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RadioLigand Therapy with [177Lu]Lu-PSMA-617 for Salivary Gland Cancers: Literature Review and First Compassionate Use
Marie Terroir1, Chloé Lamesa2, Mehdi Krim1
1Nuclear Medicine Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, CEDEX 09, 31059 Toulouse, France.
Abstract:
Salivary gland cancers are rare tumors comprising a large group of heterogeneous tumors with variable prognosis. Their therapeutic management at a metastatic stage is challenging due to the lack of therapeutic lines and the toxicity of treatments. [177Lu]Lu-PSMA-617 (prostate-specific membrane antigen) is a vectored radioligand therapy (RLT) initially developed to treat castration-resistant metastatic prostate cancer with encouraging results in terms of efficacy and toxicity. Many malignant cells could be treated with [177Lu]Lu-PSMA-617 as long as they express PSMA as a consequence of androgenic pathway activation. RLT may be used when anti-androgen hormonal treatment has failed, particularly in prostate cancer. [177Lu]Lu-PSMA-617 has been proposed in certain salivary gland cancers, though the expression of PSMA is demonstrated by a significant uptake using [68Ga]Ga-PSMA-11 PET scan. This theranostic approach could be a new therapeutic option, warranting prospective investigation in a larger cohort. We review the literature on this subject and offer a clinical illustration of compassionate use in France as a perspective for administering [177Lu]Lu-PSMA-617 in salivary gland cancer.
Insights
Lutetium-177 (177Lu) PSMA-617 radioligand therapy shows promise for salivary gland cancers expressing prostate-specific membrane antigen (PSMA). This theranostic approach offers a potential new treatment option for advanced disease.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiopharmaceutical Therapy
Background:
- Salivary gland cancers are rare, heterogeneous tumors with challenging metastatic management.
- Current treatments for advanced salivary gland cancers have limited efficacy and significant toxicity.
Purpose of the Study:
- To review the literature on the use of 177Lu-PSMA-617 in salivary gland cancers.
- To present a clinical case of compassionate use of 177Lu-PSMA-617 in France.
- To explore the potential of PSMA-targeted radioligand therapy (RLT) for salivary gland cancers.
Main Methods:
- Literature review on 177Lu-PSMA-617 in salivary gland cancers.
- Case report of compassionate use of 177Lu-PSMA-617.
- Assessment of PSMA expression via 68Ga-PSMA-11 PET scans.
Main Results:
- 177Lu-PSMA-617 is a PSMA-targeted RLT initially developed for prostate cancer.
- PSMA expression, confirmed by 68Ga-PSMA-11 PET, is crucial for RLT efficacy.
- Compassionate use case illustrates potential administration in salivary gland cancer.
Conclusions:
- 177Lu-PSMA-617 represents a potential novel therapeutic option for PSMA-expressing salivary gland cancers.
- The theranostic approach warrants further prospective investigation in larger cohorts.
- RLT may be a viable option after failure of anti-androgen hormonal treatment.
