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Vöö S, Mercadante V, Riaz S, Algodayan S, Scott C, Priftakis D, Shephard M, Bomanji J. Molecular radionuclide therapy-induced salivary gland toxicity: an unappreciated threat to patients' quality of life? Nucl Med Commun 2024; 45:547-549. [PMID: 38586985 DOI: 10.1097/mnm.0000000000001839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Stefan Vöö
- Institute of Nuclear Medicine, Molecular Radionuclide Therapy Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust (UCLH)
| | | | - Saima Riaz
- Institute of Nuclear Medicine, Molecular Radionuclide Therapy Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust (UCLH)
| | - Sarah Algodayan
- Institute of Nuclear Medicine, Molecular Radionuclide Therapy Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust (UCLH)
| | - Catherine Scott
- Institute of Nuclear Medicine, Molecular Radionuclide Therapy Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust (UCLH)
| | - Dimitris Priftakis
- Institute of Nuclear Medicine, Molecular Radionuclide Therapy Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust (UCLH)
| | | | - Jamshed Bomanji
- Institute of Nuclear Medicine, Molecular Radionuclide Therapy Unit, University College London Hospital, University College London Hospitals NHS Foundation Trust (UCLH)
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2
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Ndlovu H, Mokoala KMG, Lawal I, Emmett L, Sathekge MM. Prostate-specific Membrane Antigen: Alpha-labeled Radiopharmaceuticals. PET Clin 2024; 19:371-388. [PMID: 38658230 DOI: 10.1016/j.cpet.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Novel prostate-specific membrane antigen (PSMA) ligands labeled with α-emitting radionuclides are sparking a growing interest in prostate cancer treatment. These targeted alpha therapies (TATs) have attractive physical properties that deem them effective in progressive metastatic castrate-resistant prostate cancer (mCRPC). Among the PSMA TAT radiopharmaceuticals, [225Ac]Ac-PSMA has been used extensively on a compassionate basis and is currently undergoing phase I trials. Notably, TAT has the potential to improve quality of life and has favorable antitumor activity and outcomes in multiple scenarios other than in mCRPC. In addition, resistance mechanisms to TAT may be amenable to combination therapies.
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Affiliation(s)
- Honest Ndlovu
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa; Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
| | - Kgomotso M G Mokoala
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa; Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
| | - Ismaheel Lawal
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Louise Emmett
- Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney, Australia
| | - Mike M Sathekge
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa; Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa.
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3
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Muniz M, Loprinzi CL, Orme JJ, Koch RM, Mahmoud AM, Kase AM, Riaz IB, Andrews JR, Thorpe MP, Johnson GB, Kendi AT, Kwon ED, Nauseef JT, Morgans AK, Sartor O, Childs DS. Salivary toxicity from PSMA-targeted radiopharmaceuticals: What we have learned and where we are going. Cancer Treat Rev 2024; 127:102748. [PMID: 38703593 PMCID: PMC11160931 DOI: 10.1016/j.ctrv.2024.102748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
Clinical trials of prostate-specific membrane antigen (PSMA) targeted radiopharmaceuticals have shown encouraging results. Some agents, like lutetium-177 [177Lu]Lu-PSMA-617 ([177Lu]Lu-PSMA-617), are already approved for late line treatment of metastatic castration-resistant prostate cancer (mCRPC). Projections are for continued growth of this treatment modality; [177Lu]Lu-PSMA-617 is being studied both in earlier stages of disease and in combination with other anti-cancer therapies. Further, the drug development pipeline is deep with variations of PSMA-targeting radionuclides, including higher energy alpha particles conjugated to PSMA-honing vectors. It is safe to assume that an increasing number of patients will be exposed to PSMA-targeted radiopharmaceuticals during the course of their cancer treatment. In this setting, it is important to better understand and mitigate the most commonly encountered toxicities. One particularly vexing side effect is xerostomia. In this review, we discuss the scope of the problem, inventories to better characterize and monitor this troublesome side effect, and approaches to preserve salivary function and effectively palliate symptoms. This article aims to serve as a useful reference for prescribers of PSMA-targeted radiopharmaceuticals, while also commenting on areas of missing data and opportunities for future research.
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Affiliation(s)
- Miguel Muniz
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, US.
| | | | - Jacob J Orme
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, US.
| | - Regina M Koch
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, US.
| | | | - Adam M Kase
- Department of Medical Oncology, Mayo Clinic, Jacksonville FL, US.
| | - Irbaz B Riaz
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, US.
| | - Jack R Andrews
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ, US.
| | - Matthew P Thorpe
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, US.
| | - Geoffrey B Johnson
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, US; Department of Immunology, Mayo Clinic, Rochester, MN, US.
| | - Ayse T Kendi
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, US.
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, MN, US.
| | - Jones T Nauseef
- Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY, US.
| | - Alicia K Morgans
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, US.
| | - Oliver Sartor
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, US; Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, US.
| | - Daniel S Childs
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, US.
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4
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Müller M, Lucaroni L, Favalli N, Bassi G, Neri D, Cazzamalli S, Oehler S. Discovery of Glutamate Carboxypeptidase III Ligands to Compete the Uptake of [ 177Lu]Lu-PSMA-617 in Healthy Organs. J Med Chem 2024; 67:8247-8260. [PMID: 38716576 DOI: 10.1021/acs.jmedchem.4c00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Prostate-specific membrane antigen (PSMA)-targeted radio ligand therapeutics (RLTs), such as [177Lu]Lu-PSMA-617 (Pluvicto), have been shown to accumulate in salivary glands and kidneys, potentially leading to undesired side effects. As unwanted accumulation in normal organs may derive from the cross-reactivity of PSMA ligands to glutamate carboxypeptidase III (GCPIII), it may be convenient to block this interaction with GCPIII-selective ligands. Parallel screening of a DNA-encoded chemical library (DEL) against GCPIII and PSMA allowed the identification of GCPIII binders. Structure-activity relationship (SAR) studies resulted in the identification of nanomolar GCPIII ligands with up to 1000-fold selectivity over PSMA. We studied the ability of GCPIII ligands to counteract the binding of [177Lu]Lu-PSMA-617 to human salivary glands by autoradiography and could demonstrate a partial radioprotection.
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Affiliation(s)
| | | | | | | | - Dario Neri
- Philochem AG, Otelfingen 8112, Switzerland
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH Zurich), Zurich 8093, Switzerland
- Philogen S.p.A., Siena 53100, Italy
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Vorster M, Sathekge M. Advances in PSMA Alpha Theragnostics. Semin Nucl Med 2024:S0001-2998(24)00029-1. [PMID: 38658300 DOI: 10.1053/j.semnuclmed.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
Alpha theranostics offer an attractive alternative form of therapy, which has best been investigated and documented with 225Ac-PSMA in patients with prostate cancer. Advantages offered by targeted alpha therapy include overcoming radiation resistance, oxygen independence, effecting double-stranded DNA breakages within the tumors with anticipated improved clinical outcomes and an acceptable side effect profile. The previous Seminars article on this topic, published in 2020, had to rely mostly on published case reports and small observational studies. In the last few years, however, several meta-analyses have emerged that evaluate the safety and efficacy of 225Ac-PSMA in prostate cancer patients, followed most recently by a multi-center retrospective study initiated by WARMTH. The findings of these publications, together with the exploration of TAT offered in clinical conditions other than as a last resort, is the focus of this updated overview. Unresolved clinical issues that remain, include the appropriate selection of patients that would benefit most from treatment with 225Ac-PSMA, treatment timing within the disease landscape, optimal dosing schedule, dosimetry, when and how to best use combination therapies and minimization and treatment of side effects, particularly that of xerostomia.
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Affiliation(s)
- Mariza Vorster
- Department of Nuclear Medicine at Inkosi Albert Luthuli Hospital, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
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Taş H, Bakos G, Bauder-Wüst U, Schäfer M, Remde Y, Roscher M, Benešová-Schäfer M. Human ABC and SLC Transporters: The Culprit Responsible for Unspecific PSMA-617 Uptake? Pharmaceuticals (Basel) 2024; 17:513. [PMID: 38675472 PMCID: PMC11053447 DOI: 10.3390/ph17040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
[177Lu]Lu-PSMA-617 has recently been successfully approved by the FDA, the MHRA, Health Canada and the EMA as Pluvicto®. However, salivary gland (SG) and kidney toxicities account for its main dose-limiting side-effects, while its corresponding uptake and retention mechanisms still remain elusive. Recently, the presence of different ATP-binding cassette (ABC) transporters, such as human breast cancer resistance proteins (BCRP), multidrug resistance proteins (MDR1), multidrug-resistance-related proteins (MRP1, MRP4) and solute cassette (SLC) transporters, such as multidrug and toxin extrusion proteins (MATE1, MATE2-K), organic anion transporters (OAT1, OAT2v1, OAT3, OAT4) and peptide transporters (PEPT2), has been verified at different abundances in human SGs and kidneys. Therefore, our aim was to assess whether [177Lu]Lu-PSMA-617 and [225Ac]Ac-PSMA-617 are substrates of these ABC and SLC transporters. For in vitro studies, the novel isotopologue ([α,β-3H]Nal)Lu-PSMA-617 was used in cell lines or vesicles expressing the aforementioned human ABC and SLC transporters for inhibition and uptake studies, respectively. The corresponding probe substrates and reference inhibitors were used as controls. Our results indicate that [177Lu]Lu-PSMA-617 and [225Ac]Ac-PSMA-617 are neither inhibitors nor substrates of the examined transporters. Therefore, our results show that human ABC and SLC transporters play no central role in the uptake and retention of [177Lu]Lu-PSMA-617 and [225Ac]Ac-PSMA-617 in the SGs and kidneys nor in the observed toxicities.
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Affiliation(s)
- Harun Taş
- German Cancer Research Center (DKFZ), Research Group Molecular Biology of Systemic Radiotherapy, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.T.); (G.B.); (U.B.-W.)
| | - Gábor Bakos
- German Cancer Research Center (DKFZ), Research Group Molecular Biology of Systemic Radiotherapy, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.T.); (G.B.); (U.B.-W.)
| | - Ulrike Bauder-Wüst
- German Cancer Research Center (DKFZ), Research Group Molecular Biology of Systemic Radiotherapy, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.T.); (G.B.); (U.B.-W.)
| | - Martin Schäfer
- German Cancer Research Center (DKFZ), Service Unit for Radiopharmaceuticals and Preclinical Trials, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (M.S.); (Y.R.); (M.R.)
| | - Yvonne Remde
- German Cancer Research Center (DKFZ), Service Unit for Radiopharmaceuticals and Preclinical Trials, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (M.S.); (Y.R.); (M.R.)
| | - Mareike Roscher
- German Cancer Research Center (DKFZ), Service Unit for Radiopharmaceuticals and Preclinical Trials, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (M.S.); (Y.R.); (M.R.)
| | - Martina Benešová-Schäfer
- German Cancer Research Center (DKFZ), Research Group Molecular Biology of Systemic Radiotherapy, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (H.T.); (G.B.); (U.B.-W.)
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Ahmadzadehfar H, Seifert R, Afshar-Oromieh A, Kratochwil C, Rahbar K. Prostate Cancer Theranostics With 177Lu-PSMA. Semin Nucl Med 2024:S0001-2998(24)00024-2. [PMID: 38570288 DOI: 10.1053/j.semnuclmed.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
This review paper highlights the transformative role of PSMA-targeted diagnostics and therapy in prostate cancer management, particularly focusing on 177Lu-PSMA-617, approved by the FDA and EMA for metastatic castration-resistant prostate cancer (mCRPC) patients post-chemotherapy and ARPI treatment. Originating from the VISION trial's success, this paper navigates the current radioligand therapy (RLT) indications, emphasizing practical patient selection, planning, and treatment execution. It critically examines Lu-PSMA's comparative effectiveness against cabazitaxel and Ra-223, addressing decision-making dilemmas for mCRPC treatments. Furthermore, the paper discusses Lu-PSMA in chemotherapy-naïve patients and its application in hormone-sensitive prostate cancer, underlined by ongoing global studies. A significant concern is Lu-PSMA's long-term safety profile, particularly nephrotoxicity risks, necessitating further investigation. The possibility of Lu-PSMA rechallenge in responsive patients is explored, stressing the need for comprehensive analyses and real-world data to refine treatment protocols. Conclusively, PSMA-targeted therapy marks a significant advance in prostate cancer therapy, advocating for its integration into a multimodal, patient-centric treatment approach. The review underscores the imperative for additional comparative studies to optimize treatment sequences and outcomes, ultimately enhancing long-term prognosis and disease control in prostate cancer management.
