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

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 is under curr...

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Publicado en:European Journal of Nuclear Medicine & Molecular Imaging Vol. 52; no. 6; pp. 2015 - 2023
Autores principales: Wenzel, Mike, Hoeh, Benedikt, Siech, Carolin, Koll, Florestan, Humke, Clara, Groener, Daniel, Steuber, Thomas, Graefen, Markus, Maurer, Tobias, Banek, Severine, Chun, Felix K. H., Mandel, Philipp
Formato: Journal Article
Publicado: Springer Nature May2025
Acceso en línea:Ver este registro en EBSCOhost
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      dt: May2025
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      pub: Springer Nature
      place: New York, New York
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        182181022
        10.1007/s00259-025-07076-7
        184671083
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        atl: Lutetium-177 PSMA radioligand therapy in taxan-naive first- and second-line metastatic castration resistant prostate cancer after first-line ARPI therapy.
      aug:
        au:
          Wenzel, Mike
          Hoeh, Benedikt
          Siech, Carolin
          Koll, Florestan
          Humke, Clara
          Groener, Daniel
          Steuber, Thomas
          Graefen, Markus
          Maurer, Tobias
          Banek, Severine
          Chun, Felix K. H.
          Mandel, Philipp
        affil: https://ror.org/03f6n9m15 Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt, Germany
      sug:
      ab: 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 is under current investigation. Methods: We relied on the FRAMCAP database to elaborate Lu-PSMA therapy outcomes of progression-free (PFS) and overall (OS) in taxan-naïve mCRPC patients after previous ARPI treatment. Comparison was made against current standard of care with ARPI or docetaxel, irrespective of the previous used staging modality. Results: Of 269 patients, 11% received Lu-PSMA in first/second-line mCRPC vs. 57% ARPI vs. 33% docetaxel. Mostly no significant baseline differences between Lu-PSMA and ARPI patients were observed, while Lu-PSMA patients were significantly older, received less systematic treatments and ECOG1-2 proportions were higher, relative to docetaxel patients. In PFS (13.3 vs. 8.2 months, hazard ratio [HR]: 0.70, p = 0.16) and OS analyses (68.9 vs. 39.1 months, HR: 0.64, p = 0.2), Lu-PSMA was numerically more favorable than ARPI. In additional multivariable Cox regression models, Lu-PSMA was significant better regarding PFS and OS, relative to ARPI (both p < 0.05). Compared to docetaxel, also significant better PFS (13.3 vs. 8.1 months, HR: 0.46) and OS (68.9 vs. 27.3 months, HR: 0.34, both p < 0.01) was observed for Lu-PSMA treatment. The OS advantage was also observed after multivariable adjustment (p < 0.01). Conclusion: This retrospective single-center study including a substantial proportion of patients with treatment preference for Lu-PSMA suggests that Lu-PSMA therapy provides significantly more favorable PFS and OS outcomes in taxan-naïve mCRPC patients after previous ARPI treatment, relative to ARPI or docetaxel treatment and may be considered as an early mCRPC treatment option.
      pubtype: Academic Journal
      doctype: Journal Article
      ougenre: Article
    language: English
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