As a prerequisite, all patients underwent a pre-therapy diagnostic 68Ga-PSMA-11 PET/CT scans using 68Ga-PSMA-HBED-CC to ensure the presence of PSMA overexpression in a majority of the lesions. 
Hence the treatment protocol was individualized and may suffer from heterogeneity in the treatment and outcomes. Progression-free survival. psma radioimmunotherapy lutetium treatment cancer antibody This study was funded by the Indian Council of Medical Research and registered on the Clinical Trial Registry-India (CTRI Ref No: CTRI/06/006998). The following criteria are required to qualify for Lu-177 PSMA: If you have received treatment with Xofigo or other types of radiation therapy, for prostate cancer, you should wait 2 weeks after completion of these therapies before participating in lutetium-177 PSMA therapy. Enter multiple addresses on separate lines or separate them with commas.
Combination therapy, especially regarding second-line androgen deprivation therapy or chemotherapy, was assessed in our patient population, and its use did not affect the OS in the long-run. It doesn't cross the blood-brain barrier and therefore wont affect the central nervous system. The normal distributed continuous data were presented as mean, standard deviation, and range. [4] re-challenged the second set of 177Lu-PSMA-617 therapy regimen in their patient cohort. 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). Conclusions Our initial results indicate that PRLT with Lu-PSMA is safe and seems to have low early side effects profile. Similarly, Kessel et al. The association of PSA response with the overall survival has been previous studied with variable results. Writing review & editing, Roles Out of 27 patients who demonstrate initial PR, two achieved complete remission, eight patients further responded to treatment (NCR/PR), and 17 patients progressed. Finally, 121 patients with a median age of 67 years who fulfilled the mandate criteria were included in the analysis. Copyright 2022 | Booking Med Travel. Project administration, https://doi.org/10.1371/journal.pone.0251375, Editor: Christopher J.D. [14] reported a decline in PSA levels of >50% significantly attributed to the longer median OS (70 wks; 95% CI: 39.5100.5) compared those patients with PSA decline <50% (49 wks; 95% CI: 30.267.8). Find out about COVID-19, COVID-19 vaccines, and Mayo Clinic patient and visitor updates.
There was a significant reduction in the VASmax score post-treatment (8 vs. 5; P < 0.0001). Similarly, a significant decrease in mean AS from the baseline was observed (3 vs. 2 1 [P< 0.000]). The DAgostino-Pearson test was conducted to assess the normality of the data. It varied among the patients between 3.70 and 7.78 GBq per cycle. The most awaited among the trials include the VISION phase III trial comparing 177Lu-PSMA-617 vs. best supportive or best standard of care in mCRPC patients (NCT03511664). You will need to sign consent forms before receiving any procedures. Hence, in the remaining 95 patients, only 177Lu-PSMA-617 was diluted in 30 mL normal saline (0.9%), and administered by slow intravenous infusion over 510 minutes. However, scarce literature is reported on the long-term outcome of these patients. Other toxicities such as diarrhea were reported in 14% 18/121) of patients. This study objective was to detail the single-institution-based, long-term follow-up and outcome of an extended cohort of patients who received 177Lu-PSMA-617 therapy.
