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Calais J, Morris MJ, Kendi AT, Kalebasty AR, Tutrone R, Anderson MJ, Sartor O. Best Patient Care Practices for Administering PSMA-Targeted Radiopharmaceutical Therapy. J Nucl Med 2024:jnumed.124.268363. [PMID: 39362764 DOI: 10.2967/jnumed.124.268363] [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: 07/05/2024] [Accepted: 09/09/2024] [Indexed: 10/05/2024] Open
Abstract
Optimal patient management protocols for metastatic castration-resistant prostate cancer (mCRPC) are poorly defined and even further complexified with new therapy approvals, such as radiopharmaceuticals. The prostate-specific membrane antigen (PSMA)-targeted agent 177Lu vipivotide tetraxetan ([177Lu]Lu-PSMA-617), approved after the phase III VISION study, presents physicians with additional aspects of patient management, including specific adverse event (AE) monitoring and management, as well as radiation safety. Drawing on our experience as VISION study investigators, here we provide guidance on best practices for delivering PSMA-targeted radiopharmaceutical therapy (RPT) to patients with mCRPC. After a comprehensive review of published evidence and guidelines on RPT management in prostate cancer, we identified educational gaps in managing the radiation safety and AEs associated with [177Lu]Lu-PSMA-617. Our results showed that providing sufficient education on AEs (e.g., fatigue and dry mouth) and radiation safety principles is key to effective delivery and management of patient expectations. Patient counseling by health care professionals, across disciplines, is a cornerstone of optimal patient management during PSMA-targeted RPT. Multidisciplinary collaboration is crucial, and physicians must adhere to radiation safety protocols and counsel patients on radiation safety considerations. Treatment with [177Lu]Lu-PSMA-617 is generally well tolerated; however, additional interventions may be required, such as dosing modification, medications, or transfusions. Urinary incontinence can be challenging in the context of radiation safety. Multidisciplinary collaboration between medical oncologists and nuclear medicine teams ensures that patients are monitored and managed safely and efficiently. In clinical practice, the benefit-to-risk ratio should always be evaluated on a case-by-case basis.
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Affiliation(s)
- Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Michael J Morris
- Department of Genitourinary Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Ronald Tutrone
- Chesapeake Urology Research Associates, Towson, Maryland
| | - Michael J Anderson
- Department of Radiation Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada; and
| | - Oliver Sartor
- Departments of Urology and Oncology, Mayo Clinic, Rochester, Minnesota
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2
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Yadav S, Lowery B, Tuchayi AM, Jiang F, Saelee R, Aggarwal RR, Juarez R, Flavell RR, Hope TA. Impact of Posttreatment SPECT/CT on Patient Management During 177Lu-PSMA-617 Radiopharmaceutical Therapy. J Nucl Med 2024; 65:1395-1401. [PMID: 39117452 DOI: 10.2967/jnumed.124.267955] [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] [Received: 04/15/2024] [Accepted: 07/04/2024] [Indexed: 08/10/2024] Open
Abstract
177Lu can be imaged after administration using SPECT/CT. Most work to date has focused on using posttreatment imaging to measure normal organ and tumor dose. We aimed to assess the impact of posttreatment SPECT/CT on the management of patients undergoing 177Lu-prostate-specific membrane antigen (PSMA) radiopharmaceutical therapy (RPT). Methods: In this retrospective study, 122 patients underwent PSMA RPT with subsequent SPECT/CT 24 h after treatment. We determined a qualitative response at each cycle and reviewed patient charts to assess the impact that posttreatment SPECT/CT had on patient management. Changes in patient management were classified as changes on the basis of progression and response, and specific cycles when they occurred were noted. Miscellaneous changes in patient management were also evaluated. Results: Among the 122 consecutive patients examined, 42%-56% exhibited stable disease, whereas 19%-39% of patients exhibited response on visual assessment across treatment cycles. In total, 49% (n = 60) of patients experienced changes in management, of which 57% (n = 34) were due to progression, 40% (n = 24) were due to response, and 3% (n = 2) were due to miscellaneous changes. Changes due to disease progression were observed mostly after cycles 2 and 4. Changes due to response to RPT occurred mostly after cycles 3 and 4. Conclusion: At our center, 49% of patients experienced changes in management based on posttreatment SPECT/CT, and most of these changes occurred at cycles 2 and 4. Integrating posttreatment SPECT/CT into routine PSMA RPT protocols can aid in patient management.
