Combined PRLT using Ac-225 and Lu-177 labeled PSMA-617 (TANDEM-PRLT) in end-stage metastatic prostate cancer: a concept to reduce salivary gland toxicity?
| Autor: | T Langbein, HR Kulkarni, A Singh, C Lehmann, C Schuchardt, J Zhang, RP Baum |
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| Rok vydání: | 2019 |
| Předmět: |
Chemotherapy
medicine.medical_specialty Taxane Ejection fraction Salivary gland business.industry medicine.medical_treatment Urology medicine.disease 030218 nuclear medicine & medical imaging 03 medical and health sciences Prostate cancer 0302 clinical medicine medicine.anatomical_structure 030220 oncology & carcinogenesis Toxicity medicine Risk factor Adverse effect business |
| Zdroj: | 57. Jahrestagung der Deutschen Gesellschaft für Nuklearmedizin. |
| ISSN: | 2567-6407 |
| DOI: | 10.1055/s-0039-1683741 |
| Popis: | 77 Objectives: First clinical data of Ac-225-labeled PSMA radioligand therapy in advanced metastatic prostate cancer (PC) demonstrated encouraging results (1,2). However, xerostomia became the dose-limiting toxicity. Recently, our group presented the initial experience of a protocol using lower administered activity of Ac-225-PSMA-617 applied with Lu-177-PSMA-617 to minimize adverse effects while proposing potential synergistic efficacy (3). This study investigates salivary gland (SG) toxicity of this TANDEM-PRLT approach. Methods: 18 cases of end-stage PC patients (median age 68 y) selected for TANDEM-PRLT with available follow-up data at 2 months after treatment were investigated. Risk factors like previous taxane-based chemotherapy (7 of 18 pts), external radiotherapy to the head and neck region (2 of 18 pts) or Lu-177-PSMA (14 of 18 pts) were considered. 2.0 - 7.0 MBq of Ac-225 and 3.0- 7.2 GBq of Lu-177 were applied. Dryness of mouth was documented pre- and post-therapeutically according to CTCAE (v5.0) and the shorted xerostomia inventory (XI). Furthermore, a quantified salivary gland scintigraphy (SGS; maximum Uptake Umax; Ejection fraction EF) and SUVmax as well as the metabolic volume of the SG on the Ga-68-PSMA-11-PET/CT were compared. Results: Xerostomia increased significantly from grade 0 (max grade 1) to grade 1 (max grade 2; p= 0.001), the average XI rose from 10.73 (± 3.5) to 15.55 (± 4.18) (p= 0.003), however, no severe xerostomia was observed, no patient discontinued treatment. SGS revealed a significant decline of the EF in all SG (p< 0.001) while the Umax showed no significant changes. The Ga-68-PSMA uptake of all SG declined significantly (p< 0.05), while - despite tendencies - there were no strong significant changes of the metabolic volume detectable. Pretreatment with chemotherapy appeared to be a risk factor, although there was no significant correlation also with age. Conclusions: Besides limitations (number of patients, early follow-up setting) initial results propose a reduced SG toxicity of the TANDEM-protocol. Nevertheless, since findings confirmed a clear SG impairment when using Ac-225-PSMA, preventive strategies remain an urgent need, especially in subsequent alpha-PRLT cycles. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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