This study aimed to give an overview on the long-term outcome of 177Lu-PSMA-617 therapy in a heavily pre-treated mCRPC patient cohort, who had received at least two lines of prior treatment; particularly, focused on the survival outcomes and the prognostic factors that influence the survival. Less serious, but more common, side effects included xerostomia, fatigue, and nausea. In this context, Ahmadzadehfar et al. In addition to standard quality assessments, an evaluation of the size of lesions by Ga68 DOTANOC positron emission tomography/computed tomography scanning is performed at each three months interval after the last administration of the radioisotope. No IEC-517] and conducted by the ethical standards declared by the Helsinki Convention. Essential criteria included pathologically confirmed prostatic adenocarcinoma, documented mCRPC status, progressive disease on standard treatment options including taxane-based chemotherapy, first-line and or second-line anti-androgen treatment, and/or androgen inhibitor therapies, patients on concomitant systemic treatments, documented disease progression on 68Ga-PSMA PET/CT scan obtained within 28 days before the beginning of 177Lu-PSMA-617 RLT with PSMA expression in lesions greater than the liver for soft tissue lesions and uptake greater than vertebra for the skeletal metastases and ECOG performance status up to 4. Formal analysis, Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. During the preliminary phase of the study when there was no pharmacokinetic data available, the initial 26 patients were treated adopting a single-day kidney protection protocol. [18] retrospectively evaluated the impact of prior therapies on OS in 416 patients treated with 177Lu-PSMA-617 from 11 different clinics. Prospective RCTs comparing 177Lu-PSMA-617 with Olaparib (PARP inhibitor, recently FDA approved) and immunotherapy (PD-1 and PD-L1 inhibitors), respectively, are in the pipeline (NCT03874884) and (NCT03658447). broad scope, and wide readership a perfect fit for your research every time. An aggressive treatment approach, either sequential or in combination with second-generation anti-androgens, chemotherapies, or with investigational 225Ac-PSMA-617 alpha therapies, might prolong the survival of mCRPC patients in the future. [14 vs. 22 mo, HR: 0.4, 95% CI: 0.2240.549; P<0.0001] with consistent significance in the multivariate Cox-proportional hazard model (Fig 3E). Metastatic castration-resistant prostate cancer, mCRPC, Lu-177 and Lutetium-177 PSMA therapy, Diagnosis of Prostate cancer with PSMA PET/CT Scan, Treatment of Prostate cancer by Open radical prostatectomy, Treatment of Prostate cancer by Laparoscopic radical prostatectomy, Treatment of Prostate cancer by Robotic-assisted laparoscopic radical prostatectomy, Treatment of Prostate cancer by Hormonal Therapy, Treatment of Prostate cancer by Chemotherapy, Treatment of Prostate cancer by Vaccine Treatment, Treatment of Prostate cancer by Intensity modulated radiation therapy (IMRT), Treatment of Prostate cancer by Gamma Knife, Treatment of Prostate cancer by CyberKnife, Treatment of Prostate cancer by Proton beam therapy, Treatment of Prostate cancer by Brachytherapy, Treatment of Prostate cancer by Lutetium 177-PSMA (LU-177), Treatment of Prostate cancer by High intensity focused ultrasound (HIFU), Treatment of prostate cancer by PSMA radioguided surgery. In the future, even administering concurrent therapies in these patients is feasible. The median duration of first-line and second-line treatment has been detailed in Table 1. https://doi.org/10.1371/journal.pone.0251375.t001. This content does not have an Arabic version. A median of 3 cycles of 177Lu-PSMA-617 was administered with the mean cumulative activity of 20 GBq (range, 3.737 GBq). Hence, in the subsequent phase of the study, dosing of 177Lu-PSMA-617 RLT ranged between 3.70 to 7.8 GBq at each cycle. radiotherapy cells prostate https://doi.org/10.1371/journal.pone.0251375.g003, https://doi.org/10.1371/journal.pone.0251375.t002. [17] observed second-line cabazitaxel chemotherapy (6.7 vs. 15.7 mo, P = 0.002) significantly associated with a shorter OS compared to patients who had not received second-line chemotherapy (7.9 vs.14.6 mo, Log-rank P = 0.002; HR 2.1, P = 0.009). NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Despite the encouraging results, the long-term data is crucial to decide if 177Lu-PSMA-617 RLT therapy has a sustained response rate. Visualization, Only Two patients had only massive lymph node metastases. Analysis on correlation of Tg with lesions counts ratio of, Generation and validation of a surrogate truth model for xSPECT Bone concordance analysis, Radio-sensitizing effect of BRG1-BRD overexpression on radioiodine