RECIP 1.0 + PSA for response assessment in mCRPC patients treated with ²²⁵Ac / ¹⁷⁷Lu PSMA combination therapy.

IF 3.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

EJNMMI Research Pub Date : 2025-03-04 DOI:10.1186/s13550-025-01211-z

Gabriel T Sheikh, Astrid Delker, Mathias J Zacherl, Adrien Holzgreve, Sarah L Takayama Fouladgar, Marcus Unterrainer, Johannes Rübenthaler, Jozefina Casuscelli, Andrei Gafita, Lena M Unterrainer

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引用次数: 0

Abstract

Background: Targeted alpha therapy (TAT) with ²²⁵Ac has shown promising results in metastatic castration-resistant prostate cancer (mCRPC) patients pre-treated with [¹⁷⁷Lu]Lu-PSMA radioligand therapy (RLT). A combination treatment regimen adding ¹⁷⁷Lu to decreased ²²⁵Ac activities may improve toxicity profile while maintaining sufficient anti-tumor effect. We therefore evaluated clinical and image-based response parameters in patients treated with ²²⁵Ac-/¹⁷⁷Lu-PSMA combination therapies (ALCT).

Results: Complete response (RECIP-CR), partial response (RECIP-PR), stable disease (RECIP-SD), progressive disease (RECIP-PD) according to RECIP 1.0 was observed in 0/25 (0%), 12/25 (48%), 9/25 (36%) and 4/25 (16%) patients, respectively. Response by RECIP + PSA was observed in 14/25 (56%) patients and progression by RECIP + PSA in 8/25 (32%) patients. Interrater reliability for visual RECIP was substantial (κ = 0.757, p < 0.001), while agreement between visual and quantitative RECIP was almost fully congruent (κ = 0.879, p < 0.001). OS did not significantly vary among the four different therapy regimens (p > 0.05). When grouping patients with declining / stable PSA as responders, these patients showed no significant difference in overall survival compared to patients with progressive PSA after ALCT (p = 0.312). Similarly, there was no significant difference in median overall survival between patients without RECIP-progression (RECIP-PR + RECIP-SD) and patients with RECIP-progression (RECIP-PD) (p > 0.05), but when applying the composite classification, RECIP + PSA responders survived significantly longer compared to patients with RECIP + PSA progression (p = 0.049).

Conclusions: ALCT is a promising therapeutic regimen that may prolong survival in patients who progress during [¹⁷⁷Lu]Lu-PSMA RLT. Our results motivate to further investigate the use of RECIP + PSA as tool for response assessment and for overall survival prediction in mCRPC under ALCT.

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RECIP 1.0 + PSA用于225Ac / 177Lu PSMA联合治疗mCRPC患者的疗效评估

背景：225Ac靶向α治疗（TAT）在转移性去势抵抗性前列腺癌（mCRPC）患者中显示出有希望的效果，该患者先前接受了[177Lu]Lu-PSMA放射配体治疗（RLT）。在降低225Ac活性的基础上加入177Lu的联合治疗方案可以改善毒副作用，同时保持足够的抗肿瘤作用。因此，我们评估了接受225Ac-/177Lu-PSMA联合治疗（ALCT）的患者的临床和基于图像的反应参数。结果：0/25（0%）、12/25（48%）、9/25（36%）、4/25（16%）患者按RECIP 1.0标准分别观察到完全缓解（repi - cr）、部分缓解（repi - pr）、病情稳定（repi - sd）、病情进展（repi - pd）。14/25（56%）的患者通过RECIP + PSA缓解，8/25（32%）的患者通过RECIP + PSA进展。视觉RECIP的量表间信度显著（κ = 0.757, p 0.05）。当将PSA下降/稳定的患者分组为应答者时，与ALCT后PSA进展的患者相比，这些患者的总生存率无显著差异（p = 0.312）。同样，无进展患者（RECIP- pr + RECIP- sd）和进展患者（RECIP- pd）的中位总生存期无显著差异（p < 0.05），但当应用复合分类时，RECIP + PSA应答者比RECIP + PSA进展患者的生存期明显更长（p = 0.049）。结论：ALCT是一种很有前景的治疗方案，可以延长在[177Lu]Lu-PSMA RLT期间进展的患者的生存期。我们的研究结果激励我们进一步研究将RECIP + PSA作为ALCT下mCRPC反应评估和总生存预测的工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

EJNMMI Research RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING&nb-

CiteScore

5.90

自引率

3.10%

发文量

审稿时长

13 weeks

期刊介绍： EJNMMI Research publishes new basic, translational and clinical research in the field of nuclear medicine and molecular imaging. Regular features include original research articles, rapid communication of preliminary data on innovative research, interesting case reports, editorials, and letters to the editor. Educational articles on basic sciences, fundamental aspects and controversy related to pre-clinical and clinical research or ethical aspects of research are also welcome. Timely reviews provide updates on current applications, issues in imaging research and translational aspects of nuclear medicine and molecular imaging technologies. The main emphasis is placed on the development of targeted imaging with radiopharmaceuticals within the broader context of molecular probes to enhance understanding and characterisation of the complex biological processes underlying disease and to develop, test and guide new treatment modalities, including radionuclide therapy.