Lutetium-177 PSMA radioligand therapy in taxan-naive first- and second-line metastatic castration resistant prostate cancer after first-line ARPI therapy

European Journal of Nuclear Medicine and Molecular Imaging, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 13, 2025

Abstract Purpose Lutetium-177 Prostate-specific membrane antigen (Lu-PSMA) radioligand therapy is EMA-approved for metastatic castration resistant prostate cancer (mCRPC) after androgen receptor pathway inhibition (ARPI) and taxan-based chemotherapy. However, its effect in taxan-naïve patients under current investigation. Methods We relied on the FRAMCAP database to elaborate Lu-PSMA outcomes of progression-free (PFS) overall (OS) mCRPC previous ARPI treatment. Comparison was made against standard care with or docetaxel, irrespective used staging modality. Results Of 269 patients, 11% received first/second-line vs. 57% 33% docetaxel. Mostly no significant baseline differences between were observed, while significantly older, less systematic treatments ECOG1-2 proportions higher, relative docetaxel patients. In PFS (13.3 8.2 months, hazard ratio [HR]: 0.70, p = 0.16) OS analyses (68.9 39.1 HR: 0.64, 0.2), numerically more favorable than ARPI. additional multivariable Cox regression models, better regarding OS, (both < 0.05). Compared also 8.1 0.46) 27.3 0.34, both 0.01) observed The advantage adjustment ( 0.01). Conclusion This retrospective single-center study including a substantial proportion treatment preference suggests that provides treatment, may be considered as an early option.

Language: Английский

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Real-World Comparison of Cabazitaxel Versus¹⁷⁷Lu-PSMA Radiopharmaceutical Therapy in Metastatic Castration-Resistant Prostate Cancer

Journal of Nuclear Medicine, Journal Year: 2024, Volume and Issue: 66(1), P. 61 - 66

Published: Nov. 14, 2024

¹⁷⁷Lu-vipivotide tetraxetan prostate-specific membrane antigen (¹⁷⁷Lu-PSMA) therapy is under current scientific investigation and aims to become established in the treatment of metastatic castration-resistant prostate cancer (mCRPC). However, real-world evidence comparison scant. Methods: We relied on FRAMCAP database compared cabazitaxel versus ¹⁷⁷Lu-PSMA mCRPC patients regarding progression-free survival (PFS) overall (OS). Sensitivity analyses addressed second- fourth-line approximate phase III patient selection criteria. Results: Of 373 patients, 14% received cabazitaxel, 65% ¹⁷⁷Lu-PSMA, 21% both. Patients undergoing were significantly older than (median, 72 y vs. 66 y; P < 0.01), a higher proportion had an Eastern Cooperative Oncology Group score 2 or more (12% 5.0%, = 0.1). Rates decline at least 50% 32% 0% for cabazitaxel. In outcome analyses, significant superior median PFS was observed (13.4 mo 7.1 mo, 0.001), even after multivariable adjustment (hazard ratio, 0.38; 0.001). Regarding OS, rates also differed, with OS 14.7 16.5 29.6 both treatments (P 0.01). sensitivity treatment, therapies qualitatively remained same as entire cohort. Conclusion: setting, provides better does chemotherapy should therefore be considered valuable option advanced according European Medicines Agency approval.

Language: Английский

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Review on the Increasing Role for PSMA-Based Radioligand Therapy in Prostate Cancer

Cancers, Journal Year: 2024, Volume and Issue: 16(14), P. 2520 - 2520

Published: July 12, 2024

In 2021, two randomized controlled trials (RCTs), TheraP and VISION, demonstrated that 177Lu-PSMA-617 as monotherapy was more effective for the decline of PSA than comparator third-line treatments. Methods: Our review summarizes new RCTs add to use radioligand therapy (RLT) patients with high-risk prostate cancer (PCa). Results: Four past present included 1081 patients. An RCT, ENZA-p, studied first-line treatment metastatic castration-resistant PCa (mCRPC). A combination enzalutamide (ENZA) gave longer progression-free survival ENZA monotherapy. Other mCRPC, including PSMAfore, SPLASH trials, showed second-line better androgen receptor pathway inhibitors (combined p value < 6.9 × 10−6). Conclusions: Patients gain if they are given PSMA-RLT early in part therapies.

Language: Английский

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Cancer-Control Outcomes of Patients With Metastatic Castration-Resistant Prostate Cancer With BRCA Gene or Tumor Suppressor Mutations Undergoing 177-Lutetium Prostate-Specific Membrane Antigen Radioligand Therapy

JCO Precision Oncology, Journal Year: 2024, Volume and Issue: 8

Published: Dec. 1, 2024

PURPOSE Several tumor gene mutations are known for metastatic castration-resistant prostate cancer (mCRPC). The individual response to 177-lutetium specific membrane antigen radioligand therapy (Lu-PSMA) is under current investigation regarding the genomic profile of patients with mCRPC. MATERIALS AND METHODS We relied on FRAMCAP database and compared progression-free survival (PFS) overall (OS) rates mCRPC breast cancer–related ( BRCA ) or suppressor TP53 , PTEN RB1 ). Specifically, subgroup analyses were performed Lu-PSMA–treated RESULTS Of 194 mCRPC, 22% was BRCA1/2 versus 14% PTEN/TP53/RB1 63% without one these mutations. Patients no mutation harbored a significantly lower Gleason score 8-10, relative patients. In PFS first-line difference between all three groups observed, whereas median OS differed 46.3 48.7 95.4 months mutated P < .05). univariable Cox regression models, BRCA-mutated at higher risk death (hazard ratio, 2.57; .01), not = .4). 87 significant differences in observed (both ≤ .02). multivariable Lu-PSMA death, had similar outcomes as CONCLUSION real-world setting, substantially - -mutated patients, could be computed. worst

Language: Английский

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