Marcel Schwinger, Charis Kalogirou, Vincent Scheper, Maximiliane Däuwel, Simon Weber, Anna Katharina Seitz, Hubert Kübler, Andreas K Buck, Rudolf A Werner, Philipp E Hartrampf
{"title":"[177Lu]Lu-PSMA I&T治疗老年患者的安全性、有效性和生存预后因素","authors":"Marcel Schwinger, Charis Kalogirou, Vincent Scheper, Maximiliane Däuwel, Simon Weber, Anna Katharina Seitz, Hubert Kübler, Andreas K Buck, Rudolf A Werner, Philipp E Hartrampf","doi":"10.1007/s00259-025-07519-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to evaluate the safety and efficacy to explore predictors of prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) with [¹⁷⁷Lu]Lu-PSMA I&T in metastatic castration-resistant prostate cancer (mCRPC) patients aged ≥ 75 and explored baseline predictors of overall survival (OS).</p><p><strong>Materials and methods: </strong>56 men (median age 78, range 75-95) were treated with RLT. Adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Baseline Gleason score, blood parameters (PSA, LDH), and sites of metastases (bone, lymph nodes, liver, lung) were recorded. Quantitative PET parameters such as SUVmean (mean standardized uptake value), SUVpeak (peak standardized uptake value), SUVmax (maximum standardized uptake value), PSMA-TV (PSMApositive tumor volume), TL-PSMA (total lesion PSMA) were measured. PET response was assessed by RECIP 1.0 (response evaluation criteria in PSMA imaging); biochemical response by PCWG3 (prostate cancer working group 3). Associations with OS were analyzed via uni- and multivariable Cox regression and Kaplan-Meier curves.</p><p><strong>Results: </strong>No CTCAE grade III-V toxicities occurred. Grade I/II hematologic events included anemia (23.2%), leukocytopenia (18.6%) and thrombocytopenia (9.3%); eGFR declined by 2.5% (grade I/II in 18.6%). Median OS was 11 months; 60.7% of patients died. 74.4% of patients (32/43) showed PSA declines (median - 58%; 14/43 ≥ 50%). Higher baseline PSA (HR 1.001 per ng/mL; P < 0.10) and LDH (HR 1.008 per U/L; P < 0.01) were associated with shorter OS. Patients with progressive disease by both RECIP and PCWG3 had shorter OS than others (11 vs. 22 months; HR 3.3; P < 0.01). Any PSA response predicted longer OS (21 vs. 7 months; HR 0.3; P < 0.01). Presence of liver metastases portended poorer survival (8 vs. 21 months; HR 6.7; P < 0.001).</p><p><strong>Conclusion: </strong>[¹⁷⁷Lu]Lu-PSMA I&T RLT is well tolerated in patients ≥ 75 years. Lower baseline PSA and LDH but not PSMA-TV predict longer OS. Early PSA response strongly correlates with improved survival. Combined use of RECIP and PCWG3 criteria optimizes response assessment.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":7.6000,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Radioligand treatment with [<sup>177</sup>Lu]Lu-PSMA I&T in elderly Patients - Safety, efficacy, and prognostic factors for survival.\",\"authors\":\"Marcel Schwinger, Charis Kalogirou, Vincent Scheper, Maximiliane Däuwel, Simon Weber, Anna Katharina Seitz, Hubert Kübler, Andreas K Buck, Rudolf A Werner, Philipp E Hartrampf\",\"doi\":\"10.1007/s00259-025-07519-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>We aimed to evaluate the safety and efficacy to explore predictors of prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) with [¹⁷⁷Lu]Lu-PSMA I&T in metastatic castration-resistant prostate cancer (mCRPC) patients aged ≥ 75 and explored baseline predictors of overall survival (OS).</p><p><strong>Materials and methods: </strong>56 men (median age 78, range 75-95) were treated with RLT. Adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Baseline Gleason score, blood parameters (PSA, LDH), and sites of metastases (bone, lymph nodes, liver, lung) were recorded. Quantitative PET parameters such as SUVmean (mean standardized uptake value), SUVpeak (peak standardized uptake value), SUVmax (maximum standardized uptake value), PSMA-TV (PSMApositive tumor volume), TL-PSMA (total lesion PSMA) were measured. PET response was assessed by RECIP 1.0 (response evaluation criteria in PSMA imaging); biochemical response by PCWG3 (prostate cancer working group 3). Associations with OS were analyzed via uni- and multivariable Cox regression and Kaplan-Meier curves.