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Affiliation(s)
- Surekha Yadav
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Blair Lowery
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Abuzar Moradi Tuchayi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Fei Jiang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Rachelle Saelee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Rahul R Aggarwal
- Division of Medical Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Roxanna Juarez
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California
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3
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Belge Bilgin G, Burkett BJ, Bilgin C, Orme JJ, Childs DS, Rincon MM, Abdelrazek AS, Johnson DR, Johnson GB, Kwon ED, Sartor O, Kendi AT. Neurologic Symptoms After 177Lu-Prostate-Specific-Membrane Antigen-617 Therapy: A Single-Center Experience. J Nucl Med 2024; 65:1402-1408. [PMID: 39089816 DOI: 10.2967/jnumed.124.267643] [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] [Received: 02/19/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024] Open
Abstract
Treatment with 177Lu-prostate-specific membrane antigen (PSMA)-617 (177Lu-vipivotide tetraxetan [Pluvicto]) prolongs both progression-free and overall survival in advanced PSMA-positive metastatic castration-resistant prostate cancer. Data examining specifically neurologic symptoms after 177Lu-PSMA-617 treatment are scarce. In this study, we aimed to review the neurologic findings in a large cohort of metastatic castration-resistant prostate cancer patients undergoing 177Lu-PSMA-617 therapy. Methods: The clinical records and imaging data of patients who received their initial dose of 177Lu-PSMA-617 between March 2022 and November 2022 were retrospectively reviewed. All patients presenting for medical evaluation, regardless of specific specialty appointments, with new or worsening neurologic symptoms were included in the study. Results: A total of 185 patients underwent 177Lu-PSMA-617 therapy. The median age was 70 y (range, 58-90 y). The mean follow-up time was 12.04 ± 2.87 mo. Fifty-five new or worsening neurologic symptoms were observed in 50 patients (27%, 50/185). Of these, 27 (11.9%, 27/185) reported altered taste. Eleven patients (6%, 11/185) experienced dizziness with no other clear etiology; 2 of these patients were admitted to the emergency department (ED). Paresthesia symptoms were reported in 6 patients (3.2%, 6/185). Five patients (2.7%, 5/185) reported headaches, 3 of these patients were admitted to the ED because of the severity of the symptoms. Two patients (1.08%, 2/185) presented with extremity weakness. Two patients (1.08%, 2/185) had an ischemic stroke and were admitted to the ED. One patient (0.05%, 1/185) exhibited gait disturbances. In total, 7 patients (3.78%, 7/185) were admitted to the ED because of neurologic symptoms. None of the patients discontinued or failed to complete the 177Lu-PSMA-617 therapy because of neurologic symptoms. Conclusion: After 177Lu-PSMA-617 treatment, the most common neurologic symptoms were dysgeusia and dizziness. In this study, our follow-up period and population size might not have been sufficient to detect delayed or uncommon neurologic symptoms. In patients without neurologic symptoms or central nervous system metastases before treatment, we found the development of severe neurologic problems to be rare and unlikely to require discontinuation of treatment.
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Affiliation(s)
| | | | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jacob J Orme
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Geoffrey B Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Immunology, Mayo Clinic, Rochester, Minnesota; and
| | - Eugene D Kwon
- Department of Immunology, Mayo Clinic, Rochester, Minnesota; and
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Oliver Sartor
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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4
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Angappulige DH, Barashi NS, Pickersgill N, Weimholt C, Luo J, Shadmani G, Tarcha Z, Rayamajhi S, Mahajan NP, Andriole GL, Siegel BA, Kim EH, Mahajan K. Prostate-Specific Membrane Antigen-Targeted Imaging and Its Correlation with HOXB13 Expression. J Nucl Med 2024; 65:1210-1216. [PMID: 38936974 PMCID: PMC11294063 DOI: 10.2967/jnumed.123.267301] [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] [Received: 12/19/2023] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
Homeobox 13 (HOXB13) is an oncogenic transcription factor that directly regulates expression of folate hydrolase 1, which encodes prostate-specific membrane antigen (PSMA). HOXB13 is expressed in primary and metastatic prostate cancers (PCs) and promotes androgen-independent PC growth. Since HOXB13 promotes resistance to androgen receptor (AR)-targeted therapies and regulates the expression of folate hydrolase 1, we investigated whether SUVs on PSMA PET would correlate with HOXB13 expression. Methods: We analyzed 2 independent PC patient cohorts who underwent PSMA PET/CT for initial staging or for biochemical recurrence. In the discovery cohort, we examined the relationship between HOXB13, PSMA, and AR messenger RNA (mRNA) expression in prostate biopsy specimens from 179 patients who underwent PSMA PET/CT with 18F-piflufolastat. In the validation cohort, we confirmed the relationship between HOXB13, PSMA, and AR by comparing protein expression in prostatectomy and lymph node (LN) sections from 19 patients enrolled in 18F-rhPSMA-7.3 PET clinical trials. Correlation and association analyses were also used to confirm the relationship between the markers, LN positivity, and PSMA PET SUVs. Results: We observed a significant correlation between PSMA and HOXB13 mRNA (P < 0.01). The association between HOXB13 and 18F-piflufolastat SUVs was also significant (SUVmax, P = 0.0005; SUVpeak, P = 0.0006). Likewise, the PSMA SUVmax was significantly associated with the expression of HOXB13 protein in the 18F-rhPSMA-7.3 PET cohort (P = 0.008). Treatment-naïve patients with LN metastases demonstrated elevated HOXB13 and PSMA levels in their tumors as well as higher PSMA tracer uptake and low AR expression. Conclusion: Our findings demonstrate that HOXB13 correlates with PSMA expression and PSMA PET SUVs at the mRNA and protein levels. Our study suggests that the PSMA PET findings may reflect oncogenic HOXB13 transcriptional activity in PC, thus potentially serving as an imaging biomarker for more aggressive disease.
