223Ra-dichloride (223Ra) and 177Lu-prostate-specific membrane antigen (PSMA) are approved treatments for metastatic castration-resistant prostate cancer (mCRPC). The safety and effectiveness of sequential use of 223Ra and 177Lu-PSMA in patients with mCRPC are not well described.
This study aimed to evaluate 177Lu-PSMA safety and efficacy in patients with mCRPC previously treated with 223Ra. Methods: The radium→lutetium (RALU) study was a multicenter, retrospective, medical chart review. Participants had received at least 1 223Ra dose and, in any subsequent therapy line, at least 1 177Lu-PSMA dose. Primary endpoints included the incidence of adverse events (AEs), serious AEs, grade 3-4 hematologic AEs, and abnormal laboratory values. Secondary endpoints included overall survival, time to next treatment/death, and change from baseline in serum prostate-specific antigen and alkaline phosphatase levels. Results: Data were from 133 patients. Before 177Lu-PSMA therapy, 56% (75/133) of patients received at least 4 life-prolonging therapies; all patients received 223Ra (73% received 5-6 injections). Overall, 27% (36/133) of patients received at least 5 177Lu-PSMA infusions. Any-grade treatment-emergent AEs were reported in 79% (105/133) of patients and serious AEs in 30% (40/133). The most frequent grade 3-4 laboratory abnormalities were anemia (30%, 40/133) and thrombocytopenia (13%, 17/133). Median overall survival was 13.2 mo (95% CI, 10.5-15.6 mo) from the start of 177Lu-PSMA. Conclusion: In this real-world setting, 223Ra followed by 177Lu-PSMA therapy in heavily pretreated patients with mCRPC was clinically feasible, with no indication of impairment of 177Lu-PSMA safety or effectiveness.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2023 Oct 12 [Epub ahead of print]
Kambiz Rahbar, Markus Essler, Matthias Eiber, Christian la Fougère, Vikas Prasad, Wolfgang P Fendler, Philipp Rassek, Ergela Hasa, Helmut Dittmann, Ralph A Bundschuh, Kim M Pabst, Milena Kurtinecz, Anja Schmall, Frank Verholen, Oliver Sartor
Department of Nuclear Medicine, University of Münster Medical Center, Münster, Germany; ., Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany., Department of Nuclear Medicine, Technical University of Munich, Munich, Germany., Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, Tübingen, Germany., Department of Nuclear Medicine, University of Ulm, Ulm, Germany., Department of Nuclear Medicine, German Cancer Consortium University Hospital Essen, Essen, Germany., Department of Nuclear Medicine, University of Münster Medical Center, Münster, Germany., Bayer HealthCare Pharmaceuticals, Whippany, New Jersey., Bayer Consumer Care, Basel, Switzerland; and., Tulane Cancer Center, Tulane Medical School, New Orleans, Louisiana.