Abstract

Case Report

Near Complete Response to 177Lu-PSMA-DKFZ-617 Therapy in a Patient with Metastatic Castration Resistant Prostate Cancer

Madhav Prasad Yadav, Sanjana Ballal a and Chandrasekhar Bal*

Published: 05 November, 2017 | Volume 1 - Issue 3 | Pages: 083-086

Prostate specific membrane antigen, a type II transmembrane protein is an excellent target for the radionuclide therapy in advanced prostate cancer patients due to its high expression in the prostate cancer cells. We present the case of a 69-year old man with advanced metastatic castration resistant prostate cancer. In view of rising serum PSA levels despite hormonal and chemotherapy, we decided to perform a 68Ga-PSMA-HBED-CC PET/CT scan (prostate specific membrane antigen). It revealed intense radiotracer uptake in the prostate, lymph nodes and multiple skeletal sites. Five cycles of 177Lu-PSMA-DKFZ-617 radioligand therapy were administered in the patient followed by an intrim 68Ga-PSMA-HBED-CC PET/CT. Intrim 68Ga-PSMA-HBED-CC PET/CT scan demonstrated a near complete remission of disease with a corresponding decrease in the sPSA levels. During the follow-up duration of 12 months, the patient did not develop haematological, kidney and liver toxicity during the course of treatment and follow-up. 177Lu-PSMA-DKFZ-617 is a promising therapeutic option in metastatic castration resistant prostate cancer (mCRPC) patients.

Read Full Article HTML DOI: 10.29328/journal.jro.1001012 Cite this Article Read Full Article PDF

Keywords:

Metastatic castration resistant prostate cancer; 68Ga- PSMA-HBED-CC PET/CT; 177Lu-PSMA-DKFZ-617 Radioligand therapy

References

  1. Hotte SJ, Saad F. Current management of castrate-resistant prostate cancer. Curr Oncol. 2010; 17: 72-79. Ref.: https://goo.gl/fnZuRe
  2. Kirby M, Hirst C, Crawford ED. Characterising the castration-resistant prostate cancer population: a systemic review. Int J Clin Pract. 2011; 65: 1180-1192. Ref.: https://goo.gl/UJ2PXY
  3. Green S, Weiss GR. Southwest Onology group standard response criteria, endpoint definitions and toxicity criteria. Invest new Drugs. 1992; 10: 239-253. Ref.: https://goo.gl/EfnvAK
  4. Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of PCa: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013; 40: 486-495. Ref.: https://goo.gl/ZNDQFU
  5. Minner S, Wittmer C, Graefen M, Salomon G, Steuber T, et al. High level PSMA expression is associated with early PSA recurrence in surgically treated prostate cancer. Prostate. 2011; 71: 281-288. Ref.: https://goo.gl/4m3X6d
  6. Rybalov M, Ananias HJ, Hoving HD, van der Poel HG, Rosati S, et al. PSMA, EpCAM, VEGF and GRPR as imaging targets in locally recurrent prostate cancer after radiotherapy. Int J Mol Sci. 2014; 15: 6046-6061. Ref.: https://goo.gl/QNrNbm
  7. Baum RP, Kulkarni HR, Schuchardt C, Singh A, Wirtz M, et al. 177Lu-Labeled Prostate-Specific Membrane Antigen Radioligand Therapy of Metastatic Castration-Resistant Prostate Cancer: Safety and Efficacy. J Nucl Med. 2016; 57: 1006-1013. Ref.: https://goo.gl/vBz8DZ
  8. Afshar-Oromieh A, Holland-Letz T, Giesel FL, Kratochwil C, Mier W, et al. Diagnostic performance of (68)Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging. 2017; 44: 1258-1268. Ref.: https://goo.gl/HmbeA6
  9. Afshar-Oromieh A, Hetzheim H, Kratochwil C, Benesova M, Eder M, et al. The Theranostic PSMA Ligand PSMA-617 in the Diagnosis of Prostate Cancer by PET/CT: Biodistribution in Humans, Radiation Dosimetry, and First Evaluation of Tumor Lesions. J Nucl Med. 2015; 56: 1697-1705. Ref.: https://goo.gl/mwdodQ
  10. Kratochwil C, Giesel FL, Stefanova M, Benešová M, Bronzel M, et al. PSMA-Targeted Radionuclide Therapy of Metastatic Castration-Resistant Prostate Cancer with 177Lu-Labeled PSMA-617. J Nucl Med. 2016; 57: 1170-1176. Ref.: https://goo.gl/Ehvsmj
  11. Rahbar K, Ahmadzadehfar H, Kratochwil C, Haberkorn U, Schäfers M, et al. German Multicenter Study Investigating 177Lu-PSMA-617 Radioligand Therapy in Advanced Prostate Cancer Patients. J Nucl Med. 2017; 58: 85-90. Ref.: https://goo.gl/zptRHE
  12. Yadav MP, Ballal S, Tripathi M, Damle NA, Sahoo RK, et al. (177)Lu-DKFZ-PSMA-617 therapy in metastatic castration resistant prostate cancer: safety, efficacy, and quality of life assessment. Eur J Nucl Med Mol Imaging. 2017; 44: 81-91. Ref.: https://goo.gl/z3GMyq
  13. Rahbar K, Boegemann M, Yordanova A, Eveslage M, Schäfers M, et al. PSMA targeted radioligandtherapy in metastatic castration resistant prostate cancer after chemotherapy, abiraterone and/or enzalutamide. A retrospective analysis of overall survival. Eur J Nucl Med Mol Imaging. 2017; 45: 12-19. Ref.: https://goo.gl/gKxd59
  14. Kabasakal L, Toklu T, Yeyin N, Demirci E, Abuqbeitah M, et al. Lu-177-PSMA-617 Prostate-Specific Membrane Antigen Inhibitor Therapy in Patients with Castration-Resistant Prostate Cancer: Stability, Bio-distribution and Dosimetry. Mol Imaging Radionucl Ther. 2017; 26: 62-68. Ref.: https://goo.gl/vyDNeE
  15. Delker A, Fendler WP, Kratochwil C, Brunegraf A, Gosewisch A, et al. Dosimetry for (177)Lu-DKFZ-PSMA-617: a new radiopharmaceutical for the treatment of metastatic prostate cancer. Eur J Nucl Med Mol Imaging. 2016; 43: 42-51. Ref.: https://goo.gl/Kdwi38
  16. Yadav MP, Ballal S, Tripathi M, Damle NA, Sahoo RK, et al. Post-therapeutic dosimetry of 177Lu-DKFZ-PSMA-617 in the treatment of patients with metastatic castration-resistant prostate cancer. Nucl Med Commun. 2017; 38: 91-98. Ref.: https://goo.gl/DbHCt6

Figures:

Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More