCRPC Patients. Semin Nucl Med 2020; 50: 98-109 . doi:10.1053/j.semnuclmed.2019.07.003
    CrossrefPubMedGoogle Scholar
  • 2 Hofman MS, Violet J, Hicks RJ. et al [(177)Lu]-PSMA-617 radionuclide treatment in patients with metastatic castration-resistant prostate cancer (LuPSMA trial): a single-centre, single-arm, phase 2 study. Lancet Oncol 2018; 19: 825-833 . doi:10.1016/S1470-2045(18)30198-0
    CrossrefPubMedGoogle Scholar
  • 3 Ahmadzadehfar H, Rahbar K, Baum RP. et al Prior therapies as prognostic factors of overall survival in metastatic castration-resistant prostate cancer patients treated with [(177)Lu]Lu-PSMA-617. A WARMTH multicenter study (the 617 trial). Eur J Nucl Med Mol Imaging 2020; DOI: 10.1007/s00259-020-04797-9.
    CrossrefPubMedGoogle Scholar
  • 4 Procopio G, Ratta R, de Braud F. Improved quality of life is the way to longer life. Lancet Oncol 2016; 17: 862-863 . doi:10.1016/S1470-2045(16)30158-9
    CrossrefPubMedGoogle Scholar
  • 5 Ahmadzadehfar H, Rahbar K, Kurpig S. et al Early side effects and first results of radioligand therapy with (177)Lu-DKFZ-617 PSMA of castrate-resistant metastatic prostate cancer: a two-centre study. EJNMMI Res 2015; 5: 114 . doi:10.1186/s13550-015-0114-2
    CrossrefPubMedGoogle Scholar
  • 6 Ahmadzadehfar H, Eppard E, Kurpig S. et al Therapeutic response and side effects of repeated radioligand therapy with 177Lu-PSMA-DKFZ-617 of castrate-resistant metastatic prostate cancer. Oncotarget 2016; 7: 12477-12488 . doi:10.18632/oncotarget.7245
    CrossrefPubMedGoogle Scholar
  • 7 Ferdinandus J, Eppard E, Gaertner FC. et al Predictors of Response to Radioligand Therapy of Metastatic Castrate-Resistant Prostate Cancer with 177Lu-PSMA-617. J Nucl Med 2017; 58: 312-319 . doi:10.2967/jnumed.116.178228
    CrossrefPubMedGoogle Scholar
  • 8 Aaronson NK, Ahmedzai S, Bergman B. et al The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365-376 . doi:10.1093/jnci/85.5.365
    CrossrefPubMedGoogle Scholar
  • 9 Fayers PM. Interpreting quality of life data: population-based reference data for the EORTC QLQ-C30. Eur J Cancer 2001; 37: 1331-1334 . doi:10.1016/s0959-8049(01)00127-7
    CrossrefPubMedGoogle Scholar
  • 10 King MT. The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 1996; 5: 555-567 . doi:10.1007/BF00439229
    CrossrefPubMedGoogle Scholar
  • 11 Yadav MP, Ballal S, Sahoo RK. et al Radioligand Therapy With (177)Lu-PSMA for Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis. Am J Roentgenol 2019; 213: 275-285 . doi:10.2214/Am J Roentgenol.18.20845
    CrossrefPubMedGoogle Scholar
  • 12 von Eyben FE, Roviello G, Kiljunen T. et al Third-line treatment and (177)Lu-PSMA radioligand therapy of metastatic castration-resistant prostate cancer: a systematic review. Eur J Nucl Med Mol Imaging 2018; 45: 496-508 . doi:10.1007/s00259-017-3895-x
    CrossrefPubMedGoogle Scholar
  • 13 Kim YJ, Kim YI. Therapeutic Responses and Survival Effects of 177Lu-PSMA-617 Radioligand Therapy in Metastatic Castrate-Resistant Prostate Cancer: A Meta-analysis. Clin Nucl Med 2018; 43: 728-734 . doi:10.1097/RLU.0000000000002210
    CrossrefPubMedGoogle Scholar