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Affiliation(s)
- Duminduni Hewa Angappulige
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Nimrod S Barashi
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Nicholas Pickersgill
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Cody Weimholt
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri
| | - Jingqin Luo
- Division of Public Health, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri; and
| | - Ghazal Shadmani
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Ziad Tarcha
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Sampanna Rayamajhi
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Nupam P Mahajan
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri; and
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Barry A Siegel
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri; and
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Eric H Kim
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri; and
| | - Kiran Mahajan
- Division of Urologic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri;
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri; and
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5
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Capozza M, Digilio G, Gagliardi M, Tei L, Marchesi S, Terreno E, Stefania R. Silicon Phthalocyanines Functionalized with Axial Substituents Targeting PSMA: Synthesis and Preliminary Assessment of Their Potential for PhotoDynamic Therapy of Prostate Cancer. ChemMedChem 2024:e202400218. [PMID: 39082378 DOI: 10.1002/cmdc.202400218] [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: 03/28/2024] [Revised: 07/10/2024] [Indexed: 10/01/2024]
Abstract
Photodynamic therapy (PDT) is a clinical modality based on the irradiation of different diseases, mostly tumours, with light following the selective uptake of a photosensitiser by the pathological tissue. In this study, two new silicon(IV)phtalocyanines (SiPcs) functionalized at both axial positions with a PSMA inhibitor are reported as candidate photosensitizers for PDT of prostate cancer, namely compounds SiPc-PQ(PSMAi)2 and SiPc-OSi(PSMAi)2. These compounds share the same PSMA-binding motif, but differ in the linker that connects the inhibitor moiety to the Si(IV) atom: an alkoxy (Si-O-C) bond for SiPc-PQ(PSMAi)2, and a silyloxy (Si-O-Si) bond for SiPc-OSi(PSMAi)2. Both compounds were synthesized by a facile synthetic route and fully characterized by 2D NMR, mass spectrometry and absorption/fluorescence spectrophotometry. The PDT agents showed a suitable solubility in water, where they essentially exist in monomeric form. SiPc-PQ(PSMAi)2 showed a higher singlet oxygen quantum yield ΦΔ, higher fluorescence quantum yields ΦF and better photostability than SiPc-OSi(PSMAi)2. Both compounds were efficiently taken up by PSMA(+) PC3-PIP cells, but not by PSMA(-) PC3-FLU cells. However, SiPc-PQ(PSMAi)2 showed a more specific photoinduced cytotoxicity in vitro, which is likely attributable to a better stability of its water solutions.
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Affiliation(s)
- Martina Capozza
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Piazza Nizza 44bis, Torino, 10126, Italy
| | - Giuseppe Digilio
- Department of Science and Technological Innovation, University of Eastern Piedmont "Amedeo Avogadro", Viale Teresa Michel 11, Alessandria, 15120, Italy
| | - Michela Gagliardi
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Piazza Nizza 44bis, Torino, 10126, Italy
| | - Lorenzo Tei
- Department of Science and Technological Innovation, University of Eastern Piedmont "Amedeo Avogadro", Viale Teresa Michel 11, Alessandria, 15120, Italy
| | - Stefano Marchesi
- Department of Science and Technological Innovation, University of Eastern Piedmont "Amedeo Avogadro", Viale Teresa Michel 11, Alessandria, 15120, Italy
| | - Enzo Terreno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Piazza Nizza 44bis, Torino, 10126, Italy
| | - Rachele Stefania
- Department of Science and Technological Innovation, University of Eastern Piedmont "Amedeo Avogadro", Viale Teresa Michel 11, Alessandria, 15120, Italy
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6
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Bakht MK, Beltran H. Biological determinants of PSMA expression, regulation and heterogeneity in prostate cancer. Nat Rev Urol 2024:10.1038/s41585-024-00900-z. [PMID: 38977769 DOI: 10.1038/s41585-024-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 07/10/2024]
Abstract
Prostate-specific membrane antigen (PSMA) is an important cell-surface imaging biomarker and therapeutic target in prostate cancer. The PSMA-targeted theranostic 177Lu-PSMA-617 was approved in 2022 for men with PSMA-PET-positive metastatic castration-resistant prostate cancer. However, not all patients respond to PSMA-radioligand therapy, in part owing to the heterogeneity of PSMA expression in the tumour. The PSMA regulatory network is composed of a PSMA transcription complex, an upstream enhancer that loops to the FOLH1 (PSMA) gene promoter, intergenic enhancers and differentially methylated regions. Our understanding of the PSMA regulatory network and the mechanisms underlying PSMA suppression is evolving. Clinically, molecular imaging provides a unique window into PSMA dynamics that occur on therapy and with disease progression, although challenges arise owing to the limited resolution of PET. PSMA regulation and heterogeneity - including intertumoural and inter-patient heterogeneity, temporal changes, lineage dynamics and the tumour microenvironment - affect PSMA theranostics. PSMA response and resistance to radioligand therapy are mediated by a number of potential mechanisms, and complementary biomarkers beyond PSMA are under development. Understanding the biological determinants of cell surface target regulation and heterogeneity can inform precision medicine approaches to PSMA theranostics as well as other emerging therapies.