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Affiliation(s)
- Hojjat Ahmadzadehfar
- Department of Nuclear Medicine, Klinikum Westfalen, Dortmund, Germany; Department of Nuclear Medicine, Institute of Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus, Bochum, Germany.
| | - Robert Seifert
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; West German Cancer Center, Münster, Germany
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8
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Huang SS, DiFilippo FP, Lindner DJ, Heston WD. A novel PSMA-targeting tracer with highly negatively charged linker demonstrates decreased salivary gland uptake in mice compared to [ 68Ga]Ga-PSMA-11. EJNMMI Radiopharm Chem 2024; 9:7. [PMID: 38289450 PMCID: PMC10828251 DOI: 10.1186/s41181-024-00237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The current generation of radiolabeled PSMA-targeting therapeutic agents is limited by prominent salivary gland binding, which results in dose-limiting xerostomia from radiation exposure. JB-1498 is a urea-based small molecule with a highly negatively charged linker targeting prostate specific membrane antigen (PSMA). Prior work on a similar tracer with the same negatively charged linker demonstrated low normal organ/soft tissue background uptake compared to [68Ga]Ga-PSMA-11. The purpose of this study was to investigate if [68Ga]Ga-JB-1498 had reduced salivary gland uptake in mice compared to [68Ga]Ga-PSMA-11. RESULTS JB-1498 demonstrated high affinity for PSMA binding and tumor uptake in a murine tumor model. In an initial biodistribution study with low molar activity, [68Ga]Ga-JB-1498 demonstrated salivary gland uptake of 0.13 ± 0.01%ID/g. In a second biodistribution study in non-tumor-bearing mice with high molar activity, [68Ga]Ga-JB1498 demonstrated salivary gland uptake of 0.39 ± 0.24% ID/g and kidney activity of 10.12 ± 1.73% ID/g at one hour post IV injection. This salivary gland uptake is significantly less than the published uptake of [68Ga]Ga-PSMA-11. Micro-PET visually confirmed the findings of the biodistribution studies. Dynamic micro-PET imaging demonstrated gradually decreasing [68Ga]Ga-JB1498 activity in salivary glands and kidneys, compared to gradually increasing [68Ga]Ga-PSMA-11 activity in these two organs during the first hour. CONCLUSION Biodistribution and micro-PET imaging of [68Ga]Ga-JB-1498 demonstrate significantly decreased salivary gland uptake and different pharmacokinetic behavior in kidneys and salivary glands in mice compared to [68Ga]Ga-PSMA-11. Our findings suggest that constructing a PSMA-targeting molecule with a highly negatively charged linker is a promising strategy to reduce salivary gland uptake of GCP-II/PSMA ligands in theranostic applications.
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Affiliation(s)
- Steve S Huang
- Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Department of Radiology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA.
| | | | | | - Warren D Heston
- Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Hekman L, Napierkowski E, Hartman NC, Ellis JL, Wagner RH, Bova D, Picken MM, Flanigan RC. Incidental Discovery of Hepatocellular Carcinoma on 18F-PSMA PET CT Performed for Prostate Cancer Reassessment. Case Rep Surg 2023; 2023:1458175. [PMID: 38125746 PMCID: PMC10733019 DOI: 10.1155/2023/1458175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Prostate-specific membrane antigen positron emission tomography (PSMA PET) has been approved by the Food and Drug Administration (FDA) to identify prostate cancer in the setting of biochemical recurrence but can also identify other malignancies. 18F-PSMA PET has not been studied as a potential tool for hepatocellular carcinoma (HCC). We describe the case of a 76-year-old male with a rising prostate-specific antigen (PSA) after definitive prostate cancer treatment and no prior liver pathology who was incidentally found to have HCC on 18F-PSMA PET.
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Affiliation(s)
- Lauren Hekman
- Loyola University Medical Center, Department of Urology, USA
| | | | | | | | - Robert H. Wagner
- Loyola University Medical Center, Department of Nuclear Medicine, USA
| | - Davide Bova
- Loyola University Medical Center, Department of Radiology, USA
| | - Maria M. Picken
- Loyola University Medical Center, Department of Pathology, USA
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Sathekge M, Bruchertseifer F, Vorster M, Lawal IO, Mokoala K, Reed J, Maseremule L, Ndlovu H, Hlongwa K, Maes A, Morgenstern A, Van de Wiele C. 225Ac-PSMA-617 radioligand therapy of de novo metastatic hormone-sensitive prostate carcinoma (mHSPC): preliminary clinical findings. Eur J Nucl Med Mol Imaging 2023; 50:2210-2218. [PMID: 36864360 PMCID: PMC10199874 DOI: 10.1007/s00259-023-06165-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/19/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE 225Ac-PSMA-617 has demonstrated good anti-tumor effect as a treatment option for metastatic castration-resistant prostate cancer (mCRPC) patients. No study has previously assessed treatment outcome and survival following 225Ac-PSMA-617 treatment of de novo metastatic hormone-sensitive prostate carcinoma (mHSPC) patients. Based on the potential side effects that are known and explained to the patients by the oncologist, some of the patients refused the standard treatment and are seeking alternative therapies. Thus, we report our preliminary findings in a retrospective series of 21 mHSPC patients that refused standard treatment options and were treated with 225Ac-PSMA-617. METHODS We retrospectively reviewed patients with histologically confirmed de novo treatment-naïve bone ± visceral mHSPC that were treated with 225Ac-PSMA-617 radioligand therapy (RLT). Inclusion criteria included an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2, treatment-naive bone ± visceral mHSPC, and patients refusal for ADT ± docetaxel, abiraterone acetate, or enzalutamide. We evaluated the response to treatment using prostate-specific antigen (PSA) response and the progression-free survival (PFS) and overall survival (OS) as well as the toxicities. RESULTS Twenty-one mHSPC patients were included in this preliminary work. Following treatment, twenty patients (95%) had any decline in PSA and eighteen patients (86%) presented with a PSA decline of ≥ 50% including 4 patients in whom PSA became undetectable. A lower percentage decrease in PSA following treatment was associated with increased mortality and shorter progression-free survival. Overall, administration of 225Ac-PSMA-617 was well tolerated. The commonest toxicity seen was grade I/II dry mouth observed in 94% of patients. CONCLUSIONS Given these favorable results, randomized prospective multicenter trials assessing the clinical value of 225Ac-PSMA-617 as a therapeutic agent for mHSPC administered either as monotherapy or administered concomitant with ADT are of interest.
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Affiliation(s)
- Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa.
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, South Africa.
| | | | - Mariza Vorster
- Department of Nuclear Medicine, University of Kwa-Zulu Natal & Inkosi Albert Luthuli Central Academic Hospital, Durban, South Africa
| | - Ismaheel O Lawal
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, South Africa
| | - Kgomotso Mokoala
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, South Africa
| | - Janet Reed
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, South Africa
| | - Letjie Maseremule
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, South Africa
| | - Honest Ndlovu
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, South Africa
| | - Khanyi Hlongwa
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, South Africa
| | - Alex Maes
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- Katholieke University Leuven, Kortrijk, Belgium
| | - Alfred Morgenstern
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- European Commission, Joint Research Centre, Karlsruhe, Germany
| | - Christophe Van de Wiele
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, 0001, South Africa
- Ghent University, Ghent, Belgium
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Benfante V, Stefano A, Ali M, Laudicella R, Arancio W, Cucchiara A, Caruso F, Cammarata FP, Coronnello C, Russo G, Miele M, Vieni A, Tuttolomondo A, Yezzi A, Comelli A. An Overview of In Vitro Assays of 64Cu-, 68Ga-, 125I-, and 99mTc-Labelled Radiopharmaceuticals Using Radiometric Counters in the Era of Radiotheranostics. Diagnostics (Basel) 2023; 13:diagnostics13071210. [PMID: 37046428 PMCID: PMC10093267 DOI: 10.3390/diagnostics13071210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
Radionuclides are unstable isotopes that mainly emit alpha (α), beta (β) or gamma (γ) radiation through radiation decay. Therefore, they are used in the biomedical field to label biomolecules or drugs for diagnostic imaging applications, such as positron emission tomography (PET) and/or single-photon emission computed tomography (SPECT). A growing field of research is the development of new radiopharmaceuticals for use in cancer treatments. Preclinical studies are the gold standard for translational research. Specifically, in vitro radiopharmaceutical studies are based on the use of radiopharmaceuticals directly on cells. To date, radiometric β- and γ-counters are the only tools able to assess a preclinical in vitro assay with the aim of estimating uptake, retention, and release parameters, including time- and dose-dependent cytotoxicity and kinetic parameters. This review has been designed for researchers, such as biologists and biotechnologists, who would like to approach the radiobiology field and conduct in vitro assays for cellular radioactivity evaluations using radiometric counters. To demonstrate the importance of in vitro radiopharmaceutical assays using radiometric counters with a view to radiogenomics, many studies based on 64Cu-, 68Ga-, 125I-, and 99mTc-labeled radiopharmaceuticals have been revised and summarized in this manuscript.
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Affiliation(s)
- Viviana Benfante
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90127 Palermo, Italy
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy
| | - Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy
| | - Muhammad Ali
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90127 Palermo, Italy
| | | | - Walter Arancio
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy
| | - Antonino Cucchiara
- Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy
| | - Fabio Caruso
- Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy
| | - Francesco Paolo Cammarata
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy
| | - Claudia Coronnello
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy
- National Biodiversity Future Center (NBFC), 90133 Palermo, Italy
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy
- National Biodiversity Future Center (NBFC), 90133 Palermo, Italy
| | - Monica Miele
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy
| | - Alessandra Vieni
- Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy
| | - Antonino Tuttolomondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90127 Palermo, Italy
| | - Anthony Yezzi
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Albert Comelli
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy
- National Biodiversity Future Center (NBFC), 90133 Palermo, Italy
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12
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Shin D, Ha S, O JH, Rhew SA, Yoon CE, Kwon HJ, Moon HW, Park YH, Park SY, Park C, Chi DY, Yoo IR, Lee JY. A Single Dose of Novel PSMA-Targeting Radiopharmaceutical Agent [ 177Lu]Ludotadipep for Patients with Metastatic Castration-Resistant Prostate Cancer: Phase I Clinical Trial. Cancers (Basel) 2022; 14:cancers14246225. [PMID: 36551710 PMCID: PMC9777064 DOI: 10.3390/cancers14246225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
[177Lu]Ludotadipep, which enables targeted delivery of beta-particle radiation to prostate tumor cells, had been suggested as a promising therapeutic option for mCRPC. From November 2020 to March 2022, a total of 30 patients were enrolled for single dose of [177Lu]Ludotadipep RPT, 6 subjects in each of the 5 different activity groups of 1.9 GBq, 2.8 GBq, 3.7 GBq, 4.6 GBq, and 5.6 GBq. [177Lu]Ludotadipep was administered via venous injection, and patients were hospitalized for three days to monitor for any adverse effects. Serum PSA levels were followed up at weeks 1, 2, 3, 4, 6, 8, and 12, and PSMA PET/CT with [18F]Florastamin was obtained at baseline and again at weeks 4 and 8. The subjects required positive PSMA PET/CT prior to [177Lu]Ludotadipep administration. Among the 29 subjects who received [177Lu]Ludotadipep, 36 treatment emergent adverse events (TEAEs) occurred in 17 subjects (58.6%) and 4 adverse drug reactions (ADRs) in 3 subjects (10.3%). Of the total 24 subjects who had full 12-week follow-up data, 16 (66.7%) showed decrease in PSA of any magnitude, and 9 (37.5%) showed a decrease in PSA by 50% or greater. A total of 5 of the 24 patients (20.8%) showed disease progression (PSA increase of 25% or higher from the baseline) at the 12th week following single dose of [177Lu]Ludotadipep. These data thus far suggest that [177Lu]Ludotadipep could be a promising RPT agent with low toxicity in mCRPC patients who have not been responsive to conventional treatments.
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Affiliation(s)
- Dongho Shin
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Seunggyun Ha
- Department of Nuclear Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Joo Hyun O
- Department of Nuclear Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Seung ah Rhew
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Chang Eil Yoon
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyeok Jae Kwon
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yong Hyun Park
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sonya Youngju Park
- Department of Nuclear Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Chansoo Park
- Research Institute of Labeling, FutureChem Co., Ltd., Seoul 04793, Republic of Korea
| | - Dae Yoon Chi
- Research Institute of Labeling, FutureChem Co., Ltd., Seoul 04793, Republic of Korea
| | - Ie Ryung Yoo
- Department of Nuclear Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: (I.R.Y.); (J.Y.L.); Tel./Fax: +82-2-2258-1401 (I.R.Y.); +82-2-2258-1401 (J.Y.L.)
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: (I.R.Y.); (J.Y.L.); Tel./Fax: +82-2-2258-1401 (I.R.Y.); +82-2-2258-1401 (J.Y.L.)
