[177Lu]Lu-PSMA再挑战治疗转移性去势抵抗性前列腺癌的疗效和安全性：一项系统综述和荟萃分析

IF 7.6 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Nuclear Medicine and Molecular Imaging Pub Date : 2025-07-24 DOI:10.1007/s00259-025-07438-1

Zineddine Belabaci,Leonie Schmidt,Mouhammed Sleiay,Felipe Couñago,Fernando López Campos,Marwan Tolba,Thomas Zilli,Ali Afshar-Oromieh,Mohamed Shelan

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引用次数: 0

摘要

背景：lutetium -177 PSMA放射配体治疗（[¹⁷⁷Lu]Lu-PSMA- rlt）是转移性去势抵抗性前列腺癌（mCRPC）患者的有效治疗选择。前瞻性研究报告了长达6个周期的Lu- psma的良好疗效和安全性结果。本研究旨在评估[¹⁷⁷Lu]Lu- psma再挑战疗法在初始疗程[¹⁷Lu]Lu- psma - rlt后进展的mCRPC患者的疗效和安全性。方法本系统评价遵循系统评价和荟萃分析首选报告项目（PRISMA）指南。系统检索PubMed、EMBASE、Scopus等相关关键词，检索时间自成立至2025年3月。主要终点包括前列腺特异性抗原（PSA）下降超过50%和任何PSA下降的生化反应。次要结局包括用[¹⁷⁷Lu]Lu- psma再挑战治疗后的生存结局和治疗相关毒性。采用随机效应模型，通过meta分析产生合并比例。结果共纳入7项研究，共307例患者。其中，196例单独接受177Lu- psma RLT， 111例接受串联177Lu/225Ac-PSMA RLT。PSA下降超过50%和任何PSA下降的患者的合并比例分别为0.45 （95% CI: 0.36-0.54）和0.71 （95% CI: 0.61-0.80）。102例患者中，44例（43%）表现为低级别1-2口干；然而，没有严重口干症（≥3级）的病例报告。此外，出现≥3级毒性的患者的合并比例为0.14 （95% CI: 0.09-0.19）。结论[¹⁷⁷Lu]Lu- psma再挑战治疗对于晚期/晚期mCRPC患者是一种可行且安全的治疗选择。采用[225Ac]Ac-PSMA的串联方法可能有助于扩大对[¹⁷⁷Lu]Lu- psma进展后如何优化结果的理解。然而，这些发现需要在前瞻性随机研究中得到证实，比较不同的再挑战策略，以确定晚期前列腺癌的最佳测序和患者选择标准。

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Efficacy and safety of rechallenge therapy with [177Lu]Lu-PSMA in metastatic castration-resistant prostate cancer: a systematic review and meta-analysis.

BACKGROUND Lutetium-177 PSMA radioligand therapy ([¹⁷⁷Lu]Lu-PSMA-RLT) is an effective treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). Prospective studies reported favourable efficacy and safety outcomes of up to 6 cycles of [¹⁷⁷Lu]Lu-PSMA. This study aimed to evaluate the efficacy and safety of [¹⁷⁷Lu]Lu-PSMA rechallenge therapy in patients with mCRPC who progressed after an initial course of [¹⁷⁷Lu]Lu-PSMA-RLT. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was performed using relevant keywords in PubMed, EMBASE, and Scopus from establishment to March 2025. Primary endpoints included biochemical responses with a decline in prostate-specific antigen (PSA) of more than 50% and any PSA decline. Secondary outcomes included survival outcomes and treatment-related toxicity following rechallenge therapy with [¹⁷⁷Lu]Lu-PSMA. A random-effects model was used to generate pooled proportions through meta-analysis. RESULTS Eleven studies with 307 patients were included in the final analysis. Of these, 196 received 177Lu-PSMA RLT alone, and 111 received tandem 177Lu/225Ac-PSMA RLT. The pooled proportions of patients with more than a 50% PSA decline and any PSA decline were 0.45 (95% CI: 0.36-0.54) and 0.71 (95% CI: 0.61-0.80), respectively. In a total of 102 patients, 44 (43%) showed low-grade 1-2 xerostomia; however, no cases of serious xerostomia (grade ≥ 3) were reported. Moreover, the pooled proportion of patients experiencing grade ≥ 3 toxicity was 0.14 (95% CI: 0.09-0.19). CONCLUSION Rechallenge therapy with [¹⁷⁷Lu]Lu-PSMA is a feasible and safe treatment option for late/end mCRPC patients. Tandem approaches with [225Ac]Ac-PSMA may help expand understanding of how to optimize outcomes after [¹⁷⁷Lu]Lu-PSMA progression. However, these findings require confirmation in prospective, randomized studies comparing different rechallenge strategies to define optimal sequencing and patient selection criteria in advanced prostate cancer.

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来源期刊

European Journal of Nuclear Medicine and Molecular Imaging 医学-核医学

CiteScore

15.60

自引率

9.90%

发文量

392

审稿时长

3 months

期刊介绍： The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.