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Affiliation(s)
- Martin K Bakht
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Himisha Beltran
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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7
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Stamatakos PV, Fragkoulis C, Leventi A, Gklinos K, Kontolatis N, Papatsoris A, Dellis A. PSMA-based therapeutics for prostate cancer. Expert Opin Pharmacother 2024; 25:1405-1419. [PMID: 39054909 DOI: 10.1080/14656566.2024.2385726] [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] [Received: 05/14/2024] [Revised: 07/11/2024] [Accepted: 07/24/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION The prostate cancer (PCa) consists the most frequently diagnosed malignancy of urogenital system in males. Traditionally, treatment of localized PCa was based on surgery or radiotherapy while hormonotherapy was used in more advanced stages. However, the implementation of radiolabels has revolutionized the landscape of prostate cancer. Specifically, prostate-specific membrane antigen (PSMA) has been investigated in different aspects of PCa therapeutic era. AREAS COVERED A literature review is presented about the implications of PSMA radiolabels on prostate cancer treatment. PSMA tracers were initially used as an imaging technique. Afterwards, PSMA labeled with isotopes presenting cytotoxic abilities, such as lutetium-117 and actinium-225, while reports exist about the use of radioligand immunotherapy. Meanwhile, ongoing trials examine the development of novel radionuclides as well as the evolution of the PSMA-targeted ligands. EXPERT OPINION Currently, PSMA radioligand treatment of prostate cancer is approved in the metastatic stage of the disease. Meanwhile, a variety of trials exist about its possible role in less advanced stages. However, plenty of parameters should be addressed before these implementations, such as PSMA dosage, dosimetry issues, and its safety profile. A future well-designed study with proper patient selection is mandatory to further explore PSMA radioligand theranostics perspectives.
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Affiliation(s)
| | | | - Aggeliki Leventi
- Department of Urology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Konstantinos Gklinos
- Department of Urology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Nikolaos Kontolatis
- Department of Urology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Hospital of Athens "Sismanoglio", Athens, Greece
| | - Athanasios Dellis
- 1st Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Hospital of Athens "Aretaieion", Athens, Greece
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An S, Wang L, Xie F, Jiang D, Huang G, Liu J, Ma X, Wei W. Pathway to Approval of Innovative Radiopharmaceuticals in China. J Nucl Med 2024; 65:72S-76S. [PMID: 38719236 DOI: 10.2967/jnumed.123.267127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/29/2024] [Indexed: 07/16/2024] Open
Abstract
Since the late 1950s, radiopharmaceuticals have been used for diagnosis and treatment in clinical nuclear medicine in China. Over the decades, China has successfully established a relatively sophisticated system for radiopharmaceutical production and management, supported by state-of-the-art facilities. With the rapid growth of the national economy, the radiopharmaceutical market in China is expanding at a remarkable pace. This burgeoning market has led to an escalating demand for clinical-stage radiopharmaceuticals, either produced domestically or imported. Despite this positive trajectory, the development and application of radiopharmaceuticals in China have been hindered by several challenges that persist, such as inadequate research, insufficient investment, limited availability of radionuclides, shortage of trained personnel in related fields, and imperfections in policies and regulations. In an exciting development, the regulation reforms implemented since 2015 have positively affected China's drug regulatory system. The introduction of the "Mid- and Long-Term Development Plan (2021-2035) for Medical Isotopes" created concurrently an opportune environment for the advancement of innovative radiopharmaceuticals. In this review, we aim to provide an overview of the approval process for novel radiopharmaceuticals by the National Medical Products Administration and the status of radiopharmaceuticals in research and development in China. Preclinical development and clinical translation of radiopharmaceuticals are undergoing rapid evolution in China. As practitioners in the field in China, we provide several practical suggestions to stimulate open discussions and thoughtful consideration.