</p><p><strong>Results: </strong>No CTCAE grade III-V toxicities occurred. Grade I/II hematologic events included anemia (23.2%), leukocytopenia (18.6%) and thrombocytopenia (9.3%); eGFR declined by 2.5% (grade I/II in 18.6%). Median OS was 11 months; 60.7% of patients died. 74.4% of patients (32/43) showed PSA declines (median - 58%; 14/43 ≥ 50%). Higher baseline PSA (HR 1.001 per ng/mL; P < 0.10) and LDH (HR 1.008 per U/L; P < 0.01) were associated with shorter OS. Patients with progressive disease by both RECIP and PCWG3 had shorter OS than others (11 vs. 22 months; HR 3.3; P < 0.01). Any PSA response predicted longer OS (21 vs. 7 months; HR 0.3; P < 0.01). Presence of liver metastases portended poorer survival (8 vs. 21 months; HR 6.7; P < 0.001).</p><p><strong>Conclusion: </strong>[¹⁷⁷Lu]Lu-PSMA I&T RLT is well tolerated in patients ≥ 75 years. Lower baseline PSA and LDH but not PSMA-TV predict longer OS. Early PSA response strongly correlates with improved survival. Combined use of RECIP and PCWG3 criteria optimizes response assessment.</p>\",\"PeriodicalId\":11909,\"journal\":{\"name\":\"European Journal of Nuclear Medicine and Molecular Imaging\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.6000,\"publicationDate\":\"2025-08-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Nuclear Medicine and Molecular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00259-025-07519-1\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Nuclear Medicine and Molecular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00259-025-07519-1","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Radioligand treatment with [177Lu]Lu-PSMA I&T in elderly Patients - Safety, efficacy, and prognostic factors for survival.
Purpose: We aimed to evaluate the safety and efficacy to explore predictors of prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) with [¹⁷⁷Lu]Lu-PSMA I&T in metastatic castration-resistant prostate cancer (mCRPC) patients aged ≥ 75 and explored baseline predictors of overall survival (OS).
Materials and methods: 56 men (median age 78, range 75-95) were treated with RLT. Adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Baseline Gleason score, blood parameters (PSA, LDH), and sites of metastases (bone, lymph nodes, liver, lung) were recorded. Quantitative PET parameters such as SUVmean (mean standardized uptake value), SUVpeak (peak standardized uptake value), SUVmax (maximum standardized uptake value), PSMA-TV (PSMApositive tumor volume), TL-PSMA (total lesion PSMA) were measured. PET response was assessed by RECIP 1.0 (response evaluation criteria in PSMA imaging); biochemical response by PCWG3 (prostate cancer working group 3). Associations with OS were analyzed via uni- and multivariable Cox regression and Kaplan-Meier curves.
Results: No CTCAE grade III-V toxicities occurred. Grade I/II hematologic events included anemia (23.2%), leukocytopenia (18.6%) and thrombocytopenia (9.3%); eGFR declined by 2.5% (grade I/II in 18.6%). Median OS was 11 months; 60.7% of patients died. 74.4% of patients (32/43) showed PSA declines (median - 58%; 14/43 ≥ 50%). Higher baseline PSA (HR 1.001 per ng/mL; P < 0.10) and LDH (HR 1.008 per U/L; P < 0.01) were associated with shorter OS. Patients with progressive disease by both RECIP and PCWG3 had shorter OS than others (11 vs. 22 months; HR 3.3; P < 0.01). Any PSA response predicted longer OS (21 vs. 7 months; HR 0.3; P < 0.01). Presence of liver metastases portended poorer survival (8 vs. 21 months; HR 6.7; P < 0.001).
Conclusion: [¹⁷⁷Lu]Lu-PSMA I&T RLT is well tolerated in patients ≥ 75 years. Lower baseline PSA and LDH but not PSMA-TV predict longer OS. Early PSA response strongly correlates with improved survival. Combined use of RECIP and PCWG3 criteria optimizes response assessment.
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.
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