therapy in mouse tumor xenograft model, Early side effects of radio ligand therapy with 177-Lutetium-PSMA of metastatic castrate-resistant prostate cancer. In agreement, meta-analysis data pooled from the previously published works addressed a median overall survival of 13.7 (IQR: 814) mo [1]. Interestingly, 13 of these 27 patients are still alive and are responding to their current treatments (Table 4). The impact of further treatment post after 177Lu-PSMA-617 may be the underlying fact for improved survival of 22 mo compared to 14 mo in the re-treatment nave cohort. While most patients respond well to surgery or radiation treatment, some develop advanced disease and become incurable. they were transient and limited to grade I/II only. Afterward, the patient will move onto another exam table where they will remain for about 1 hour. During the treatment or follow-up, >25% PSA progression was observed in, 79 (65%) patients. However, multivariate, stepwise, Cox proportional hazard regression analysis revealed only failure to demonstrate more than 50% PSA decline (hazard ratio [HR], 4.1; P<0.0001; 95% CI: 2.5846.650) as significant factors associated with an inferior PFS. During the treatment and follow-up, 88 (73%) patients experienced any PSA decline, and the best PSA response of >50% PSA decline was seen in 74 (61%) patients. Sanjana Ballal, Roles Conceptualization, Before every cycle of 177Lu-PSMA-617 RLT, complete blood counts (CBC), kidney function tests (KFT), glomerular filtration rate (GFR), liver function tests (LFT), and serum prostate specific antigen (sPSA) levels were documented in all patients. Biochemical response to treatment was assessed as per the Prostate Cancer Working Group 3 criteria (PCWG3) [7]. You are suffering from advanced metastatic castration-resistant prostate cancer, You are not responding to other treatments (i.e. The amount of administered activity was based on the extent of metastasis on the 68Ga-PSMA-11 PET/CT scan, laboratory parameters, and the ECOG performance status. The baseline characteristics of patients are displayed in Table 1. SAFE CONNECTION SSL Although Lu-177 PSMA therapy is considered safe as the dose of Lutetium-177 radiation is well calculated for each patient before the therapy but still, some side effects can be expected including: Other possible side effects include fatigue, fever, headache, bone marrow suppression, skin rash, and low blood counts. Eight patients also received enzalutamide among whom 3 are alive (Table 4). However, these findings are preliminary, and the type of concomitant medications varied across the patients. You do not have another serious illness or condition I.e. lutetium psma mcrpc No, Is the Subject Area "Chemotherapy" applicable to this article? Portions of this document last updated: Feb. 01, 2022.
Blood pressure is checked. https://doi.org/10.1371/journal.pone.0251375.g002. Among 135 consecutive mCRPC patients screened for eligibility, 14 patients dropped out for the following reasons: four had neuroendocrine differentiation of prostate cancer, six demonstrated low PSMA avidity on baseline 68Ga-PSMA-11 PET/CT scan, three patients had grade III haematological toxicity associated with previous therapies, and one patient did not follow-up and dropped out after the first cycle of 177Lu-PSMA-617 therapy on self-consent. It emits high-energy gamma rays that can damage DNA inside the cancer cells. Your information is confidential. A recently published meta-analysis in 744 mCRPC patients on 177Lu-PSMA-617 reported a pooled >50% PSA decline rate of 46% (95% CI, 4053%) [1]. PLoS ONE 16(5): 
Madhav Prasad Yadav, The delayed toxicity is low and acceptable by most of these patients. Interestingly, there was no grade III thrombocytopenia or leukopenia in any of the patients. [4] and ours would be the second to elaborate the long-term outcome of patients treated with 177Lu-PSMA-617 RLT with a median follow-up duration of 36 months.
Once the Lu-177 PSMA molecule enters the body, it travels throughout the bloodstream until it finds an area with active prostate cancer growth where it gets attached to the PSMA receptor. The pancytopenia was limited to grade 2, transient with a nadir around four weeks of therapy. The American Cancer Society estimates that over 30,000 new cases of prostate cancer were diagnosed in 2020 alone. The drug is injected into the bloodstream, attaching itself to the cell surface protein known as PSMA. Methodology, A phase II clinical trial on 177Lu-PSMA-617 molecular radiotherapy in patients with progressive mCRPC was conducted at the University of California Los Angeles, USA, and Excel Diagnostics & Nuclear Oncology Centre (Houston, TX, USA) (NCT03042312). 
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