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Affiliation(s)
- Shuxian An
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Wang
- Center of Cyclotron and PET Radiopharmaceuticals, Department of Nuclear Medicine and PET/CT-MRI Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fang Xie
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Dawei Jiang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
- Key Laboratory of Biological Targeted Therapy, Ministry of Education, Wuhan, China; and
| | - Gang Huang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaowei Ma
- Department of Nuclear Medicine, Second Xiangya Hospital of Central South University, Changsha, China
| | - Weijun Wei
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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9
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Piranfar A, Moradi Kashkooli F, Zhan W, Bhandari A, Saboury B, Rahmim A, Soltani M. Radiopharmaceutical transport in solid tumors via a 3-dimensional image-based spatiotemporal model. NPJ Syst Biol Appl 2024; 10:39. [PMID: 38609421 PMCID: PMC11015041 DOI: 10.1038/s41540-024-00362-4] [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: 09/01/2023] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Lutetium-177 prostate-specific membrane antigen (177Lu-PSMA)-targeted radiopharmaceutical therapy is a clinically approved treatment for patients with metastatic castration-resistant prostate cancer (mCRPC). Even though common practice reluctantly follows "one size fits all" approach, medical community believes there is significant room for deeper understanding and personalization of radiopharmaceutical therapies. To pursue this aim, we present a 3-dimensional spatiotemporal radiopharmaceutical delivery model based on clinical imaging data to simulate pharmacokinetic of 177Lu-PSMA within the prostate tumors. The model includes interstitial flow, radiopharmaceutical transport in tissues, receptor cycles, association/dissociation with ligands, synthesis of PSMA receptors, receptor recycling, internalization of radiopharmaceuticals, and degradation of receptors and drugs. The model was studied for a range of values for injection amount (100-1000 nmol), receptor density (10-500 nmol•l-1), and recycling rate of receptors (10-4 to 10-1 min-1). Furthermore, injection type, different convection-diffusion-reaction mechanisms, characteristic time scales, and length scales are discussed. The study found that increasing receptor density, ligand amount, and labeled ligands improved radiopharmaceutical uptake in the tumor. A high receptor recycling rate (0.1 min-1) increased radiopharmaceutical concentration by promoting repeated binding to tumor cell receptors. Continuous infusion results in higher radiopharmaceutical concentrations within tumors compared to bolus administration. These insights are crucial for advancing targeted therapy for prostate cancer by understanding the mechanism of radiopharmaceutical distribution in tumors. Furthermore, measures of characteristic length and advection time scale were computed. The presented spatiotemporal tumor transport model can analyze different physiological parameters affecting 177Lu-PSMA delivery.
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Affiliation(s)
- Anahita Piranfar
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | | | - Wenbo Zhan
- School of Engineering, King's College, University of Aberdeen, Aberdeen, AB24 3UE, UK
| | - Ajay Bhandari
- Biofluids Research Lab, Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, 826004, India
| | - Babak Saboury
- Department of Computational Nuclear Oncology, Institute of Nuclear Medicine, Bethesda, MD, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
- Departments of Radiology and Physics, University of British Columbia, Vancouver, BC, Canada
| | - M Soltani
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran.
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada.
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, ON, Canada.
- Centre for Biotechnology and Bioengineering (CBB), University of Waterloo, Waterloo, ON, Canada.
