监测[177Lu]Lu-PSMA放射药物治疗转移性去势抵抗性前列腺癌疗效的临床方案

IF 0.2 4区医学 Q4 PATHOLOGY

Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique Pub Date : 2025-03-01 DOI:10.1016/j.mednuc.2025.01.172

L. Djaileb , L. Unterrainer , N. De Leiris , M. Unterrainer , H. Ilhan , K. Kiraz , M. Laramas , C.J. Paller , L.B. Solnes , A. Gafita

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引用次数: 0

摘要

目的：通过视觉RECIP 1.0评估治疗后[177Lu] LuPSMA放射配体治疗期间Lu-PSMA (LuPSMA)-SPECT/CT的预后价值，并制定基于证据的临床方案来监测对LuPSMA的疗效。方法纳入2019年4月至2023年11月期间接受LuPSMA治疗并至少接受两次LuPSMA-SPECT/CT （SPECT）检查的患者。三位独立的读者在2个疗程的治疗后对基线和中期LuPSMA-SPECT/CT进行了解释，以评估psma成像（RECIP） 1.0中的视觉反应评价标准。主要终点是经RECIP 1.0检测的治疗后SPECT对LuPSMA患者总生存期的预后价值。次要结果是在2个周期的LuPSMA后进行SPECT和PSMA-PET/CT （PET）之间的一致性。结果共纳入105例患者。在SPECT中，PD与SD相比与更短的OS相关(HR = 2.51；95%；Ci: 1.19-5.28；p = 0.015)和PR (HR = 6.48；95%；Ci: 2.67-15.70；p & lt;0.001)。73/105（69.5%）患者在2个周期后复查PET。SPECT、PET、SPECT + PSA和PET + PSA分别显示7/73（10%）、30/73（41%）、22/73（30%）和30/73（41%）患者肿瘤进展。所有7/73(10%)SPECT诊断的PD患者都有PET诊断的PD。SPECT的c指数低于SPECT + PSA的c指数(0.54 vs 0.62；p = 0.03)和PET(0.54 vs. 0.66；p & lt;0.001)，而SPECT + PSA与PET无显著差异(0.62 vs. 0.66；p = 0.07)。结论经2个疗程的LuPSMA治疗后，recp 1.0 SPECT/CT可预测患者的总生存期，可用于治疗反应评价。与LuPSMA-SPECT/CT相比，PSMA-PET/CT识别出的进展性疾病患者数量显著增加。LuPSMA- spect /CT + PSA复合分类系统与临时PSMA-PET/CT评价LuPSMA疗效无显著差异。

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Clinical protocols to monitor efficacy of [177Lu]Lu-PSMA radiopharmaceutical therapy in metastatic castration-resistant prostate cancer

Introduction

To assess the prognostic value of post-therapy [177Lu]Lu-PSMA (LuPSMA)-SPECT/CT by visual RECIP 1.0 during LuPSMA radioligand therapy and to develop an evidence-based clinical protocol to monitor efficacy to LuPSMA.

Methods

Patients who received LuPSMA between April 2019 and November 2023 and who underwent at least two LuPSMA-SPECT/CT (SPECT) were included. Three independent readers interpreted pairs of baseline and interim LuPSMA-SPECT/CT after 2 cycles of therapy for visual Response Evaluation Criteria In PSMA-imaging (RECIP) 1.0. The primary outcome was the prognostic value of post-therapeutic SPECT by RECIP 1.0 for overall survival after LuPSMA. The secondary outcome was the agreement between SPECT and PSMA-PET/CT (PET) performed after 2 cycles of LuPSMA.

Results

In total, 105 patients were included. In SPECT PD was associated with shorter OS compared to SD (HR = 2.51 ; 95 % ; CI : 1.19–5.28 ; p = 0.015) and to PR (HR = 6.48 ; 95 % ; CI : 2.67–15.70 ; p < 0.001). 73/105(69.5 %) had a PET after 2 cycles. 7/73(10 %), 30/73(41 %), 22/73(30 %), and 30/73(41 %) patients had a tumor progression by SPECT, PET, SPECT + PSA, and PET + PSA, respectively. All 7/73(10 %) patients with PD by SPECT had PD by PET. The C-index for SPECT was inferior to the one of SPECT + PSA(0.54 vs. 0.62 ; p = 0.03) and PET(0.54 vs. 0.66 ; p < 0.001) while SPECT + PSA did not differ significantly from PET(0.62 vs. 0.66 ; p = 0.07).

Conclusion

Post-therapeutic SPECT/CT by RECIP 1.0 after 2 cycles of LuPSMA therapy is prognostic for overall survival and can be used for treatment response evaluation purposes. PSMA-PET/CT identified significantly higher number of patients with progressive disease compared to LuPSMA-SPECT/CT. A composite classification system of LuPSMA-SPECT/CT + PSA was not significantly different from interim PSMA-PET/CT for response evaluation to LuPSMA.

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来源期刊

Medecine Nucleaire-Imagerie Fonctionnelle et Metabolique PATHOLOGY-

CiteScore

0.30

自引率

0.00%

发文量

160

审稿时长

19.8 weeks

期刊介绍： Le but de Médecine nucléaire - Imagerie fonctionnelle et métabolique est de fournir une plate-forme d''échange d''informations cliniques et scientifiques pour la communauté francophone de médecine nucléaire, et de constituer une expérience pédagogique de la rédaction médicale en conformité avec les normes internationales.