M Bögemann1,2, K Herrmann3,4, J P Radtke5,4, K Rahbar6,4. 1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 GB A1, 48149, Münster, Deutschland. martin.boegemann@ukmuenster.de. 2. Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Deutschland. martin.boegemann@ukmuenster.de. 3. Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Deutschland. 4. Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Deutschland. 5. Klinik für Urologie, Universitätsklinikum Essen, Essen, Deutschland. 6. Klinik für Nuklearmedizin, Universitätsklinikum Münster, Münster, Deutschland.
Abstract
BACKGROUND: Based on significant progress in recent years, metastatic castration-resistant prostate cancer (mCRPC) patients can be treated better and better. The medications include androgen signaling inhibitors, chemotherapy, 223Ra, and sipuleucel-T. Most patients treated with these agents will still develop primary or secondary resistance against any given drug. The 177Lutetium-PSMA radioligand therapy (177Lu-PSMA-RLT) represents a good reserve option and can be used within compassionate use provisions demonstrating promising efficacy in the majority of patients in Germany. OBJECTIVES: Establishment of status quo of 177Lu-PSMA-RLT in mCRPC in 2020. MATERIALS AND METHODS: Presentation of the therapy landscape in mCRPC and the current evidence on 177Lu-PSMA-RLT after PubMed based literature search. RESULTS: Several larger retrospective studies and the first prospective trials on 177Lu-PSMA-RLT show premature but encouraging evidence on 177Lu-PSMA-RLT to be a promising new option in mCRPC patients. The toxicity profile seems to be favorable. The phase III trial VISION aims to provide evidence for the approval of 177Lu-PSMA-RLT in combination with abiraterone or enzalutamide in patients having been pretreated with enzalutamide or abiraterone and docetaxel. CONCLUSIONS: Despite the promising preliminary results of 177Lu-PSMA-RLT, the efficacy results of VISION need to be awaited prior to using the therapy outside of compassionate use provisions.
BACKGROUND: Based on significant progress in recent years, metastatic castration-resistant prostate cancer (mCRPC) patients can be treated better and better. The medications include androgen signaling inhibitors, chemotherapy, 223Ra, and sipuleucel-T. Most patients treated with these agents will still develop primary or secondary resistance against any given drug. The 177Lutetium-PSMA radioligand therapy (177Lu-PSMA-RLT) represents a good reserve option and can be used within compassionate use provisions demonstrating promising efficacy in the majority of patients in Germany. OBJECTIVES: Establishment of status quo of 177Lu-PSMA-RLT in mCRPC in 2020. MATERIALS AND METHODS: Presentation of the therapy landscape in mCRPC and the current evidence on 177Lu-PSMA-RLT after PubMed based literature search. RESULTS: Several larger retrospective studies and the first prospective trials on 177Lu-PSMA-RLT show premature but encouraging evidence on 177Lu-PSMA-RLT to be a promising new option in mCRPC patients. The toxicity profile seems to be favorable. The phase III trial VISION aims to provide evidence for the approval of 177Lu-PSMA-RLT in combination with abiraterone or enzalutamide in patients having been pretreated with enzalutamide or abiraterone and docetaxel. CONCLUSIONS: Despite the promising preliminary results of 177Lu-PSMA-RLT, the efficacy results of VISION need to be awaited prior to using the therapy outside of compassionate use provisions.
Authors: Christian W Wichmann; Uwe Ackermann; Stan Poniger; Kenneth Young; Benjamin Nguyen; Gordon Chan; John Sachinidis; Andrew M Scott Journal: J Labelled Comp Radiopharm Date: 2020-11-02 Impact factor: 1.921