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10
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Tagawa ST, Thomas C, Sartor AO, Sun M, Stangl-Kremser J, Bissassar M, Vallabhajosula S, Castellanos SH, Nauseef JT, Sternberg CN, Molina A, Ballman K, Nanus DM, Osborne JR, Bander NH. Prostate-Specific Membrane Antigen-Targeting Alpha Emitter via Antibody Delivery for Metastatic Castration-Resistant Prostate Cancer: A Phase I Dose-Escalation Study of 225Ac-J591. J Clin Oncol 2024; 42:842-851. [PMID: 37922438 PMCID: PMC10906595 DOI: 10.1200/jco.23.00573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 11/05/2023] Open
Abstract
PURPOSE Novel therapies are needed to extend survival in metastatic castration-resistant prostate cancer (mCRPC). Prostate-specific membrane antigen (PSMA), a cell surface antigen overexpressed in PC, provides a validated target. This dose-escalation study investigated the safety, efficacy, maximum tolerated dose (MTD), and recommended phase II dose (RP2D) for 225Ac-J591, anti-PSMA monoclonal antibody J591 radiolabeled with the alpha emitter actinium-225. METHODS Following investigational new drug-enabling preclinical studies, we enrolled patients with progressive mCRPC that was refractory to or who refused standard treatment options (including androgen receptor pathway inhibitor and had received or been deemed ineligible for taxane chemotherapy). No selection for PSMA was performed. Patients received a single dose of 225Ac-J591 at one of seven dose-escalation levels followed by expansion at the highest dose. Primary end point of dose-escalation cohort was determination of dose-limiting toxicity (DLT) and RP2D. RESULTS Radiochemistry and animal studies were favorable. Thirty-two patients received 225Ac-J591 in an accelerated dose-escalation design (22 in dose escalation, 10 in expansion). One patient (1 of 22; 4.5%) experienced DLT in cohort 6 (80 KBq/kg) but none in cohort 7; MTD was not reached, and RP2D was the highest dose level (93.3 KBq/kg). The majority of high-grade adverse events (AEs) were hematologic with an apparent relationship with administered radioactivity. Nonhematologic AEs were generally of low grade. Prostate-specific antigen (PSA) declines and circulating tumor cell (CTC) control were observed: 46.9% had at least 50% PSA decline at any time (34.4% confirmed PSA response), and protocol-defined CTC count response occurred in 13 of 22 (59.1%). CONCLUSION To our knowledge, this is the first-in-human phase I dose-escalation trial of a single dose of 225Ac-J591 in 32 patients with pretreated progressive mCRPC demonstrated safety and preliminary efficacy signals. Further investigation is underway.
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Affiliation(s)
- Scott T. Tagawa
- Division of Hematology & Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
- Department of Urology, Weill Cornell Medicine, New York, NY
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
| | - Charlene Thomas
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - A. Oliver Sartor
- Departments of Medicine and Urology, Tulane University School of Medicine, New Orleans, LA
| | - Michael Sun
- Division of Hematology & Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Mahelia Bissassar
- Division of Hematology & Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Sandra Huicochea Castellanos
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
- Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Jones T. Nauseef
- Division of Hematology & Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
| | - Cora N. Sternberg
- Division of Hematology & Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
- Department of Urology, Weill Cornell Medicine, New York, NY
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
| | - Ana Molina
- Division of Hematology & Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
| | - Karla Ballman
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - David M. Nanus
- Division of Hematology & Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
- Department of Urology, Weill Cornell Medicine, New York, NY
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
| | - Joseph R. Osborne
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
- Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Neil H. Bander
- Department of Urology, Weill Cornell Medicine, New York, NY
- Meyer Cancer Center, Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, NY
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11
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Farolfi A, Armstrong WR, Djaileb L, Gafita A, Hotta M, Allen-Auerbach M, Unterrainer LM, Fendler WP, Rettig M, Eiber M, Hofman MS, Hadaschik B, Herrmann K, Czernin J, Calais J, Benz MR. Differences and Common Ground in 177Lu-PSMA Radioligand Therapy Practice Patterns: International Survey of 95 Theranostic Centers. J Nucl Med 2024; 65:438-445. [PMID: 38238041 DOI: 10.2967/jnumed.123.266391] [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] [Received: 07/19/2023] [Accepted: 11/18/2023] [Indexed: 03/03/2024] Open
Abstract
177Lu-labeled prostate-specific membrane antigen (PSMA) radioligand therapy effectively treats metastatic castration-resistant prostate cancer. Patients requiring treatment, and consequently the number of theranostic centers, are expected to increase significantly after Food and Drug Administration and European Medicines Agency approval. This requires standardization or harmonization among theranostic centers. The aim of this study was to assess operational differences and similarities among 177Lu-PSMA treatment centers. Methods: A questionnaire comprising 62 items, designed by a core team of 5 physicians and externally reviewed by international experts, was developed. Study participants were asked to provide answers about their center, patient selection, radiopharmaceuticals, clinical assessment before and after 177Lu-PSMA treatments, laboratory values, treatment discontinuation, posttreatment imaging, and general information. An invitation e-mail to participate in the study was sent in June 2022. Duplicates were removed to allow for only one valid response per center. Results: Ninety-five of 211 (45%) contacted centers completed the questionnaire. Most participating centers were in Europe (51%), followed by America (22%) and Asia (22%). During the 12 mo before this study, a total of 5,906 patients received 177Lu-PSMA therapy at the 95 participating centers. Most of these patients were treated in Europe (2,840/5,906; 48%), followed by Asia (1,313/5,906; 22%) and Oceania (1,225/5,906; 21%). PSMA PET eligibility for 177Lu-PSMA was determined most frequently using 68Ga-PSMA-11 (77%). Additional pretherapy imaging included 18F-FDG PET/CT, CT, renal scintigraphy, and bone scintigraphy at 41 (49%), 27 (32%), 25 (30%), and 13 (15%), respectively, of the 84 centers for clinical standard of care, compassionate care, or local research protocols and 11 (26%), 25 (60%), 9 (21%), and 28 (67%), respectively, of the 42 centers for industry-sponsored trials. PSMA PET eligibility criteria included subjective qualitative assessment of PSMA positivity at 33% of centers, VISION criteria at 23%, and TheraP criteria at 13%. The mean standard injected activity per cycle was 7.3 GBq (range, 5.5-11.1 GBq). Sixty-two (65%) centers applied standardized response assessment criteria, and PSMA PET Progression Criteria were the most applied (37%). Conclusion: Results from this international survey revealed interinstitutional differences in several aspects of 177Lu-PSMA radionuclide therapy, including patient selection, administered activity, and the response assessment strategy. Standardization or harmonization of protocols and dedicated training are desirable in anticipation of increasing numbers of patients and theranostic centers.
