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Published on: January 29, 2019
Overall Survival with [177Lu]Lu-PSMA-617 Versus [177Lu]Lu-PSMA I&T: A Propensity Score-Matched Real-World Analysis
Natalie Hasenauer1, Charlotte Probst2, Wiebke Schloetelburg2
1Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany; and hasenauer_n@ukw.de.
Summary
This study compared lutetium-177 PSMA I&T and lutetium-177 PSMA-617 radiopharmaceutical therapies for metastatic castration-resistant prostate cancer, finding comparable survival outcomes. [177Lu]Lu-PSMA-617 showed greater PSA decline and biochemical response rates.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiopharmaceutical Therapy
Background:
- Metastatic castration-resistant prostate cancer (mCRPC) is an advanced stage of prostate cancer.
- Radiopharmaceutical therapy using lutetium-177 (177Lu)-labeled prostate-specific membrane antigen (PSMA) ligands has emerged as a treatment option for mCRPC.
- Real-world data comparing different 177Lu-PSMA agents are crucial for clinical decision-making.
Purpose of the Study:
- To compare the clinical outcomes and safety profiles of [177Lu]Lu-PSMA-617 and [177Lu]Lu-PSMA I&T in patients with mCRPC under real-world conditions.
- To evaluate overall survival (OS), biochemical response, prognostic factors, and treatment-related toxicity between the two therapies.
Main Methods:
- Single-center retrospective matched-pair analysis of 140 chemotherapy-pretreated mCRPC patients.
- Matched cohorts received either commercially available [177Lu]Lu-PSMA-617 (7.4 GBq every 6 wk) or in-house produced [177Lu]Lu-PSMA I&T (6.0 GBq every 8 wk).
- Propensity score matching was used based on age, baseline PSA, and tumor volume, stratified by Gleason score.
Main Results:
- Median overall survival was comparable between [177Lu]Lu-PSMA I&T (14 mo) and [177Lu]Lu-PSMA-617 (15 mo) cohorts.
- [177Lu]Lu-PSMA-617 demonstrated a greater median PSA decline (-58% vs. -14%) and higher biochemical response rates (70% vs. 54%).
- Toxicity profiles were comparable, though [177Lu]Lu-PSMA-617 showed more pronounced hematologic changes.
Conclusions:
- Both [177Lu]Lu-PSMA I&T and [177Lu]Lu-PSMA-617 offer comparable survival outcomes in mCRPC patients despite differing treatment protocols.
- Enhanced biochemical responses with [177Lu]Lu-PSMA-617 may suggest higher cumulative radiation exposure, warranting further investigation with patient-specific dosimetry.
- Higher baseline lactate dehydrogenase levels are a significant predictor of shorter OS in both treatment groups.
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