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13
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Langbein T, Kulkarni HR, Schuchardt C, Mueller D, Volk GF, Baum RP. Salivary Gland Toxicity of PSMA-Targeted Radioligand Therapy with 177Lu-PSMA and Combined 225Ac- and 177Lu-Labeled PSMA Ligands (TANDEM-PRLT) in Advanced Prostate Cancer: A Single-Center Systematic Investigation. Diagnostics (Basel) 2022; 12:diagnostics12081926. [PMID: 36010276 PMCID: PMC9406477 DOI: 10.3390/diagnostics12081926] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: PSMA-targeted radioligand therapy (PRLT) is a promising treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). However, a high uptake of the radiopharmaceutical in the salivary glands (SG) can lead to xerostomia and becomes dose-limiting for 225Ac-PSMA-617. This study investigated the sialotoxicity of 177Lu-PSMA-I&T/-617 monotherapy and co-administered 225Ac-PSMA-617 and 177Lu-PSMA-617 (Tandem-PPRLT). Methods: Three patient cohorts, that had undergone 177Lu-PSMA-I&T/-617 monotherapy or Tandem-PRLT, were retrospectively analyzed. In a short-term cohort (91 patients), a xerostomia assessment (CTCAE v.5.0), a standardized questionnaire (sXI), salivary gland scintigraphy (SGS), and SG SUVmax and the metabolic volume (MV) on 68Ga-PSMA-11-PET/CT were obtained before and after two cycles of 177Lu-PSMA-I&T/-617. In a long-term cohort, 40 patients were similarly examined. In a Tandem cohort, the same protocol was applied to 18 patients after one cycle of Tandem-PRLT. Results: Grade 1 xerostomia in the short-term follow-up was observed in 22 (24.2%) patients with a worsening of sXI from 7 to 8 at (p < 0.05). In the long-term cohort, xerostomia grades 1 to 2 occurred in 16 (40%) patients. SGS showed no significant changes, but there was a decline of the MV of all SGs. After Tandem-PRLT, 12/18 (66.7%) patients reported xerostomia grades 1 to 2, and the sXI significantly worsened from 9.5 to 14.0 (p = 0.005), with a significant reduction in the excretion fraction (EF) and MV of all SGs. Conclusion: 177Lu-PSMA-I&T/-617 causes only minor SG toxicity, while one cycle of Tandem-PRLT results in a significant SG impairment. This standardized protocol may help to objectify and quantify SG dysfunction.
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Affiliation(s)
- Thomas Langbein
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, 99438 Bad Berka, Germany
- Department of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, 81675 Munich, Germany
- Correspondence: ; Tel.: +49-8941402972; Fax: +49-8941404950
| | - Harshad R. Kulkarni
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, 99438 Bad Berka, Germany
- BAMF Health, Grand Rapids, MI 49503, USA
| | - Christiane Schuchardt
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, 99438 Bad Berka, Germany
| | - Dirk Mueller
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, 99438 Bad Berka, Germany
- Department of Nuclear Medicine, University Hospital Ulm, 89081 Ulm, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Facial-Nerve-Center Jena, Center for Rare Diseases Jena, Jena University Hospital, 07743 Jena, Germany
| | - Richard P. Baum
- Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka, 99438 Bad Berka, Germany
- CURANOSTICUM Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, 65191 Wiesbaden, Germany
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14
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Sublingual Atropine Administration as a Tool to Decrease Salivary Glands' PSMA-Ligand Uptake: A Preclinical Proof of Concept Study Using [ 68Ga]Ga-PSMA-11. Pharmaceutics 2022; 14:pharmaceutics14061276. [PMID: 35745848 PMCID: PMC9230580 DOI: 10.3390/pharmaceutics14061276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
Prostate Specific Membrane Antigen (PSMA)-directed radionuclide therapy has gained an important role in the management of advanced castration-resistant prostate cancer. Although extremely promising, the prolongation in survival and amelioration of disease-related symptoms must be balanced against the direct toxicities of the treatment. Xerostomia is amongst the most common and debilitating of these, particularly when using an alpha emitter. It is therefore of main importance to develop new preventive strategies. This preclinical study has evaluated the effect of α-adrenergic and anticholinergic drugs on [99mTc]TcO4− Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) and [68Ga]Ga-PSMA-11 Positron Emission Tomography (PET/CT). Methods: The effects of phenylephrine, scopolamine, atropine, and ipratropium on salivary glands uptake were evaluated in non-tumor-bearing mice by [99mTc]TcO4− microSPECT/CT. The most efficient identified strategy was evaluated in non-tumor-bearing and xenografted mice by [68Ga]Ga-PSMA-11 PET/CT. Results: Scopolamine and atropine showed a significant decrease in the parotid glands’ uptake on SPECT/CT whereas phenylephrine and ipratropium failed. Atropine premedication (sublingual route), which was the most effective strategy, also showed a drastic decrease of [68Ga]Ga-PSMA-11 salivary glands’ uptake in both non-tumor-bearing mice (−51.6% for the parotids, p < 0.0001) and human prostate adenocarcinoma xenografted mice (−26.8% for the parotids, p < 0.0001). Conclusion: Premedication with a local administration of atropine could represent a simple, safe, and efficient approach for reducing salivary glands’ uptake.
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15
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Song H, Guja KE, Iagaru A. PSMA theragnostics for metastatic castration resistant prostate cancer. Transl Oncol 2022; 22:101438. [PMID: 35659674 PMCID: PMC9163091 DOI: 10.1016/j.tranon.2022.101438] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 01/23/2023] Open
Abstract
PSMA targeted theragnostic agents have shown tremendous potential in detecting and treating metastatic prostate cancer. The PSMA small molecular inhibitor-based imaging agents achieve extraordinary tumor to background ratios and the PSMA small molecule therapeutic agents have shown impressive therapeutic index in mCRPC. The development and optimization of PSMA theragnostic agents provides invaluable information that may help guide development of future theragnostics for other solid tumors.
There has been tremendous growth in the development of theragnostics for personalized cancer diagnosis and treatment over the past two decades. In prostate cancer, the new generation of prostate specific membrane antigen (PSMA) small molecular inhibitor-based imaging agents achieve extraordinary tumor to background ratios and allow their therapeutic counterparts to deliver effective tumor doses while minimizing normal tissue toxicity. The PSMA targeted small molecule positron emission tomography (PET) agents 18F-DCFPyL (2-(3-{1-carboxy-5-((6-(18)F-fluoro-pyridine-3-carbonyl)-amino)-pentyl}-ureido)-pentanedioic acid) and Gallium-68 (68Ga)-PSMA-11 have been approved by the United States Food and Drug Administration (FDA) for newly diagnosed high risk prostate cancer patients and for patients with biochemical recurrence. More recently, the Phase III VISION trial showed that Lutetium-177 (177Lu)-PSMA-617 treatment increases progression-free survival and overall survival in patients with heavily pre-treated advanced PSMA-positive metastatic castration-resistant prostate cancer (mCRPC). Here, we review the PSMA targeted theragnostic pairs under clinical investigation for detection and treatment of metastatic prostate cancer.
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Affiliation(s)
- Hong Song
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University and Hospital, 300 Pasteur Dr H2200, Stanford 94305, United States
| | - Kip E Guja
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University and Hospital, 300 Pasteur Dr H2200, Stanford 94305, United States
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University and Hospital, 300 Pasteur Dr H2200, Stanford 94305, United States.
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16
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Assessment of salivary gland function after 177Lu-PSMA radioligand therapy: Current concepts in imaging and management. Transl Oncol 2022; 21:101445. [PMID: 35523007 PMCID: PMC9079342 DOI: 10.1016/j.tranon.2022.101445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
The United States food and drug administration has recently granted approval to the targeted 177Lu-PSMA-617 therapy in prostate cancer patients. Salivary glands show high PSMA-ligand uptake and are prone to radiation damage secondary to accumulation of 177Lu-PSMA-617. Salivary gland scintigraphy is a noninvasive highly reproducible technique, useful for objective and quantitative assessment of salivary flow and function of parotid and submandibular glands and can help detect early changes post 177Lu-PSMA-617 therapy.
Prostate specific membrane antigen (PSMA) is a transmembrane protein that is highly expressed on prostate epithelial cells and is strongly upregulated in prostate cancer. Radioligand therapy using beta-emitting Lutetium-177 (177Lu)-labeled-PSMA-617, a radiolabeled small molecule, has gained attention as a novel targeted therapy for metastatic prostate cancer, given its high affinity and long tumor retention, and rapid blood pool clearance. In March 2022, the United States Food and Drug administration has granted approval to the targeted 177Lu-PSMA-617 therapy for treatment of patients with PSMA-positive metastatic castration resistant prostate cancer, who have been previously treated with an androgen-receptor pathway inhibitor and taxane-based chemotherapy. Studies have demonstrated the adverse effects of this treatment, mainly encountered due to radiation exposure to non-target tissues. Salivary glands show high PSMA-ligand uptake and receive increased radiation dose secondary to accumulation of 177Lu-PSMA-617. This predisposes the glands to radiation-mediated toxicity. The exact mechanism, scope and severity of radiation-mediated salivary gland toxicity are not well understood, however, the strategies for its prevention and treatment are under evaluation. This review will focus on the current knowledge about salivary gland impairment post 177Lu labeled PSMA-based radioligand therapies, diagnostic methodologies, and imaging with emphasis on salivary gland scintigraphy. The preventive strategies and known treatment options would also be briefly highlighted.
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17
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O'Neill E, Cornelissen B. Know thy tumour: Biomarkers to improve treatment of molecular radionuclide therapy. Nucl Med Biol 2022; 108-109:44-53. [PMID: 35276447 DOI: 10.1016/j.nucmedbio.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
Molecular radionuclide therapy (MRT) is an effective treatment for both localised and disseminated tumours. Biomarkers can be used to identify potential subtypes of tumours that are known to respond better to standard MRT protocols. These enrolment-based biomarkers can further be used to develop dose-response relationships using image-based dosimetry within these defined subtypes. However, the biological identity of the cancers treated with MRT are commonly not well-defined, particularly for neuroendocrine neoplasms. The biological heterogeneity of such cancers has hindered the establishment of dose-responses and minimum tumour dose thresholds. Biomarkers could also be used to determine normal tissue MRT dose limits and permit greater injected doses of MRT in patients. An alternative approach is to understand the repair capacity limits of tumours using radiobiology-based biomarkers within and outside patient cohorts currently treated with MRT. It is hoped that by knowing more about tumours and how they respond to MRT, biomarkers can provide needed dimensionality to image-based biodosimetry to improve MRT with optimized protocols and personalised therapies.
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Affiliation(s)
- Edward O'Neill
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK.
| | - Bart Cornelissen
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands.
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18
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Boshomane TM, Lawal IO, Sathekge MM. Nuclear medicine therapy of prostate cancer: State of the art and future perspectives. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Jackson P, Hofman M, McIntosh L, Buteau JP, Ravi Kumar A. Radiation Dosimetry in 177Lu-PSMA-617 Therapy. Semin Nucl Med 2021; 52:243-254. [PMID: 34893320 DOI: 10.1053/j.semnuclmed.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radionuclide therapy using the small molecule PSMA bound to the beta-emitting radionuclide, Lutetium-177 (177Lu-PSMA) has demonstrated efficacy and survival benefit castrate resistant metastatic disease and represents a novel new line of therapy. Whilst dosimetry was critical for early development, it was not incorporated into either the TheraP or VISION randomized studies, highlighting the difficulty of adopting dosimetry in routine clinical practice. Accumulated clinical experience has also shown that the common (and generally low grade) toxicities such as nausea, xerostomia, and cytopenias are not readily predicted on the basis of dosimetry estimates. The majority of dosimetry and clinical literature deals with the radiopharmaceutical 177Lu-PSMA-617 which displays relatively consistent patterns of retention among normal tissues and high specificity for metastatic prostate cancer phenotypes. Population dosimetry incorporating estimates to the kidneys, salivary glands, and bone marrow have been widely reported the typical range of doses is becoming well established. There is growing interest on tumor dosimetry in 177Lu-PSMA-617 therapy as an overall modest side-effect profile from primary organ retention has been observed. A focus away from normal organ dosimetry to whole body tumor dosimetry may enable early prediction of treatment failure. Given the safety of 177Lu-PSMA there is also potential to escalate administered radioactivity to further improve outcomes. Importantly, the variability of uptake between individuals, both to tumor and normal organs, has also been highlighted which provides some rationale for the utility of personalized radiation analysis to optimize treatment based on potential toxicity thresholds or tumor control. Methods to perform dosimetry using serial post treatment imaging may incorporate planar, 3D SPECT, or hybrid datasets. Reliable measurements may be obtained through either method, however, continued developments in computational analysis are better suited to fully 3D imaging; particularly in conjunction with volumetric CT to assist with alignment and contouring. Dose analysis over sequential treatment cycles is vital to understand the radiobiology of these treatments which is unique compared to external beam therapy due to dose rate, fractionation scheme, and potential for intratumoral nonuniformity.