  • 14 Calopedos RJS, Chalasani V, Asher R. et al Lutetium-177-labelled anti-prostate-specific membrane antigen antibody and ligands for the treatment of metastatic castrate-resistant prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2017; 20: 352-360 . doi:10.1038/pcan.2017.23
    CrossrefPubMedGoogle Scholar
  • 15 Assadi M, Rezaei S, Jafari E. et al Potential application of lutetium-177-labeled prostate-specific membrane antigen-617 radioligand therapy for metastatic castration-resistant prostate cancer in a limited resource environment: Initial clinical experience after 2 years. World J Nucl Med 2020; 19: 15-20 . doi:10.4103/wjnm.WJNM_20_19
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Parker C, Nilsson S, Heinrich D. et al Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 2013; 369: 213-223 . doi:10.1056/NEJMoa1213755
    CrossrefPubMedGoogle Scholar
  • 17 Violet J, Sandhu S, Iravani A. et al Long term follow-up and outcomes of re-treatment in an expanded 50 patient single-center phase II prospective trial of Lutetium-177 ((177)Lu) PSMA-617 theranostics in metastatic castrate-resistant prostate cancer. J Nucl Med 2019; DOI: 10.2967/jnumed.119.236414.
    CrossrefPubMedGoogle Scholar
  • 18 Suman S, Parghane RV, Joshi A. et al Therapeutic efficacy, prognostic variables and clinical outcome of (177)Lu-PSMA-617 PRLT in progressive mCRPC following multiple lines of treatment: prognostic implications of high FDG uptake on dual tracer PET-CT vis-a-vis Gleason score in such cohort. Br J Radiol 2019; 92: 20190380 . doi:10.1259/bjr.20190380
    CrossrefPubMedGoogle Scholar
  • 19 Yadav MP, Ballal S, Tripathi M. et al (177)Lu-DKFZ-PSMA-617 therapy in metastatic castration resistant prostate cancer: safety, efficacy, and quality of life assessment. Eur J Nucl Med Mol Imaging 2017; 44: 81-91 . doi:10.1007/s00259-016-3481-7
    CrossrefPubMedGoogle Scholar
  • 20 Fendler WP, Reinhardt S, Ilhan H. et al Preliminary experience with dosimetry, response and patient reported outcome after 177Lu-PSMA-617 therapy for metastatic castration-resistant prostate cancer. Oncotarget 2017; 8: 3581-3590 . doi:10.18632/oncotarget.12240
    CrossrefPubMedGoogle Scholar
  • 21 Rasul S, Hacker M, Kretschmer-Chott E. et al Clinical outcome of standardized (177)Lu-PSMA-617 therapy in metastatic prostate cancer patients receiving 7400 MBq every 4 weeks. Eur J Nucl Med Mol Imaging 2019 DOI: 10.1007/s00259-019-04584-1.
    CrossrefPubMedGoogle Scholar
  • 22 Soydal C, Araz M, Urun Y. et al Prognostic importance of PSA response in patients who received Lutetium-177 PSMA treatment for castration resistant prostate cancer. Q J Nucl Med Mol Imaging 2019; DOI: 10.23736/S1824-4785.19.03165-0.
    CrossrefPubMedGoogle Scholar
  • 23 Heck MM, Tauber R, Schwaiger S. et al Treatment Outcome, Toxicity, and Predictive Factors for Radioligand Therapy with (177)Lu-PSMA-I&T in Metastatic Castration-resistant Prostate Cancer. Eur Urol 2019; 75: 920-926 . doi:10.1016/j.eururo.2018.11.016
    CrossrefPubMedGoogle Scholar
  • 24 Rahbar K, Bogeman M, Yordanova A. et al Delayed response after repeated (177)Lu-PSMA-617 radioligand therapy in patients with metastatic castration resistant prostate cancer. Eur J Nucl Med Mol Imaging 2018; 45: 243-246 . doi:10.1007/s00259-017-3877-z
    CrossrefPubMedGoogle Scholar