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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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.