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Affiliation(s)
- Price Jackson
- Molecular Imaging and Therapeutic Nuclear Medicine, Dept of Cancer Imaging, The Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Dept of Oncology, The University of Melbourne, Melbourne, Australia.
| | - Michael Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Dept of Cancer Imaging, The Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Dept of Oncology, The University of Melbourne, Melbourne, Australia
| | - Lachlan McIntosh
- Molecular Imaging and Therapeutic Nuclear Medicine, Dept of Cancer Imaging, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - James Patrick Buteau
- Molecular Imaging and Therapeutic Nuclear Medicine, Dept of Cancer Imaging, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Aravind Ravi Kumar
- Molecular Imaging and Therapeutic Nuclear Medicine, Dept of Cancer Imaging, The Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Dept of Oncology, The University of Melbourne, Melbourne, Australia
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20
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Sathekge MM, Bruchertseifer F, Vorster M, Morgenstern A, Lawal IO. Global experience with PSMA-based alpha therapy in prostate cancer. Eur J Nucl Med Mol Imaging 2021; 49:30-46. [PMID: 34173838 PMCID: PMC8712297 DOI: 10.1007/s00259-021-05434-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE This review discusses the current state of prostate-specific membrane antigen (PSMA)-based alpha therapy of metastatic castration-resistant prostate cancer (mCRPC). With this in-depth discussion on the growing field of PSMA-based alpha therapy (PAT), we aimed to increase the interactions between basic scientists and physician-scientists in order to advance the field. METHODS To achieve this, we discuss the potential, current status, and opportunities for alpha therapy and strategies, attempted to date, and important questions that need to be addressed. The paper reviews important concepts, including whom to treat, how to treat, what to expect regarding treatment outcome, and toxicity, and areas requiring further investigations. RESULTS There is much excitement about the potential of this field. Much of the potential exists because these therapies utilize unique mechanisms of action, difficult to achieve with other conventional therapies. CONCLUSION A better understanding of the strengths and limitations of PAT may help in creating an effective therapy for mCRPC and design a rational combinatorial approach to treatment by targeting different tumor pathways.
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Affiliation(s)
- Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa.
- Nuclear Medicine Research Infrastructure, Pretoria, South Africa.
| | - Frank Bruchertseifer
- European Commission, Joint Research Centre, Directorate for Nuclear Safety and Security, Karlsruhe, Germany
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
- Nuclear Medicine Research Infrastructure, Pretoria, South Africa
| | - Alfred Morgenstern
- European Commission, Joint Research Centre, Directorate for Nuclear Safety and Security, Karlsruhe, Germany
| | - Ismaheel O Lawal
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
- Nuclear Medicine Research Infrastructure, Pretoria, South Africa
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21
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Currie GM, Trifunovic M, Liu J, Kim S, Gurney H. 18F-DCFPyL PET/CT in Metastatic Renal Cell Carcinoma. J Nucl Med Technol 2021; 50:282-285. [PMID: 34750233 DOI: 10.2967/jnmt.121.262799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Targeted molecular imaging with positron emission tomography (PET) utilize chemical ligands is a peptide that specifically targets a receptor of interest. Prostate specific membrane antigen (PSMA) is substantially upregulated in prostate cancer but is also expressed in the neovascular tissue of several malignancies, including renal cell carcinoma (RCC). Radiolabeled peptide targets for PSMA may be helpful in detecting metastatic RCC lesions. This teaching case provides an insight incidental detection of RCC metastatic disease with PSMA targeted PET and explores potential in deliberate evaluation of RCC with PSMA targeted tracers.
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Affiliation(s)
| | - Marko Trifunovic
- Macquarie Medical Imaging, Macquarie University Hospital, Australia
| | - Jui Liu
- Macquarie Medical Imaging, Macquarie University Hospital, Australia
| | - Sang Kim
- Medical Oncology, Macquarie University, Australia
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22
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Mohan V, Bruin NM, van de Kamer JB, Sonke JJ, Vogel WV. The effect of eating on the uptake of PSMA ligands in the salivary glands. EJNMMI Res 2021; 11:95. [PMID: 34568982 PMCID: PMC8473516 DOI: 10.1186/s13550-021-00838-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/11/2021] [Indexed: 11/25/2022] Open
Abstract
Rationale PSMA-directed therapy for metastatic prostate cancer is gaining adoption as a treatment option. However, accumulation of 177Lu/225Ac-PSMA in the salivary glands remains a problem, with risk of dose-limiting xerostomia and potentially severe effect on the quality of life. Gustatory stimulation is an approach that has commonly been used in radioactive iodine therapy to reduce accumulation in the salivary glands. However, based on theoretical differences in biodistribution, it was hypothesized that this could potentially lead to adverse increased toxicity for PSMA-ligand therapy. The primary objective of this work was to determine if gustatory stimulation by eating an assortment of sweet/fatty/acidic foods during the biodistribution phase of [18F]DCFPyl could result in a clinically relevant (> 30%) change in the uptake of the tracer in the salivary glands. Methods 10 patients who already received a whole-body [18F]DCFPyl PET/CT scan for evaluation of prostate cancer, underwent a repeat (intervention) PET/CT scan within a month of the first (control) scan. During the intervention scan, patients chose from an assortment of sweet/fatty/acidic foods, which they then chewed and swallowed for a period of time starting 1 min before tracer administration to 10 min thereafter. Data from both scans were analyzed by placing VOIs on the major salivary glands and segmenting them using relative thresholds. Results A slight increase in PSMA uptake in the parotid glands was observed on the intervention scan when compared to the baseline scan (+ 7.1% SULmean and + 9.2% SULmax, p < 0.05). No significant difference in PSMA uptake in the submandibular glands was seen. Conclusions Eating only slightly increases uptake of [18F]DCFPyl in the parotid glands. We nonetheless recommend refraining from gustatory stimulation during the administration and early biodistribution phase of radionuclide therapy with PSMA-ligands to reduce the risk of avoidable additional toxicity. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-021-00838-y.
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Affiliation(s)
- V Mohan
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N M Bruin
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J-J Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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23
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Wollenweber T, Zisser L, Kretschmer-Chott E, Weber M, Grubmüller B, Kramer G, Shariat SF, Mitterhauser M, Schmitl S, Vraka C, Haug AR, Hacker M, Hartenbach M, Rasul S. Renal and Salivary Gland Functions after Three Cycles of PSMA-617 Therapy Every Four Weeks in Patients with Metastatic Castration-Resistant Prostate Cancer. Curr Oncol 2021; 28:3692-3704. [PMID: 34590608 PMCID: PMC8482282 DOI: 10.3390/curroncol28050315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND [177Lu]Lu-PSMA-617 radioligand therapy (PSMA-RLT) could affect kidney and salivary gland functions in metastatic castration-resistant prostate cancer (mCRPC) patients. METHODS We retrospectively analyzed clinical, renal, and salivary scintigraphy data and salivary [68Ga]Ga-PSMA-11 ligand PET scan measures such as metabolic volume and SUVmax values of 27 mCRPC men (mean age 71 ± 7 years) before and 4 weeks after receiving three cycles of PSMA-RLT every 4 weeks. Twenty-two patients additionally obtained renal and salivary scintigraphy prior to each cycle. A one-way ANOVA, post-hoc Scheffé test and Cochran's Q test were applied to assess organ toxicity. RESULTS In total, 54 PSMA PET scans, 98 kidney, and 98 salivary scintigraphy results were evaluated. There were no significant differences for the ejection fraction, peak time, and residual activity after 5 min for both parotid and submandibular glands prior to each cycle and 4 weeks after the last cycle. Similarly, no significant differences in serum creatinine and renal scintigraphy parameters were observed prior to each cycle and 4 weeks after the last treatment. Despite there being no changes in the metabolic volume of both submandibular glands, SUVmax values dropped significantly (p < 0.05). CONCLUSION Results evidenced no alterations in renal function and only minimal impairment of salivary function of mCRPC patients who acquired an intense PSMA-RLT regimen every 4 weeks.
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Affiliation(s)
- Tim Wollenweber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
| | - Lucia Zisser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
| | - Elisabeth Kretschmer-Chott
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Bernhard Grubmüller
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria; (B.G.); (G.K.); (S.F.S.)
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria; (B.G.); (G.K.); (S.F.S.)
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria; (B.G.); (G.K.); (S.F.S.)
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Markus Mitterhauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
- Ludwig Boltzmann Institute Applied Diagnostics, 1090 Vienna, Austria
| | - Stefan Schmitl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
| | - Chrysoula Vraka
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
| | - Alexander R. Haug
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
- Christian Doppler Laboratory for Applied Metabolomics (CDL AM), Medical University of Vienna, 1090 Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
| | - Markus Hartenbach
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria; (T.W.); (L.Z.); (E.K.-C.); (M.M.); (S.S.); (C.V.); (A.R.H.); (M.H.); (M.H.)
- Correspondence: ; Tel.: +43-1-40400-58742; Fax: +43-1-40400-55520
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24
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Armstrong WR, Gafita A, Zhu S, Thin P, Nguyen K, Alano R, Lira S, Booker K, Gardner L, Grogan T, Elashoff D, Allen-Auerbach M, Dahlbom M, Czernin J, Calais J. The Impact of Monosodium Glutamate on 68Ga-PSMA-11 Biodistribution in Men with Prostate Cancer: A Prospective Randomized, Controlled Imaging Study. J Nucl Med 2021; 62:1244-1251. [PMID: 33509974 PMCID: PMC9364769 DOI: 10.2967/jnumed.120.257931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/29/2020] [Indexed: 01/19/2023] Open
Abstract
The prostate-specific membrane antigen (PSMA) has been targeted for PET imaging and radioligand therapy (RLT) in patients with prostate cancer. Xerostomia is a common side effect of RLT because of the high salivary gland uptake of PSMA radioligands. Here, we aimed to determine the impact of monosodium glutamate (MSG) administration on PSMA-radioligand biodistribution within healthy organs and tumor lesions by using 68Ga-PSMA-11 PET imaging. Methods: Sixteen men with prostate cancer were randomized (1:1) into oral ingestion and oral topical application ("swishing") arms. Each subject underwent 2 68Ga-PSMA-11 PET/CT scans within 14 d under baseline and MSG conditions. The salivary glands and whole-body tumor lesions were segmented using qPSMA software. We quantified tracer uptake via SUVmean and SUVmax and compared parameters within each patient. Results: For the oral ingestion arm, salivary gland SUVmean and SUVmax decreased on average from the control scan to the MSG scan by 45% ± 15% (P = 0.004) and 53% ± 11% (P < 0.001), respectively. Tumor lesion SUVmean and SUVmax also decreased by 38% (interquartile range, -67% to -33%) and -52% (interquartile range, -70% to -49%), respectively (P = 0.018). Swishing had no significant effect on 68Ga-PSMA-11 accumulation in normal organs or tumor lesions. Conclusion: Oral ingestion but not topical application of MSG reduced 68Ga-PSMA-11 uptake in salivary glands. Tumor uptake also declined; therefore, the clinical application of MSG is unlikely to be useful in the framework of RLT.
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Affiliation(s)
- Wesley R. Armstrong
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Andrei Gafita
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Shaojun Zhu
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Pan Thin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Kathleen Nguyen
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Rejah Alano
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Stephanie Lira
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Kiara Booker
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Linda Gardner
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - David Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Martin Allen-Auerbach
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;,Institute of Urologic Oncology, UCLA, Los Angeles, California;,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California; and
| | - Magnus Dahlbom
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;,Physics and Biology in Medicine Interdepartmental Graduate Program, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;,Institute of Urologic Oncology, UCLA, Los Angeles, California;,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California; and,Physics and Biology in Medicine Interdepartmental Graduate Program, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;,Institute of Urologic Oncology, UCLA, Los Angeles, California;,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California; and,Physics and Biology in Medicine Interdepartmental Graduate Program, David Geffen School of Medicine, UCLA, Los Angeles, California
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25
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Calais J, Czernin J, Thin P, Gartmann J, Nguyen K, Armstrong WR, Allen-Auerbach M, Quon A, Bahri S, Gupta P, Gardner L, Dahlbom M, He B, Esfandiari R, Ranganathan D, Hermann K, Eiber M, Fendler WP, Delpassand E. Safety of PSMA-targeted molecular radioligand therapy with 177Lu-PSMA-617: results from the prospective multicenter phase 2 trial RESIST-PC NCT03042312. J Nucl Med 2021; 62:1447-1456. [PMID: 34272322 DOI: 10.2967/jnumed.121.262543] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose of the study: To report the safety evaluation of 177Lu-PSMA-617 derived from the cohort of 64 patients exposed to 177Lu-PSMA-617 in the RESIST-PC trial NCT03042312 Methods: RESIST-PC was a prospective multicenter phase 2 trial. Patients with progressive mCRPC after ≥1 novel androgen-axis drug, either chemotherapy naïve or post-chemotherapy, with sufficient bone marrow reserve, normal kidney function, sufficient PSMA expression by PSMA PET and no visceral PSMA-negative lesions were eligible. Patients were randomized (1:1) into two activity groups (6.0 or 7.4 GBq per cycle) and received up to 4 cycles every 8 weeks. The primary safety endpoint was assessed by collecting and grading Adverse Events (AE) using the CTCAE. Patients were followed until disease progression, death, serious or intolerable AE, study termination by sponsor, patient withdrawal, lost to follow-up or 24 months after the first cycle. Results: The study was closed at enrollment of 71/200 planned patients because of sponsorship transfer. A total of 64 (90.1%) patients received at least one cycle of 177Lu-PSMA-617: 28 (36%) in Arm 1 (6.0 GBq) and 41 (64%) in Arm 2 (7.4GBq). There were 10 (43.5%), 19 (46.5%) and 29 (45.3%) patients who completed 4 cycles of 177Lu-PSMA-617 in the 6.0 GBq arm, 7.4 GBq arm, and overall, respectively. The most common treatment-emergent adverse events (TEAEs) of any grade in the 6.0 GBq arm, the 7.4 GBq arm and overall, were dry mouth (47.8%; 63.4%; 57.8%, respectively), fatigue (56.5%; 51.2%; 53.1%), nausea (52.2%; 43.9%; 46.9%), and diarrhea (13.0%; 31.7%; 25.0%). Frequencies of all other TEAEs were comparable among the 2 groups (within 10% difference). Serious possibly drug-related TEAEs were reported for 5 (7.8%) patients overall (none were considered as probably or definitely related to treatment): one subdural hematoma Grade 4, one anemia grade 3, one thrombocytopenia grade 4, one gastrointestinal hemorrhage grade 3, and one acute kidney injury grade 3. There were no clinically significant changes in vital signs in ECGs in the 2 treatment groups. No trend to creatinine increase, or increasing frequency of shifts from normal to abnormal over time for any hematologic parameter was noted. Conclusion: 177Lu-PSMA-617 was safe and well-tolerated at 6.0 and 7.4 GBq per cycle given at 8-week intervals with side effects easily managed with standard medical support. With established safety, further clinical trials applying individualized dosimetry and testing different 177Lu-PSMA-617 administration schemes (activity levels, time intervals) are needed to optimize tumor dose delivery and treatment efficacy.