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Affiliation(s)
- Andrea Farolfi
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Wesley R Armstrong
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Loic Djaileb
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
- LRB, Nuclear Medicine Department, CHU Grenoble Alpes, University of Grenoble Alpes, INSERM, Grenoble, France
| | - Andrei Gafita
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Masatoshi Hotta
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Martin Allen-Auerbach
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Lena M Unterrainer
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
- Department of Nuclear Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Matthew Rettig
- Department of Medicine and Urology, UCLA, Los Angeles, California
- Department of Medicine, VA Greater Los Angeles, Los Angeles, California
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany; and
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Matthias R Benz
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California;
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
- Department of Radiological Sciences, UCLA, Los Angeles, California
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12
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Jia AY, Kiess AP, Li Q, Antonarakis ES. Radiotheranostics in advanced prostate cancer: Current and future directions. Prostate Cancer Prostatic Dis 2024; 27:11-21. [PMID: 37069330 DOI: 10.1038/s41391-023-00670-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/25/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023]
Abstract
The discovery of small molecules that target the extracellular domain of prostate-specific membrane antigen (PSMA) has led to advancements in diagnostic imaging and the development of precision radiopharmaceutical therapies. In this review, we present the available existing data and highlight the key ongoing clinical evaluations of PSMA-based imaging in the management of primary, biochemically recurrent, and metastatic prostate cancer. We also discuss clinical studies that explore the use of PSMA-based radiopharmaceutical therapy (RPT) in metastatic prostate cancer and forthcoming trials that investigate PSMA RPT in earlier disease states. Multidisciplinary collaboration in clinical trial design and therapeutic administration is critical to the continued progress of this evolving radiotheranostics field.
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Affiliation(s)
- Angela Y Jia
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Ana P Kiess
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Qiubai Li
- Department of Nuclear Medicine, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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13
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Heesch A, Florea A, Maurer J, Habib P, Werth LS, Hansen T, Stickeler E, Sahnoun SEM, Mottaghy FM, Morgenroth A. The prostate-specific membrane antigen holds potential as a vascular target for endogenous radiotherapy with [ 177Lu]Lu-PSMA-I&T for triple-negative breast cancer. Breast Cancer Res 2024; 26:30. [PMID: 38378689 PMCID: PMC10877802 DOI: 10.1186/s13058-024-01787-9] [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: 11/30/2023] [Accepted: 02/13/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Overexpression of prostate-specific membrane antigen (PSMA) on the vasculature of triple-negative breast cancer (TNBC) presents a promising avenue for targeted endogenous radiotherapy with [177Lu]Lu-PSMA-I&T. This study aimed to assess and compare the therapeutic efficacy of a single dose with a fractionated dose of [177Lu]Lu-PSMA-I&T in an orthotopic model of TNBC. METHODS Rj:NMRI-Foxn1nu/nu mice were used as recipients of MDA-MB-231 xenografts. The single dose group was treated with 1 × 60 ± 5 MBq dose of [177Lu]Lu-PSMA-I&T, while the fractionated dose group received 4 × a 15 ± 2 MBq dose of [177Lu]Lu-PSMA-I&T at 7 day intervals. The control group received 0.9% NaCl. Tumor progression was monitored using [18F]FDG-PET/CT. Ex vivo analysis encompassed immunostaining, TUNEL staining, H&E staining, microautoradiography, and autoradiography. RESULTS Tumor volumes were significantly smaller in the single dose (p < 0.001) and fractionated dose (p < 0.001) groups. Tumor growth inhibition rates were 38% (single dose) and 30% (fractionated dose). Median survival was notably prolonged in the treated groups compared to the control groups (31d, 28d and 19d for single dose, fractionated dose and control, respectively). [177Lu]Lu-PSMA-I&T decreased the size of viable tumor areas. We further demonstrated, that [177Lu]Lu-PSMA-I&T binds specifically to the tumor-associated vasculature. CONCLUSION This study highlights the potential of [177Lu]Lu-PSMA-I&T for endogenous radiotherapy of TNBC.
