We investigated a variety of neurologic complaints, including dizziness, headaches, paresthesia, seizures, gait instability, and extremity weakness. Additionally, we searched for patients with cerebrovascular accidents, encompassing both ischemic and hemorrhagic strokes and transient ischemic attacks, episodes of syncope or pre-syncope, dysgeusia, and vision changes. In our cohort, the observed neurological findings following 177Lu-PSMA-617 therapy were primarily mild, self-limiting, and effectively managed with conservative measures. Notably, severe neurologic symptoms were rare, with no direct causal link established between these symptoms and 177Lu-PSMA-617 therapy. Importantly, neurologic symptoms did not necessitate discontinuation of therapy, and overall, 177Lu-PSMA-617 therapy was well tolerated by the study cohort.
Taste alterations, including dysgeusia and hypogeusia, were the most prevalent neurologic findings among our patients. While not life-threatening, these symptoms can significantly impact patient well-being and quality of life. We found that 27 patients (14.6%, 27/185) experienced taste distortions, most commonly after the first three cycles of therapy (63%, 17/27), with no significant improvement during short-term follow-up. However, it is important to highlight that other anti-cancer treatments have also been reported to be associated with taste alterations. For example, in the TheraP trial, dysgeusia was reported in 12% of patients treated with 177Lu-PSMA-617, which is notably lower than the 27% observed in the control group treated with cabazitaxel. Other common neurologic symptoms observed post-177Lu-PSMA-617 therapy included dizziness (6%, 11/185) and headaches (2.7%, 5/185), which occurred exclusively during or immediately after treatment and were transient and managed with conservative care.
Several factors may contribute to the neurologic manifestations observed in this patient population, independent of 177Lu-PSMA-617 therapy. Given the advanced age of the patients (median age 70 years, range 58–90 years), a higher likelihood of neurologic disturbances is expected. Additionally, active cancer itself may directly or indirectly contribute to the development of neurologic symptoms. Moreover, it is important to recognize that 177Lu-PSMA-617 therapy is typically administered to patients who have previously undergone other treatments, which are often associated with various neurologic symptoms, such as neuropathy or taste alterations.
Our findings underscore the importance of detailed monitoring of neurologic symptoms during and after 177Lu-PSMA-617 therapy to increase awareness and ensure timely intervention when necessary. Continued surveillance is warranted to understand the extent of neurologic manifestations better, the course of these symptoms, and the potential emergence of delayed neurologic symptoms.
Written by: Gokce Belge Bilgin,1 Brian J Burkett,1 Cem Bilgin,1Jacob J Orme,2 Daniel S Childs,2 Miguel Muniz Rincon,2 Ahmad S Abdelrazek,1 Derek R Johnson,1 Geoffrey B Johnson,1,3 Eugene D Kwon,3,4 Oliver Sartor,1,2,4 Ayse Tuba Kendi1
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
- Department of Urology, Mayo Clinic, Rochester, Minnesota