Tolerability of PSMA radioligand therapy in metastatic prostate cancer patients with baseline mild to moderate leukopenia.

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

EJNMMI Research Pub Date : 2025-07-06 DOI:10.1186/s13550-025-01280-0

Moritz B Bastian, Tilman Speicher, Arne Blickle, Caroline Burgard, Julius L D Bastian, Mark Bartholomä, Andrea Schaefer-Schuler, Stephan Maus, Samer Ezziddin, Florian Rosar

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引用次数: 0

Abstract

Background: Aim of this study was to analyze the safety of prostate-specific membrane antigen radioligand therapy (PSMA-RLT) in patients with metastatic castration-resistant prostate cancer (mCRPC) with preexisting mild to moderate leukopenia (CTCAE ≥ 1).

Results: Thirty-seven mCRPC patients with preexisting leukopenia (leukocyte count < 3.8 × 10⁹/L) were included in this study. Patients received a median of 3 cycles of [¹⁷⁷Lu]Lu-PSMA-617 (range 1-9). No significant difference in leukocyte counts was observed between baseline and follow-up after each PSMA-RLT cycle: first cycle (3.0 ± 0.5 at baseline vs. 3.4 ± 1.4 at follow up [in × 10⁹/L], p = 0.0921), second cycle (3.1 ± 0.4 vs. 3.8 ± 1.7, p = 0. 0.0509), and third cycle (3.1 ± 0.4 vs. 3.2 ± 2.0, p = 0.2929), respectively. Similarly, baseline and end of treatment values, irrespective of the number of administered cycles, did not reveal a significant difference (3.0 ± 0.5 vs. 3.5 ± 1.4, p = 0.0684). After the end of therapy, irrespective of the number of administered cycles, 27% patients remained stable in terms of CTCAE scoring, 46% changed to a higher score and 27% improved to a lower score.

Conclusion: Although marked preexisting leukopenia is often considered a relative contraindication for PSMA-RLT, our findings indicate that PSMA-RLT is feasible in patients with leukopenia of CTCAE grade ≥ 1. In our cohort, leukocyte counts remained stable without significant RLT-induced deterioration. Therefore, patients with leukopenia should not be categorically excluded from receiving PSMA-RLT.

Trial registration: Clinicaltrials.gov identifier: NCT04833517, registered 01.01.2016.

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基线轻度至中度白细胞减少的转移性前列腺癌患者PSMA放射治疗的耐受性

背景：本研究的目的是分析前列腺特异性膜抗原放射配体治疗（PSMA-RLT）对转移性去势抵抗性前列腺癌（mCRPC）既往存在轻度至中度白细胞减少（CTCAE≥1）患者的安全性。结果：37例既往存在白细胞减少（白细胞计数9/L）的mCRPC患者纳入本研究。患者接受中位数为3个周期的[177Lu]Lu-PSMA-617（范围1-9）。每个PSMA-RLT周期后，基线和随访白细胞计数无显著差异：第一个周期（基线时3.0±0.5 vs.随访时3.4±1.4 [× 109/L], p = 0.0921），第二个周期（3.1±0.4 vs. 3.8±1.7,p = 0）。0.0509)和第三周期（3.1±0.4 vs. 3.2±2.0,p = 0.2929）。同样，无论给药周期多少，基线值和治疗结束值也没有显着差异（3.0±0.5 vs. 3.5±1.4,p = 0.0684）。在治疗结束后，无论给药周期多少，27%的患者在CTCAE评分方面保持稳定，46%的患者评分升高，27%的患者评分降低。结论：尽管先前存在明显的白细胞减少通常被认为是PSMA-RLT的相对禁忌症，但我们的研究结果表明，PSMA-RLT在CTCAE分级≥1的白细胞减少患者中是可行的。在我们的队列中，白细胞计数保持稳定，没有明显的rlt诱导的恶化。因此，白细胞减少患者不应被排除在接受PSMA-RLT之外。试验注册：Clinicaltrials.gov识别码：NCT04833517，注册日期：2016年1月1日。

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.