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Affiliation(s)
- Jeremie Calais
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Johannes Czernin
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Pan Thin
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Jeannine Gartmann
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Kathleen Nguyen
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Wesley R Armstrong
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Martin Allen-Auerbach
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Andrew Quon
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Shadfar Bahri
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Pawan Gupta
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Linda Gardner
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Magnus Dahlbom
- Department of Molecular & Medical Pharmacology, University of California Los Angeles
| | - Beile He
- Advanced Accelerator Applications, a Novartis Company, Switzerland
| | | | | | - Ken Hermann
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Munich, Klinikum rechts der Isar, Germany
| | - Wolfgang P Fendler
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany
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26
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Groener D, Nguyen CT, Baumgarten J, Bockisch B, Davis K, Happel C, Mader N, Nguyen Ngoc C, Wichert J, Banek S, Mandel P, Chun FKH, Tselis N, Grünwald F, Sabet A. Hematologic safety of 177Lu-PSMA-617 radioligand therapy in patients with metastatic castration-resistant prostate cancer. EJNMMI Res 2021; 11:61. [PMID: 34216290 PMCID: PMC8254689 DOI: 10.1186/s13550-021-00805-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Myelosuppression is a potential dose-limiting factor in radioligand therapy (RLT). This study aims to investigate occurrence, severity and reversibility of hematotoxic adverse events in patients undergoing RLT with 177Lu-PSMA-617 for metastatic castration-resistant prostate cancer (mCRPC). The contribution of pretreatment risk factors and cumulative treatment activity is taken into account specifically. METHODS RLT was performed in 140 patients receiving a total of 497 cycles. A mean activity of 6.9 [Formula: see text] 1.3 GBq 177Lu-PSMA-617 per cycle was administered, and mean cumulative activity was 24.6 [Formula: see text] 15.9 GBq. Hematological parameters were measured at baseline, prior to each treatment course, 2 to 4 weeks thereafter and throughout follow-up. Toxicity was graded based on Common Terminology Criteria for Adverse Events v5.0. RESULTS Significant (grade ≥ 3) hematologic adverse events occurred in 13 (9.3%) patients, with anemia in 10 (7.1%), leukopenia in 5 (3.6%) and thrombocytopenia in 6 (4.3%). Hematotoxicity was reversible to grade ≤ 2 through a median follow-up of 8 (IQR 9) months in all but two patients who died from disease progression within less than 3 months after RLT. Myelosuppression was significantly more frequent in patients with pre-existing grade 2 cytopenia (OR: 3.50, 95%CI 1.08-11.32, p = 0.04) or high bone tumor burden (disseminated or diffuse based on PROMISE miTNM, OR: 5.08, 95%CI 1.08-23.86, p = 0.04). Previous taxane-based chemotherapy was associated with an increased incidence of significant hematotoxicity (OR: 4.62, 95%CI 1.23-17.28, p = 0.02), while treatment with 223Ra-dichloride, cumulative RLT treatment activity and activity per cycle were not significantly correlated (p = 0.93, 0.33, 0.29). CONCLUSION Hematologic adverse events after RLT have an acceptable overall incidence and are frequently reversible. High bone tumor burden, previous taxane-based chemotherapy and pretreatment grade 2 cytopenia may be considered as risk factors for developing clinically relevant myelosuppression, whereas cumulative RLT activity and previous 223Ra-dichloride treatment show no significant contribution to incidence rates.
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Affiliation(s)
- Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Cam Tu Nguyen
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Justus Baumgarten
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Benjamin Bockisch
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Karen Davis
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Christina Nguyen Ngoc
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Jennifer Wichert
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Severine Banek
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Nikolaos Tselis
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
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27
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Mohan V, Vogel WV, Valk GD, de Boer JP, Lam MGEH, de Keizer B. PSMA PET/CT Identifies Intrapatient Variation in Salivary Gland Toxicity From Iodine-131 Therapy. Mol Imaging 2021; 19:1536012120934992. [PMID: 32619138 PMCID: PMC7493237 DOI: 10.1177/1536012120934992] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Xerostomia is a well-known complication after iodine-131 (131I) therapy for thyroid carcinoma. It is currently insufficiently understood how the dose and biodistribution of 131I relates to salivary gland toxicity, and whether this is consistent for all salivary glands within a single patient. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) was recently introduced as a new tool to evaluate the relative loss of vital acinar cells in individual salivary glands. We aimed to assess gland-specific salivary gland toxicity after 131I-therapy using PSMA PET/CT. Methods: Five patients with differentiated thyroid cancer underwent [68Ga]Ga-PSMA-11 PET/CT to evaluate their eligibility for peptide radioligand therapy with [177Lu]Lu-PSMA-617. Uptake patterns in salivary glands were evaluated visually and quantitatively as an indicator of vital acinar cell loss after prior 131I-therapy. Results: Four of 5 patients demonstrated significant lowered uptake in at least one salivary gland, after receiving at least 2 131I-treatments. Asymmetric loss of vital acinar cells occurred by gland type (parotid/submandibular) and location (right/left). The other salivary glands in these patients and all salivary glands in the fifth patient showed normal uptake, demonstrating high intrapatient and interpatient variability. Conclusions: 131I-therapy can induce salivary gland toxicity with high inter- but also high intrapatient variation among separate gland locations, which can be assessed with PSMA PET/CT. This new technique offers potential to guide further development and evaluation of protective measures in patients receiving 131I-therapy.
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Affiliation(s)
- Vineet Mohan
- Department of Nuclear Medicine, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Radiation Oncology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Radiation Oncology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan P de Boer
- Department of Medical Oncology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marnix G E H Lam
- Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart de Keizer
- Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Junqueira MZ, Rocha NH, Sapienza MT. 68Ga-PSMA PET/CT: effect of external cooling on salivary gland uptake. Radiol Bras 2021; 54:171-176. [PMID: 34108764 PMCID: PMC8177682 DOI: 10.1590/0100-3984.2020.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective To evaluate the effect that external cooling of the salivary glands (ECSG) has on the uptake of gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA), as an indirect assessment of the capacity of ECSG to reduce the local dose in lutetium-177-PSMA-617 radioligand therapy. Materials and Methods Ten patients with prostate cancer were submitted to 68Ga-PSMA positron emission tomography/computed tomography with unilateral ECSG. The ECSG was started at 30 min before the injection of the radiotracer and maintained until the end of image acquisition (1 h after injection). Each salivary gland was assessed by determining the maximum, mean, and peak standardized uptake values (SUVmax, SUVmean, and SUVpeak, respectively). The volume of each gland was determined in a volume of interest delineated by a threshold SUVmax of 10%. Paired Student's t-tests were used in order to compare the results. Results In terms of the SUV parameters, there were no statistically significant differences between the cooled and contralateral salivary glands. However, the mean volume was 27% lower in the cooled parotid glands than in the contralateral parotid glands (p = 0.004). Conclusion The use of ECSG does not appear to reduce 68Ga-PSMA uptake by the salivary glands. In addition, there is yet no evidence that ECSG is effective in preventing salivary gland toxicity.
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Affiliation(s)
| | - Nelisa Helena Rocha
- Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
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Heynickx N, Herrmann K, Vermeulen K, Baatout S, Aerts A. The salivary glands as a dose limiting organ of PSMA- targeted radionuclide therapy: A review of the lessons learnt so far. Nucl Med Biol 2021; 98-99:30-39. [PMID: 34020337 DOI: 10.1016/j.nucmedbio.2021.04.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Abstract
At present, prostate cancer remains the second most occurring cancer in men, in Europe. Treatment efficacy for therapy of advanced metastatic disease, and metastatic castration-resistant prostate cancer in particular is limited. Prostate-specific membrane antigen (PSMA) is a promising therapeutic target in prostate cancer, seeing the high amount of overexpression on prostate cancer cells. Clinical investigation of PSMA-targeted radionuclide therapy has shown good clinical efficacy. However, adverse effects are observed of which salivary gland hypofunction and xerostomia are among the most prominent. Salivary gland toxicity is currently the dose-limiting side effect for PSMA-targeted radionuclide therapy, and more specifically for PSMA-targeted alpha therapy. To date, mechanisms underlying the salivary gland uptake of PSMA-targeting compounds and the subsequent damage to the salivary glands remain largely unknown. Furthermore, preventive strategies for salivary gland uptake or strategies for treatment of salivary gland toxicity are needed. This review focuses on the current knowledge on uptake mechanisms of PSMA-targeting compounds in the salivary glands and the research performed to investigate different strategies to prevent or treat salivary gland toxicity.
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Affiliation(s)
- Nathalie Heynickx
- Institute for Environment, Health and Safety, Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium; Department of Molecular Biotechnology, Ghent University, Ghent, Belgium
| | - Ken Herrmann
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Koen Vermeulen
- Institute for Environment, Health and Safety, Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Sarah Baatout
- Institute for Environment, Health and Safety, Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium; Department of Molecular Biotechnology, Ghent University, Ghent, Belgium.
| | - An Aerts
- Institute for Environment, Health and Safety, Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
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Cytawa W, Hartrampf P, Lass P, Kircher M, Polat B, Buck AK, Lapa C. PSMA Theranostics: A "Must Have" in Every Prostate Cancer Center. Illustration of Two Clinical Cases and Review of the Literature. Clin Genitourin Cancer 2021; 19:e235-e247. [PMID: 33906800 DOI: 10.1016/j.clgc.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/14/2021] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Abstract
This manuscript describes the history of 2 patients with prostate cancer (PCa) and the role of prostate-specific membrane antigen (PSMA) theranostics in their clinical management. In the first patient, PSMA-directed positron emission tomography (PET)/computed tomography (CT) imaging was used for primary staging of high-risk PCa before initial therapy. Then after biochemical relapse it was used to plan the scope of further treatment, in which it allowed among others to perform precise target volume delineation for salvage radiotherapy for pathologic lymph nodes. In the second patient with metastatic castration-resistant prostate cancer (mCRPC), PSMA-guided imaging played a key role in the qualification for PSMA-directed radioligand therapy (RLT) with lutetium-177. We also present a review of the current literature concerning PSMA theranostics in the 2 clinical settings, ie, primary staging of PCa and PSMA RLT of mCRPC. In the first part of the review, we report on the diagnostic efficacy of various PSMA imaging radiotracers labeled with gallium-68, fluorine-18, and technetium-99m. In the second part, we describe the limitations and future perspectives of PSMA therapeutic radiopharmaceuticals, including various beta(-) and alpha emitters.
