Prostat kanserinde Lutetium-177-PSMA tedavisi: tek merkezli gerçek yaşam deneyimi

Abstract

Amaç: Lutetium-177 ile işaretli PSMA hedefli radyoligand tedavi, metastatik kastrasyona dirençli prostat kanseri (m-KRPK) için umut verici bir seçenek olarak ortaya çıkmıştır. Ancak gerçek yaşam verileri sınırlıdır. Bu çalışmada, tek merkezde Lu-177-PSMA tedavisi alan m-KRPK hastalarının klinik özellikleri, tedavi desenleri ve yanıt öngördürücü faktörleri değerlendirildi. Gereç ve Yöntemler: Ocak 2020- Ocak 2025 arasında Lu-177-PSMA tedavisi alan 49 hastanın retrospektif analizi yapılmıştır. Tedavi yanıtı PSA’da ≥%50 düşüş (PSA50) ile değerlendirildi. Temel değişkenlerin PSA50 yanıtı ile ilişkisi Mann–Whitney U testi ile, biyobelirteçlerin prediktif gücü ROC eğrisi analizi ile incelendi. Bulgular: PSA50 yanıt oranı %41,7 idi. Daha düşük başlangıç PSA, ALP ve LDH düzeyleri ile daha yüksek hemoglobin seviyeleri yanıtla anlamlı ilişkili bulundu. Hemoglobin ROC analizinde orta düzeyde ayırt edici güce sahipti (AUC = 0,692). Tedavi genellikle iyi tolere edildi ve ciddi hematolojik toksisite yalnızca bir hastada görüldü. Sonuç: Lu-177-PSMA tedavisi, m-KRPK hastalarında gerçek yaşam pratiğinde klinik fayda sağlamaktadır. Başlangıç hemoglobin düzeyi tedavi yanıtını öngörmede pratik bir biyobelirteç olabilir. Ancak prospektif çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Lutetium-177-PSMA, m-KRPK, radyoligand tedavi, PSA50, biyobelirteçler

Keywords

• Lutetium-177-PSMA
• m-KRPK
• radyoligand tedavi
• PSA50
• biyobelirteçler

Prostat kanserinde Lutetium-177-PSMA tedavisi: tek merkezli gerçek yaşam deneyimi

Abstract

Aim: Lutetium-177–labeled PSMA radioligand therapy has emerged as a promising option in metastatic castration-resistant prostate cancer (mCRPC), yet real-world data remain limited. This study aimed to evaluate clinical features, treatment patterns, and predictors of response in patients treated with Lutetium-177-PSMA therapy at a single academic center. Material and Methods: We retrospectively analyzed 49 patients with mCRPC who received Lutetium-177-PSMA between January 2020 and January 2025. Treatment response was defined as a ≥50% decline in PSA (PSA50). Associations between baseline variables and PSA50 were examined using Mann–Whitney U tests, and predictive biomarkers were evaluated by receiver operating characteristic (ROC) analysis. Results: The PSA50 response rate was 41.7%. Lower baseline PSA (p = 0.023), ALP (p = 0.037), and LDH (p = 0.004) levels, and higher hemoglobin (p = 0.024), were significantly associated with response. Hemoglobin demonstrated the highest discriminatory performance (AUC = 0.692), while PSA, ALP, and LDH showed significant but limited predictive value. Treatment was well tolerated, with only one case of grade 3-4 hematologic toxicity. Conclusion: Lutetium-177-PSMA therapy provides clinical benefit in real-world mCRPC patients. Lower tumor burden and preserved hematologic status may predict better biochemical response, with hemoglobin serving as a moderately accurate biomarker. Prospective validation is warranted.

Keywords

• lutetium-177-PSMA
• metastatic castration-resistant prostate cancer
• radioligand therapy
• PSA50
• predictive biomarkers

References

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71: 209-49.
2. Kirby M, Hirst C, Crawford E. Characterising the castration‐resistant prostate cancer population: a systematic review. Int J Clin Pract 2011; 65: 1180-92.
3. Kratochwil C, Giesel FL, Stefanova M, Benešová M, Bronzel M, Afshar-Oromieh A et al. PSMA-targeted radionuclide therapy of metastatic castration-resistant prostate cancer with 177Lu-labeled PSMA-617. J Nucl Med 2016; 57: 1170-6.
4. Sartor O, de Bono J, Chi KN, Fizazi K, Herrmann K, Rahbar K et al. Lutetium-177–PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med 2021; 385: 1091-103.
5. Hofman MS, Emmett L, Sandhu S, Iravani A, Joshua AM, Goh JC et al. [177Lu] Lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer (TheraP): a randomised, open-label, phase 2 trial. Lancet 2021; 397: 797-804.
6. Halabi S, Small EJ, Kantoff PW, Kattan MW, Kaplan EB, Dawson NA et al. Prognostic model for predicting survival in men with hormone-refractory metastatic prostate cancer. J Clin Oncol 2003; 21: 1232-7.
7. Armstrong AJ, Tannock IF, de Wit R, George DJ, Eisenberger M, Halabi S. The development of risk groups in men with metastatic castration-resistant prostate cancer based on risk factors for PSA decline and survival. Eur J Cancer 2010; 46: 517-25.
8. Heck MM, Tauber R, Schwaiger S, Retz M, D’Alessandria C, Maurer T et al. Treatment outcome, toxicity, and predictive factors for radioligand therapy with 177Lu-PSMA-I&T in metastatic castration-resistant prostate cancer. Eur Urol 2019; 75: 920-6.

9. Beer TM, Tangen CM, Bland LB, Hussain M, Goldman BH, DeLoughery TG et al. The prognostic value of hemoglobin change after initiating androgen‐deprivation therapy for newly diagnosed metastatic prostate cancer: a multivariate analysis of Southwest Oncology Group Study 8894. Cancer 2006; 107: 489-96.
10. Mori K, Janisch F, Mostafaei H, Lysenko I, Karakiewicz PI, Enikeev DV et al. Prognostic value of hemoglobin in metastatic hormone-sensitive prostate cancer: a systematic review and meta-analysis. Clinical Genitourin Cancer 2020; 18: e402-e9.