Renal Function During and After ¹⁷⁷Lu-PSMA-617 Therapy in Patients with Metastatic Castration-Resistant Prostate...

Area of Science:

• Nephrology
• Oncology
• Radiopharmaceutical Therapy

Background:

• Metastatic castration-resistant prostate cancer (mCRPC) treatment relies on therapies like Lutetium-177 PSMA-617 (177Lu-PSMA-617).
• Renal clearance of 177Lu-PSMA-617 necessitates monitoring kidney function due to radiation exposure.
• Understanding renal function trends is crucial for patient management and safety during treatment.

Purpose of the Study:

• To evaluate the stability of renal function during and after 177Lu-PSMA-617 therapy.
• To assess longitudinal changes in estimated glomerular filtration rate (eGFR) and serum creatinine.
• To analyze renal function trends in patients with comorbidities and varying degrees of baseline renal impairment.

Main Methods:

• Retrospective analysis of 56 patients receiving at least two cycles of 177Lu-PSMA-617.
• Renal function assessment at baseline, during cycles, and post-therapy (6-8 weeks).
• Statistical evaluation using patient trajectory plots and multilevel linear regression, with grading of renal toxicity per CTCAE guidelines.

Main Results:

• Most patients (44.6%) had normal baseline renal function; 35.7% had mild and 19.6% had moderate impairment.
• Hypertension (96.4%) and diabetes (60.7%) were common comorbidities.
• Renal function remained stable across cycles, with only one patient developing grade 3 toxicity. eGFR was generally stable, though moderate impairment showed a nonsignificant decline and a significant serum creatinine increase.

Conclusions:

• 177Lu-PSMA-617 exhibits a favorable short-term renal safety profile for mCRPC treatment.
• Renal function is generally stable throughout treatment, particularly in patients with normal or mild baseline impairment.
• Patients with moderate baseline impairment may experience minor serum creatinine increases but stable eGFR, warranting further long-term safety evaluation.