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Affiliation(s)
- Wojciech Cytawa
- Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland; Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
| | - Philipp Hartrampf
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Piotr Lass
- Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Malte Kircher
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Constantin Lapa
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
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Mohan V, Bruin NM, Tesselaar MET, de Boer JP, Vegt E, Hendrikx JJMA, Al-Mamgani A, van de Kamer JB, Sonke JJ, Vogel WV. Muscarinic inhibition of salivary glands with glycopyrronium bromide does not reduce the uptake of PSMA-ligands or radioiodine. EJNMMI Res 2021; 11:25. [PMID: 33710423 PMCID: PMC7953192 DOI: 10.1186/s13550-021-00770-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/03/2021] [Indexed: 02/08/2023] Open
Abstract
RATIONALE Salivary glands are highly perfused and express the prostate-specific membrane antigen (PSMA) receptor as well as the sodium-iodide symporter. As a consequence, treatment with 177Lu/225Ac-PSMA for prostate cancer or 131I for thyroid cancer leads to a high radiation dose in the salivary glands, and patients can be confronted with persistent xerostomia and reduced quality of life. Salivation can be inhibited using an antimuscarinic pharmaceutical, such as glycopyrronium bromide (GPB), which may also reduce perfusion. The primary objective of this work was to determine if inhibition with GPB could provide a considerable (> 30%) reduction in the accumulation of administered 123I or 68Ga-PSMA-11 in salivary glands. METHODS Ten patients who already received a whole-body 68Ga-PSMA-11 PET/CT scan for (re)staging of prostate cancer underwent a repeat PET/CT scan with tracer administration at 90 min after intravenous injection of 0.2 mg GPB. Four patients in follow-up after thyroid cancer, who had been treated with one round of ablative 131I therapy with curative intent and had no signs of recurrence, received 123I planar scintigraphy at 4 h after tracer administration without GPB and a repeated scan at least one week later, with tracer administration at 30 min after intramuscular injection of 0.4 mg GPB. Tracer uptake in the salivary glands was quantified on PET and scintigraphy, respectively, and values with and without GPB were compared. RESULTS No significant difference in PSMA uptake in the salivary glands was seen without or with GPB (Mean SULmean parotid glands control 5.57, intervention 5.72, p = 0.50. Mean SULmean submandibular glands control 6.25, intervention 5.89, p = 0.12). Three out of 4 patients showed increased 123I uptake in the salivary glands after GPB (Mean counts per pixel control 8.60, intervention 11.46). CONCLUSION Muscarinic inhibition of salivation with GPB did not significantly reduce the uptake of PSMA-ligands or radioiodine in salivary glands, and can be dismissed as a potential strategy to reduce toxicity from radionuclide therapies.
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Affiliation(s)
- V Mohan
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N M Bruin
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M E T Tesselaar
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J P de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E Vegt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J J M A Hendrikx
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.,Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - J B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - J-J Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - W V Vogel
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands. .,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Mohan V, Bruin NM, van de Kamer JB, Sonke JJ, Vogel WV. The increasing potential of nuclear medicine imaging for the evaluation and reduction of normal tissue toxicity from radiation treatments. Eur J Nucl Med Mol Imaging 2021; 48:3762-3775. [PMID: 33687522 PMCID: PMC8484246 DOI: 10.1007/s00259-021-05284-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
Radiation therapy is an effective treatment modality for a variety of cancers. Despite several advances in delivery techniques, its main drawback remains the deposition of dose in normal tissues which can result in toxicity. Common practices of evaluating toxicity, using questionnaires and grading systems, provide little underlying information beyond subjective scores, and this can limit further optimization of treatment strategies. Nuclear medicine imaging techniques can be utilised to directly measure regional baseline function and function loss from internal/external radiation therapy within normal tissues in an in vivo setting with high spatial resolution. This can be correlated with dose delivered by radiotherapy techniques to establish objective dose-effect relationships, and can also be used in the treatment planning step to spare normal tissues more efficiently. Toxicity in radionuclide therapy typically occurs due to undesired off-target uptake in normal tissues. Molecular imaging using diagnostic analogues of therapeutic radionuclides can be used to test various interventional protective strategies that can potentially reduce this normal tissue uptake without compromising tumour uptake. We provide an overview of the existing literature on these applications of nuclear medicine imaging in diverse normal tissue types utilising various tracers, and discuss its future potential.
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Affiliation(s)
- V Mohan
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N M Bruin
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B van de Kamer
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - J-J Sonke
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Felber VB, Valentin MA, Wester HJ. Design of PSMA ligands with modifications at the inhibitor part: an approach to reduce the salivary gland uptake of radiolabeled PSMA inhibitors? EJNMMI Radiopharm Chem 2021; 6:10. [PMID: 33638060 PMCID: PMC7910394 DOI: 10.1186/s41181-021-00124-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
AIM To investigate whether modifications of prostate-specific membrane antigen (PSMA)-targeted radiolabeled urea-based inhibitors could reduce salivary gland uptake and thus improve tumor-to-salivary gland ratios, several analogs of a high affinity PSMA ligand were synthesized and evaluated in in vitro and in vivo studies. METHODS Binding motifs were synthesized 'on-resin' or, when not practicable, in solution. Peptide chain elongations were performed according to optimized standard protocols via solid-phase peptide synthesis. In vitro experiments were performed using PSMA+ LNCaP cells. In vivo studies as well as μSPECT/CT scans were conducted with male LNCaP tumor xenograft-bearing CB17-SCID mice. RESULTS PSMA ligands with A) modifications within the central Zn2+-binding unit, B) proinhibitor motifs and C) substituents & bioisosteres of the P1'-γ-carboxylic acid were synthesized and evaluated. Modifications within the central Zn2+-binding unit of PSMA-10 (Glu-urea-Glu) provided three compounds. Thereof, only natLu-carbamate I (natLu-3) exhibited high affinity (IC50 = 7.1 ± 0.7 nM), but low tumor uptake (5.31 ± 0.94% ID/g, 1 h p.i. and 1.20 ± 0.55% ID/g, 24 h p.i.). All proinhibitor motif-based ligands (three in total) exhibited low binding affinities (> 1 μM), no notable internalization and very low tumor uptake (< 0.50% ID/g). In addition, four compounds with P1'-ɣ-carboxylate substituents were developed and evaluated. Thereof, only tetrazole derivative natLu-11 revealed high affinity (IC50 = 16.4 ± 3.8 nM), but also this inhibitor showed low tumor uptake (3.40 ± 0.63% ID/g, 1 h p.i. and 0.68 ± 0.16% ID/g, 24 h p.i.). Salivary gland uptake in mice remained at an equally low level for all compounds (between 0.02 ± 0.00% ID/g and 0.09 ± 0.03% ID/g), wherefore apparent tumor-to-submandibular gland and tumor-to-parotid gland ratios for the modified peptides were distinctly lower (factor 8-45) than for [177Lu]Lu-PSMA-10 at 24 h p.i. CONCLUSIONS The investigated compounds could not compete with the in vivo characteristics of the EuE-based PSMA inhibitor [177Lu]Lu-PSMA-10. Although two derivatives (3 and 11) were found to exhibit high affinities towards LNCaP cells, tumor uptake at 24 h p.i. was considerably low, while uptake in salivary glands remained unaffected. Optimization of the established animal model should be envisaged to enable a clear identification of PSMA-targeting radioligands with improved tumor-to-salivary gland ratios in future studies.
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Affiliation(s)
- Veronika Barbara Felber
- Technical University of Munich, Chair of Pharmaceutical Radiochemistry, Walther-Meißner-Str. 3, 85748, Garching, Germany.
| | - Manuel Amando Valentin
- Technical University of Munich, Chair of Pharmaceutical Radiochemistry, Walther-Meißner-Str. 3, 85748, Garching, Germany
| | - Hans-Jürgen Wester
- Technical University of Munich, Chair of Pharmaceutical Radiochemistry, Walther-Meißner-Str. 3, 85748, Garching, Germany
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van der Doelen MJ, Mehra N, van Oort IM, Looijen-Salamon MG, Janssen MJR, Custers JAE, Slootbeek PHJ, Kroeze LI, Bruchertseifer F, Morgenstern A, Haberkorn U, Kratochwil C, Nagarajah J, Gerritsen WR. Clinical outcomes and molecular profiling of advanced metastatic castration-resistant prostate cancer patients treated with 225Ac-PSMA-617 targeted alpha-radiation therapy. Urol Oncol 2020; 39:729.e7-729.e16. [PMID: 33353867 DOI: 10.1016/j.urolonc.2020.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/22/2020] [Accepted: 12/07/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Targeted alpha-radiation therapy (TAT) with 225Ac-labeled prostate-specific membrane antigen (PSMA) ligands is a promising novel treatment option for metastatic castration-resistant prostate cancer (mCRPC) patients. However, limited data are available on efficacy, quality of life (QoL), and pretherapeutic biomarkers. The aim of this study was to evaluate the efficacy of 225Ac-PSMA TAT and impact on QoL in advanced mCRPC, and to explore predictive biomarkers on pretherapeutic metastatic tissue biopsies. METHODS Observational cohort study including consecutive patients treated with 225Ac-PSMA TAT between February 2016 and July 2018. Primary endpoint was overall survival (OS). Furthermore, prostate-specific antigen (PSA) changes, radiological response, safety, QoL, and xerostomia were evaluated. Biopsies were analyzed with immunohistochemistry and next-generation sequencing. RESULTS Thirteen patients were included. Median OS was 8.5 months for the total cohort and 12.6 months for PSMA radioligand therapy-naïve patients. PSA declines of ≥90% and ≥50% were observed in 46% and 69% of patients, respectively. Six patients were radiologically evaluable; 50% showed partial response. All patients showed >90% total tumor volume reduction on PET imaging. Patients experienced clinically relevant decrease of pain and QoL improvement in physical and role functioning domains. Xerostomia persisted during follow-up. Patients with high baseline immunohistochemical PSMA expression or DNA damage repair alterations tended to have longer OS. CONCLUSIONS TAT with 225Ac-PSMA resulted in remarkable survival and biochemical responses in advanced mCRPC patients. Patients experienced clinically relevant QoL improvement, although xerostomia was found to be nontransient. Baseline immunohistochemical PSMA expression and DNA damage repair status are potential predictive biomarkers of response to 225Ac-PSMA TAT.
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Affiliation(s)
- Maarten J van der Doelen
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands; Radboud University Medical Center, Department of Urology, Nijmegen, The Netherlands.
| | - Niven Mehra
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
| | - Inge M van Oort
- Radboud University Medical Center, Department of Urology, Nijmegen, The Netherlands
| | | | - Marcel J R Janssen
- Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
| | - José A E Custers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, The Netherlands
| | - Peter H J Slootbeek
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
| | - Leonie I Kroeze
- Radboud University Medical Center, Department of Pathology, Nijmegen, The Netherlands
| | - Frank Bruchertseifer
- European Commission, Joint Research Centre, Nuclear Safety and Security, Karlsruhe, Germany
| | - Alfred Morgenstern
- European Commission, Joint Research Centre, Nuclear Safety and Security, Karlsruhe, Germany
| | - Uwe Haberkorn
- University Hospital Heidelberg, Department of Nuclear Medicine, Germany
| | | | - James Nagarajah
- Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands; Technical University Munich, Klinikum rechts der Isar, Department of Nuclear Medicine, Munich, Germany
| | - Winald R Gerritsen
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
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Bois F, Noirot C, Dietemann S, Mainta IC, Zilli T, Garibotto V, Walter MA. [ 68Ga]Ga-PSMA-11 in prostate cancer: a comprehensive review. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2020; 10:349-374. [PMID: 33329937 PMCID: PMC7724278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
Imaging of the prostate-specific membrane antigen (PSMA) has become an important tool for managing patients with recurrent prostate cancer, and one of the most frequently employed radiopharmaceuticals is [68Ga]Ga-PSMA-11. Herein, we summarize the preclinical development and the clinical applications of [68Ga]Ga-PSMA-11 and present side-by-side comparisons with other radiopharmaceuticals or imaging modalities, in order to assist imagers and clinicians in recommending, performing, and interpreting the results of [68Ga]Ga-PSMA-11 PET scans in patients with prostate cancer.
