Response to 225 Ac-PSMA-I&T after failure of long-term 177 Lu-PSMA RLT in mCRPC
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IMAGE OF THE MONTH
Response to 225Ac-PSMA-I&T after failure of long-term 177 Lu-PSMA RLT in mCRPC Harun Ilhan 1 & Astrid Gosewisch 1 & Guido Böning 1 & Friederike Völter 1 & Mathias Zacherl 1 & Marcus Unterrainer 2 & Peter Bartenstein 1 & Andrei Todica 1 & Franz Josef Gildehaus 1 Received: 13 June 2020 / Accepted: 31 August 2020 # The Author(s) 2020
Radioligand therapy (RLT) using 177Lu-PSMA ligands is highly effective in metastatic castration-resistant prostate cancer (mCRPC); however, failure of 177Lu-PSMA RLT remains challenging as RLT already represents last-line treatment. The α-emitter 225Ac provides higher biological effectiveness compared with 177Lu [1]. Several centers reported remarkable response after PSMA-targeted alpha therapy (TAT) using 225Ac-PSMA-617 after failure of 177LuPSMA RLT [2, 3]. Here we present encouraging response to TAT in a patient with advanced mCRPC showing progression after long-term 177Lu-PSMA RLT (10 cycles). PSA values are provided under the date of each PSMAPET MIP image (A–B using 68Ga-PSMA-11 and E–H using 18 F-PSMA-1007). The patient was referred for RLT after radical prostatectomy and radiotherapy in 2005, and anti-hormonal therapy started in 2013 due to biochemical progression. Further progression was observed in February 2017 (A) after 2nd-line anti-hormonal therapy from 2015 to 2016, 223Ra-Dichloride in 2016, and docetaxel chemotherapy from 2016 to 2017. Two cycles
This article is part of the Topical Collection on Image of the month. * Harun Ilhan [email protected] 1
Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
2
Department of Radiology, University Hospital, LMU Munich, Munich, Germany
of 177Lu-PSMA-617 were highly effective (B). PSA was still decreasing after two additional 177Lu-PSMA-617 cycles despite increasing PSMA-ligand uptake in PSMAPET (C). Maintenance therapy using 177Lu-PSMA-617 was continued until January 2019 with further response (D and E); however, disease progression occurred after watchful waiting and two cycles of 177Lu-PSMA-I&T (F and G). The patient then received two cycles of 225AcPSMA-I&T and showed encouraging response (H). The main TAT-related side effect was grade 2 xerostomia (grade 2), which was already preexisting after 10 cycles of RLT. No TAT-related grade 3/4 hematological side effects were noted. Further cycles are planned but were suspended due to the COVID-19 crisis upon patient’s request. Different approaches including tandem therapy with 177Lu or de-escalating doses during consolidation have been proposed for TAT as a trade-off between therapeutic efficacy and tolerable side effects [2, 4], and further studies investigating 225Ac-PSMA remain highly important for prostate cancer theranostics.
Eur J Nucl Med Mol Imaging
Funding Open Access funding enabled and organized by Projekt DEAL.
References
Compliance with ethical standards
1.
All procedures performed in this study involving human participants were in accordance with ethical standards of the institutional and/or national
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