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Affiliation(s)
- Frédéric Bois
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
| | - Camille Noirot
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
| | - Sébastien Dietemann
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
| | - Ismini C Mainta
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
| | - Thomas Zilli
- Division of Radiation Oncology, Oncology Department, University Hospital of GenevaGeneva, Switzerland
- Faculty of Medicine, University of GenevaGeneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
- Faculty of Medicine, University of GenevaGeneva, Switzerland
| | - Martin A Walter
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
- Faculty of Medicine, University of GenevaGeneva, Switzerland
- Center for Biomedical Imaging (CIBM)Lausanne, Switzerland
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Belli ML, Sarnelli A, Mezzenga E, Cesarini F, Caroli P, Di Iorio V, Strigari L, Cremonesi M, Romeo A, Nicolini S, Matteucci F, Severi S, Paganelli G. Targeted Alpha Therapy in mCRPC (Metastatic Castration-Resistant Prostate Cancer) Patients: Predictive Dosimetry and Toxicity Modeling of 225Ac-PSMA (Prostate-Specific Membrane Antigen). Front Oncol 2020; 10:531660. [PMID: 33251129 PMCID: PMC7674768 DOI: 10.3389/fonc.2020.531660] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/20/2020] [Indexed: 01/17/2023] Open
Abstract
Radioligand therapy is a type of internal radiotherapy combining a short-range radioisotope labeled to a carrier with a high affinity for a specific receptor expressed on tumor cells. Targeted alpha therapy (TAT) combines a high-linear energy transfer (LET) emitter (225Ac) with a prostate-specific membrane antigen (PSMA) carrier, specifically binding tumor cells in patients with metastatic castration-resistant prostate cancer. Although the antitumor activity of 225Ac-PSMA is well-documented, this treatment is nowadays only used as salvage therapy because the high incidence of xerostomia limits the therapeutic window. Thus, methods to reduce salivary toxicity and models able to describe xerostomia incidence are needed. We recently studied the efficacy of salivary gland protectors administered in combination with 177Lu-PSMA therapy. Starting from these data, we performed a predictive dosimetric evaluation of 225Ac-PSMA to assess the impact of salivary gland protectors in TAT. 225Ac-PSMA predictive dosimetry was performed in 13 patients treated with 177Lu-PSMA. Sequential whole-body planar images were acquired 0.5–1, 16–24, 36–48, and 120 h post-injection. 177Lu time-activity curves were corrected for 225Ac physical decay and assumed in equilibrium for all daughters. The OLINDA/EXM spherical model was used for dose estimation of the parotid and submandibular glands. The dose for each daughter was calculated and summed for the total dose estimation. The biologically effective dose formalism was extended to high-LET emitters. For the total biologically effective dose formalism extended to high-LET emitters, including the contribution of all daughter isotopes, the brachytherapy formalism for a mixture of radionuclides was implemented. Equivalent doses in 2 Gy/fraction (EQD2) were then calculated and compared with the normal tissue complication probability model derived from external beam radiotherapy for grade ≥2 xerostomia induction. Median predictive doses were 0.86 BdRBE5/MBq for parotid glands and 1.05 BdRBE5/MBq for submandibular glands, with a 53% reduction compared with previously published data. The results show that the radiobiological model implemented is conservative, as it overestimates the complication rate with respect to the clinical data. Our data shows the possibility of reducing salivary gland uptake in TAT with the coadministration of organ protectors, but these results should be confirmed for TAT with 225Ac-PSMA by carrying out prospective trials with defined toxicity endpoints and dosimetry procedures.
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Affiliation(s)
- Maria Luisa Belli
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Anna Sarnelli
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Emilio Mezzenga
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesco Cesarini
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Paola Caroli
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Di Iorio
- Oncology Pharmacy, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lidia Strigari
- Medical Physics Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Marta Cremonesi
- Radiation Research Unit, European Institute of Oncology (IEO) IRCCS, Milano, Italy
| | - Antonino Romeo
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Silvia Nicolini
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Federica Matteucci
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Stefano Severi
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Paganelli
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Prostate-specific membrane antigen-targeted endoradiotherapy in metastatic prostate cancer. Curr Opin Urol 2020; 30:98-105. [PMID: 31644433 DOI: 10.1097/mou.0000000000000685] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In this review, we present an update on the safety and efficacy of prostate-specific membrane antigen (PSMA) radioligand therapy (PRLT) of metastatic castration-resistant prostate cancer (mCRPC). RECENT FINDINGS Treatment of mCRPC with approved treatment agents leads to a survival advantage. The disease often progresses despite these treatments. PRLT with Lutetium-177 and Actinium-225 labeled with PSMA (LuPSMA and AcPSMA) have recently been shown to be effective and well tolerated for mCRPC treatment. LuPSMA is currently applied in patients who have exhausted approved treatment options or in whom these approved treatments are contraindicated. In this category of heavily pretreated patients, prostate-specific antigen (PSA) response (≥50% decline) is achieved in about 46% of patients. Side-effects are tolerable with rare reports of grade III-IV treatment-induced toxicity. AcPSMA is currently applied on a smaller scale in patients who relapsed after LuPSMA or in whom LuPSMA is contraindicated. PSA response occurs in up to 88% of patients treated with AcPSMA. SUMMARY PRLT with LuPSMA and AcPSMA is a well-tolerated and effective treatment modality for mCRPC. Prospective randomized control trials are necessary to facilitate its application as an approved therapy option.
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Roy J, Warner BM, Basuli F, Zhang X, Wong K, Pranzatelli T, Ton AT, Chiorini JA, Choyke PL, Lin FI, Jagoda EM. Comparison of Prostate-Specific Membrane Antigen Expression Levels in Human Salivary Glands to Non-Human Primates and Rodents. Cancer Biother Radiopharm 2020; 35:284-291. [PMID: 32074455 DOI: 10.1089/cbr.2019.3079] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Prostate-specific membrane antigen (PSMA) has emerged as a promising target for developing radionuclide therapy (RNT) in prostate cancer; however, accumulation of PSMA-RNT in salivary glands can result in irreversible xerostomia. Methods to prevent PSMA-RNT-related xerostomia could be clinically useful; however, little is known about PSMA expression in salivary glands of preclinical animal models. Using [18F]DCFPyL autoradiography/biodistribution, PSMA expression levels were determined in salivary glands of various preclinical monkey and rodent species and compared with humans. Methods: Binding affinities (Kd) and PSMA levels (Bmax) were determined by in vitro [18F]DCFPyL autoradiography studies. In vivo rodent tissue uptakes (%ID/g) were determined from [18F]DCFPyL biodistributions. Results: [18F]DCFPyL exhibited low nanomolar Kd for submandibular gland (SMG) PSMA across all the species. PSMA levels in human SMG (Bmax = 60.91 nM) were approximately two-fold lower compared with baboon SMG but were two- to three-fold higher than SMG PSMA levels of cynomolgus and rhesus. Rodents had the lowest SMG PSMA levels, with the mouse being 10-fold higher than the rat. In vivo rodent biodistribution studies confirmed these results. Conclusions: SMG of monkeys exhibited comparable PSMA expression to human SMG whereas rodents were lower. However, the results suggest that mice are relatively a better small animal preclinical model than rats for PSMA salivary gland studies.
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Affiliation(s)
- Jyoti Roy
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Blake M Warner
- National Institute of Dental and Craniofacial Surgery, National Institutes of Health, Bethesda, Maryland, USA
| | - Falguni Basuli
- Imaging Probe Development Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Xiang Zhang
- Imaging Probe Development Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Karen Wong
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas Pranzatelli
- National Institute of Dental and Craniofacial Surgery, National Institutes of Health, Bethesda, Maryland, USA
| | - Anita T Ton
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - John A Chiorini
- National Institute of Dental and Craniofacial Surgery, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Frank I Lin
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elaine M Jagoda
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Potential Applications of 68Ga-PSMA-11 PET/CT in the Evaluation of Salivary Gland Uptake Function: Preliminary Observations and Comparison with 99mTcO 4 - Salivary Gland Scintigraphy. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:1097516. [PMID: 32410918 PMCID: PMC7201830 DOI: 10.1155/2020/1097516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
Purpose To preliminarily evaluate the feasibility and potential of using 68Ga-PSMA-11 PET/CT in evaluating the function of salivary glands and lacrimal glands in comparison with 99mTc-pertechnetate (99mTcO4−) salivary gland scintigraphy (SGS). Methods A retrospective study was performed in 15 patients with different degrees of xerostomia and suspected salivary gland dysfunction. Each patient underwent 68Ga-PSMA-11 PET/CT first and SGS the next day, and the findings of both scans were compared. Results The results of 68Ga-PSMA-11 PET/CT and SGS were consistent in 12/15 patients (80%) and were inconsistent in the remaining patients (20%). For 5 (33.3%) of 15 patients, 68Ga-PSMA-11 PET/CT provided more information than did SGS. Additionally, 68Ga-PSMA-11 PET/CT corrected the misdiagnosis by SGS for 1 patient. Conclusions 68Ga-PSMA-11 PET/CT is a potentially useful imaging tool for evaluating the function of salivary glands and lacrimal glands. 68Ga-PSMA-11 PET/CT can be a promising supplement to SGS, and its clinical value deserves further study.
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Kratochwil C, Fendler WP, Eiber M, Baum R, Bozkurt MF, Czernin J, Delgado Bolton RC, Ezziddin S, Forrer F, Hicks RJ, Hope TA, Kabasakal L, Konijnenberg M, Kopka K, Lassmann M, Mottaghy FM, Oyen W, Rahbar K, Schöder H, Virgolini I, Wester HJ, Bodei L, Fanti S, Haberkorn U, Herrmann K. EANM procedure guidelines for radionuclide therapy with 177Lu-labelled PSMA-ligands ( 177Lu-PSMA-RLT). Eur J Nucl Med Mol Imaging 2019; 46:2536-2544. [PMID: 31440799 DOI: 10.1007/s00259-019-04485-3] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/13/2019] [Indexed: 12/25/2022]
Abstract
Prostate-specific membrane antigen (PSMA) is expressed in most prostate cancers and can be identified by PSMA-ligand imaging, which has already become clinically accepted in several countries in- and outside Europe. PSMA-directed radioligand therapy (PSMA-RLT) with Lutetium-177 (177Lu-PSMA) is currently undergoing clinical validation. Retrospective observational data have documented favourable safety and striking clinical responses. Recent results from a prospective clinical trial (phase II) have been published confirming high response rates, low toxicity and reduction of pain in metastatic castration-resistant prostate cancer (mCRPC) patients who had progressed after conventional treatments. Such patients typically survive for periods less than 1.5 years. This has led some facilities to adopt compassionate or unproven use of this therapy, even in the absence of validation within a randomised-controlled trial. As a result, a consistent body of evidence exists to support efficacy and safety data of this treatment. The purpose of this guideline is to assist nuclear medicine specialists to deliver PSMA-RLT as an "unproven intervention in clinical practice", in accordance with the best currently available knowledge.
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Affiliation(s)
- Clemens Kratochwil
- German Cancer Research Center and Department of Nuclear Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Matthias Eiber
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, California, USA
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro University Hospital and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Samer Ezziddin
- Department of Nuclear Medicine, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Flavio Forrer
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Thomas A Hope
- Department of Abdominal Imaging and Nuclear Medicine, University of California San Francisco, California, USA
| | - Levant Kabasakal
- Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey
| | - Mark Konijnenberg
- Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Klaus Kopka
- German Cancer Research Center and Department of Nuclear Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, Universitätsklinikum Aachen, Aachen, Germany
| | - Wim Oyen
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kambiz Rahbar
- Department of Nuclear Medicine, Universitätsklinikum Münster, Münster, Germany
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Hans-Jürgen Wester
- Department of Chemistry, Technische Universität München, Garching, Germany
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Stefano Fanti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Uwe Haberkorn
- German Cancer Research Center and Department of Nuclear Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine
- Universitätsklinikum Essen, Essen, Germany.
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Ahmadzadehfar H, Rahbar K, Essler M, Biersack HJ. PSMA-Based Theranostics: A Step-by-Step Practical Approach to Diagnosis and Therapy for mCRPC Patients. Semin Nucl Med 2019; 50:98-109. [PMID: 31843065 DOI: 10.1053/j.semnuclmed.2019.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To date, several papers have been published about prostate-specific membrane antigen (PSMA)-based radioligand diagnostic and therapeutic approaches. This paper mainly provides information for nuclear medicine physicians that are clinically engaged in the diagnosis and treatment of prostate cancer patients. It aims to present the utility of PSMA imaging and therapy in a step-by-step practical approach; thus, it does not discuss radiochemistry and the molecular basics of PSMA.
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Affiliation(s)
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Munster, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
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First Experience With 177Lu-PSMA-617 Therapy for Advanced Prostate Cancer in the Netherlands. Clin Nucl Med 2019; 44:446-451. [DOI: 10.1097/rlu.0000000000002561] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Yilmaz B, Nisli S, Ergul N, Gursu RU, Acikgoz O, Çermik TF. Effect of External Cooling on 177Lu-PSMA Uptake by the Parotid Glands. J Nucl Med 2019; 60:1388-1393. [PMID: 30850503 DOI: 10.2967/jnumed.119.226449] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
Recent years have seen the start of treatment of metastatic castration-resistant prostate cancer with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (PRLT), especially 177Lu-PSMA-617. However, PRLT has side effects on the salivary glands that limit the safety of the treatment. The current study aimed to show the effect of external cooling with ice packs on 177Lu-PSMA-617 uptake by the parotid glands (PGs). Methods: The study included 19 patients (mean age, 72.9 y) with metastatic castration-resistant prostate cancer who had been referred for the first time for 177Lu-PSMA-617 treatment and underwent pretreatment 68Ga-PSMA-11 PET/CT. Before the initiation of PRLT, the SUVmax and SUVmean of the right and left PGs were measured on 68Ga-PSMA PET/CT. Frozen ice packs were then affixed over the right PG of each patient for approximately 5 h; 1 h after they were affixed, PRLT was administered. At 4 h after PRLT, head-and-neck SPECT/CT was performed, and at both 4 and 24 h after PRLT, whole-body planar scintigraphy was performed. Regions and volumes of interest were applied for the right and left PGs, and the counts and volumes were determined. Results: Before PRLT, 68Ga-PSMA-11 PET/CT showed no significant difference in SUVmax or SUVmean between the right and left PGs (P > 0.05). At 4 and 24 h after PRLT, planar imaging showed no significant difference in counts between the cooled and noncooled PGs (P > 0.05). Furthermore, at 4 h after PRLT, SPECT/CT showed no significant difference in counts or volumes between the cooled and noncooled PGs (P > 0.05). Conclusion: External cooling does not reduce uptake of 177Lu-PSMA-617 by the PGs.
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Affiliation(s)
- Burcak Yilmaz
- Nuclear Medicine Department, Istanbul Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serap Nisli
- Nuclear Medicine Department, Istanbul Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nurhan Ergul
- Nuclear Medicine Department, Istanbul Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Riza Umar Gursu
- Medical Oncology Department, Istanbul Research and Training Hospital, University of Health Sciences, Istanbul, Turkey; and
| | - Ozgur Acikgoz
- Medical Oncology Department, Kanuni Sultan Suleyman Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tevfik Fikret Çermik
- Nuclear Medicine Department, Istanbul Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
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Dosimetry of 177Lu-PSMA-617 after Mannitol Infusion and Glutamate Tablet Administration: Preliminary Results of EUDRACT/RSO 2016-002732-32 IRST Protocol. Molecules 2019; 24:molecules24030621. [PMID: 30754620 PMCID: PMC6385027 DOI: 10.3390/molecules24030621] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 11/17/2022] Open
Abstract
Radio-ligand therapy (RLT) with177Lu-PSMA-617 is a promising option for patients with metastatic castration-resistant prostate-cancer (mCRPC). A prospective phase-II study (EUDRACT/RSO,2016-002732-32) on mCRPC is ongoing at IRST (Meldola, Italy). A total of 9 patients (median age: 68 y, range: 53⁻85) were enrolled for dosimetry evaluation of parotid glands (PGs), kidneys, red marrow (RM) and whole body (WB). Folic polyglutamate tablets were orally administered as PGs protectors and 500 mL of a 10% mannitol solution was intravenously infused to reduce kidney uptake. The whole body planar image (WBI) and blood samples were acquired at different times post infusion (1 h, 16⁻24 h, 36⁻48 h and 120 h). Dose calculation was performed with MIRD formalism (OLINDA/EXM software). The median effective half-life was 33.0 h (range: 25.6⁻60.7) for PGs, 31.4 h (12.2⁻80.6) for kidneys, 8.2 h (2.5⁻14.7) for RM and 40.1 h (31.6⁻79.7) for WB. The median doses were 0.48 mGy/MBq (range: 0.33⁻2.63) for PGs, 0.70 mGy/MBq (0.26⁻1.07) for kidneys, 0.044 mGy/MBq (0.023⁻0.067) for RM and 0.04 mGy/MBq (0.02⁻0.11) for WB. A comparison with previously published dosimetric data was performed and a significant difference was found for PGs while no significant difference was observed for the kidneys. For PGs, the possibility of reducing uptake by administering glutamate tablets during RLT seems feasible while further research is warranted for a more focused evaluation of the reduction in kidney uptake.
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Rupp NJ, Umbricht CA, Pizzuto DA, Lenggenhager D, Töpfer A, Müller J, Muehlematter UJ, Ferraro DA, Messerli M, Morand GB, Huber GF, Eberli D, Schibli R, Müller C, Burger IA. First Clinicopathologic Evidence of a Non-PSMA-Related Uptake Mechanism for 68Ga-PSMA-11 in Salivary Glands. J Nucl Med 2019; 60:1270-1276. [PMID: 30737300 DOI: 10.2967/jnumed.118.222307] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/13/2019] [Indexed: 01/03/2023] Open
Abstract
The intense accumulation of prostate-specific membrane antigen (PSMA) radioligands in salivary glands is still not well understood. It is of concern for therapeutic applications of PSMA radioligands, because therapeutic radiation will damage these glands. A better understanding of the uptake mechanism is, therefore, crucial to find solutions to reduce toxicity. The aim of this study was to investigate whether the accumulation of PSMA-targeting radioligands in submandibular glands (SMGs) can be explained with PSMA expression levels using autoradiography (ARG) and immunohistochemistry (IHC). Methods: All patients gave written informed consent for further utility of the biologic material. The SMG of 9 patients, pancreatic tissue of 4 patients, and prostate cancer (PCA) lesions of 9 patients were analyzed. Tissue specimens were analyzed by means of PSMA-IHC (using an anti-PSMA-antibody and an immunoreactivity score system [IRS]) and ARG using 177Lu-PSMA-617 (with quantification of the relative signal intensity compared with a PSMA-positive standard). The SUVmax in salivary glands, pancreas, and PCA tissues were quantified in 60 clinical 68Ga-PSMA-11 PET scans for recurrent disease as well as the 9 primary tumors selected for ARG and IHC. Results: PCA tissue samples revealed a wide range of PSMA staining intensity on IHC (IRS = 70-300) as well as in ARG (1.3%-22% of standard). This variability on PCA tissue could also be observed in 68Ga-PSMA-11 PET (SUVmax, 4.4-16) with a significant correlation between ARG and SUVmax (P < 0.001, R 2 = 0.897). On IHC, ARG, and 68Ga-PSMA-11 PET, the pancreatic tissue was negative (IRS = 0, ARG = 0.1% ± 0.05%, SUVmax of 3.1 ± 1.1). The SMG tissue displayed only focal expression of PSMA limited to the intercalated ducts on IHC (IRS = 10-15) and a minimal signal on ARG (1.3% ± 0.9%). In contrast, all SMG showed a high 68Ga-PSMA-11 accumulation on PET scans (SUVmax 23.5 ± 5.2). Conclusion: Our results indicate that the high accumulation of PSMA radioligands in salivary glands does not correspond to high PSMA expression levels determined using ARG and IHC. These findings provide evidence, that the significant accumulation of PSMA radioligands in SMG is not primarily a result of PSMA-mediated uptake.
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Affiliation(s)
- Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zürich, University of Zürich, Switzerland
| | - Christoph A Umbricht
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Daniele A Pizzuto
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Switzerland
| | - Daniela Lenggenhager
- Department of Pathology and Molecular Pathology, University Hospital Zürich, University of Zürich, Switzerland
| | - Antonia Töpfer
- Department of Pathology and Molecular Pathology, University Hospital Zürich, University of Zürich, Switzerland
| | - Julian Müller
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Switzerland
| | - Urs J Muehlematter
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Switzerland
| | - Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Switzerland
| | - Grégoire B Morand
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zürich, University of Zürich, Switzerland
| | - Gerhard F Huber
- Department of Otorhinolaryngology - Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland; and
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, University of Zürich, Switzerland
| | - Roger Schibli
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Cristina Müller
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Switzerland
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Theranostics for Advanced Prostate Cancer: Current Indications and Future Developments. Eur Urol Oncol 2019; 2:152-162. [PMID: 31017091 DOI: 10.1016/j.euo.2019.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 12/24/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022]
Abstract
CONTEXT Advanced prostate cancer (PCa) is a prominent cause of cancer death in men; positron emission tomography (PET) imaging may play a relevant role in detecting metastases and thus allowing a more tailored therapy in these patients. Radioligand therapy (RLT) may also gain relevance as a treatment strategy in advanced disease. OBJECTIVE The aim of this review is to highlight how the recently developed theranostic processes may become a part of both the available diagnostic and the therapy arsenal in advanced PCa patients. EVIDENCE ACQUISITION An expert panel of nuclear medicine physicians and a urologist, highly experienced in the fields of radionuclide imaging and RLT in advanced PCa, performed a nonsystematic review of the current indications, performance, limitations, and potential future developments of the currently available options in PCa theranostics. EVIDENCE SYNTHESIS Among PET radiotracers, prostate-specific membrane antigen (PSMA)-based compounds in advanced PCa are the focus of a continuously growing interest, mostly due to their potential relevance as theranostic agents. The impact of PSMA-based PET/computed tomography imaging on treatment strategies and prognosis is promising, but still not unquestionably clear. Potential applications may include a role as a gatekeeper to PSMA-directed RLT, as well as monitoring the spread of systemic disease. Currently, initial results seem to substantiate the role of PSMA-directed RLT in terms of feasibility and efficacy. CONCLUSIONS PSMA is a promising molecule for both imaging and therapy in advanced PCa patients; nevertheless, further studies are needed to investigate its role and to determine the impact of its side effects and its overall strategy outcome. PATIENT SUMMARY Prostate-specific membrane antigen (PSMA), a protein, is highly expressed on prostate cancer cells. The possibility to perform diagnostic imaging and subsequently administer therapies by the means of the same molecule is called "theranostics". In patients with advanced prostate cancer, PSMA might have a role in detecting disease spread through both positron emission tomography and single-photon emission computed tomography imaging, while treating prostate cancer systemic localizations with radioligand therapy. Further studies are needed to better determine patients' risks and benefits of these therapeutic approaches.
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Tönnesmann R, Meyer PT, Eder M, Baranski AC. [ 177Lu]Lu-PSMA-617 Salivary Gland Uptake Characterized by Quantitative In Vitro Autoradiography. Pharmaceuticals (Basel) 2019; 12:ph12010018. [PMID: 30678341 PMCID: PMC6469177 DOI: 10.3390/ph12010018] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/21/2018] [Accepted: 01/10/2019] [Indexed: 01/20/2023] Open
Abstract
Irradiation of salivary glands remains the main dose-limiting side effect of therapeutic PSMA-inhibitors, especially when using alpha emitters. Thus, further advances in radiopharmaceutical design and therapy strategies are needed to reduce salivary gland uptake, thereby allowing the administration of higher doses and potentially resulting in improved response rates and better tumor control. As the uptake mechanism remains unknown, this work investigates the salivary gland uptake of [177Lu]Lu-PSMA-617 by autoradiography studies on pig salivary gland tissue and on PSMA-overexpressing LNCaP cell membrane pellets. Displacement studies were performed with non-labeled PSMA-617 and 2-PMPA, respectively. The uptake of [177Lu]Lu-PSMA-617 in glandular areas was determined to be partly PSMA-specific, with a high non-specific uptake fraction. The study emphasizes that [177Lu]Lu-PSMA-617 accumulation in pig salivary glands can be attributed to a combination of both specific and non-specific uptake mechanisms. The observation is of high impact for future design of novel radiopharmaceuticals addressing the dose-limiting salivary gland irradiation of current alpha endoradiotherapy in prostate cancer.
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Affiliation(s)
- Roswitha Tönnesmann
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
| | - Philipp T Meyer
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
| | - Matthias Eder
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
| | - Ann-Christin Baranski
- Department of Nuclear Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
- Division of Radiopharmaceutical Development, German Cancer Consortium (DKTK), partner site Freiburg, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
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Initial clinical experience performing sialendoscopy for salivary gland protection in patients undergoing 225Ac-PSMA-617 RLT. Eur J Nucl Med Mol Imaging 2018; 46:139-147. [PMID: 30151743 DOI: 10.1007/s00259-018-4135-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The main side effect of prostate-specific membrane antigen targeting alpha therapy (PSMA TAT) is dry mouth syndrome. Inflammation of the salivary glands and consequent reduced salivary function have been reported in patients after radioiodine therapy. The beneficial effects of sialendoscopy on radiation-induced inflammation in tissue are well known. Thus sialendoscopy with dilatation, saline irrigation and steroid injections (prednisolone) was performed before and after 225Ac-PSMA-617 TAT to reduce inflammatory effects in the salivary glands and to improve or prevent xerostomia. METHODS Eleven men with metastatic castration-resistant prostate cancer (mean age 68.5 years, range 58-80 years) underwent sialendoscopy, dilatation, saline irrigation and steroid injection of both submandibular and both parotid glands before or after every cycle of 225Ac-PSMA-617 TAT. Sialendoscopy and steroid injection were performed by a senior ENT physician. Quality of life was evaluated using two health-related quality of life (HRQOL) questionnaires, the Xerostomia Questionnaire (XQ) and the Xerostomia Inventory (XI) before and 3 months after the intervention. RESULTS In all 11 patients both parotid and both submandibular glands were affected by radiation sialadenitis and sialendoscopy was performed. The patients experienced no complications after sialendoscopy, and showed a significant improvement in HRQOL as measured using the XQ and XI. After sialendoscopy the XQ score decreased significantly from 77.7 ± 13.6 to 42.7 ± 14.8 (p = 0.003) and the XI score decreased from 44.5 ± 6.9 to 25.8 ± 12.8 (p = 0.003). Due to the limited number of patients we only report tendencies. CONCLUSION Sialendoscopy with dilatation, saline irrigation and steroid injection had beneficial effects on salivary gland function and HRQOL in patients undergoing 225Ac-PSMA-617 RLT. However, even with sialadenoscopic support after multiple cycles of TAT, salivary gland function was reduced and xerostomia was present. Therefore, not only inflammation but also the direct effect of radiation is a putative cause of dry mouth. Further research is necessary to determine the main side effects of PSMA TAT.
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