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Affiliation(s)
- Amelie Heesch
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Alexandru Florea
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), 6202, Maastricht, The Netherlands
- School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center (MUMC+), 6202, Maastricht, The Netherlands
| | - Jochen Maurer
- Department of Obstetrics and Gynecology, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Pardes Habib
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, USA
| | - Laura S Werth
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Thomas Hansen
- Department of Obstetrics and Gynecology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, University Hospital RWTH Aachen, 52074, Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Sabri E M Sahnoun
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), 6202, Maastricht, The Netherlands
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Agnieszka Morgenroth
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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14
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Unterrainer LM, Calais J, Bander NH. Prostate-Specific Membrane Antigen: Gateway to Management of Advanced Prostate Cancer. Annu Rev Med 2024; 75:49-66. [PMID: 38285513 DOI: 10.1146/annurev-med-081522-031439] [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: 01/31/2024]
Abstract
Prostate-specific membrane antigen (PSMA) as a transmembrane protein is overexpressed by prostate cancer (PC) cells and is accessible for binding antibodies or low-molecular-weight radioligands due to its extracellular portion. Successful targeting of PSMA began with the development of humanized J591 antibody. Due to their faster clearance compared to antibodies, small-molecule radioligands for targeted imaging and therapy of PC have been favored in recent development efforts. PSMA positron emission tomography (PET) imaging has higher diagnostic performance than conventional imaging for initial staging of high-risk PC and biochemical recurrence detection/localization. However, it remains to be demonstrated how to integrate PSMA PET imaging for therapy response assessment and as an outcome endpoint measure in clinical trials. With the recent approval of 177Lu-PSMA-617 by the US Food and Drug Administration for metastatic castration-resistant PC progressing after chemotherapy, the high value of PSMA-targeted therapy was confirmed. Compared to standard of care, PSMA-based radioligand therapy led to a better outcome and a higher quality of life. This review, focusing on the advanced PC setting, provides an overview of different approved and nonapproved PSMA-targeted imaging and therapeutic modalities and discusses the future of PSMA-targeted theranostics, also with an outlook on non-radiopharmaceutical-based PSMA-targeted therapies.
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Affiliation(s)
- Lena M Unterrainer
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; ,
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; ,
| | - Neil H Bander
- Department of Urology, Weill Cornell Medicine, New York, NY, USA;
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
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15
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Ravi Kumar AS, Hofman MS. Unraveling the Impact of 177Lu-PSMA Radioligand Therapy on Renal Impairment: Distinguishing Causation from Correlation. J Nucl Med 2024; 65:85-86. [PMID: 37973187 DOI: 10.2967/jnumed.123.266638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Aravind S Ravi Kumar
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Centre Melbourne, and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Centre Melbourne, and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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16
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Hotta M, Gafita A, Murthy V, Benz MR, Sonni I, Burger IA, Eiber M, Emmett L, Farolfi A, Fendler WP, Weber MM, Hofman MS, Hope TA, Kratochwil C, Czernin J, Calais J. PSMA PET Tumor-to-Salivary Gland Ratio to Predict Response to [ 177Lu]PSMA Radioligand Therapy: An International Multicenter Retrospective Study. J Nucl Med 2023; 64:1024-1029. [PMID: 36997329 DOI: 10.2967/jnumed.122.265242] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 04/01/2023] Open
Abstract
Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy can improve the outcome of patients with advanced metastatic castration-resistant prostate cancer, but patients do not respond uniformly. We hypothesized that using the salivary glands as a reference organ can enable selective patient stratification. We aimed to establish a PSMA PET tumor-to-salivary gland ratio (PSG score) to predict outcomes after [177Lu]PSMA. Methods: In total, 237 men with metastatic castration-resistant prostate cancer treated with [177Lu]PSMA were included. A quantitative PSG (qPSG) score (SUVmean ratio of whole-body tumor to parotid glands) was semiautomatically calculated on baseline [68Ga]PSMA-11 PET images. Patients were divided into 3 groups: high (qPSG > 1.5), intermediate (qPSG = 0.5-1.5), and low (qPSG < 0.5) scores. Ten readers interpreted the 3-dimensional maximum-intensity-projection baseline [68Ga]PSMA-11 PET images and classified patients into 3 groups based on visual PSG (vPSG) score: high (most of the lesions showed higher uptake than the parotid glands) intermediate (neither low nor high), and low (most of the lesions showed lower uptake than the parotid glands). Outcome data included a more than 50% prostate-specific antigen decline, prostate-specific antigen (PSA) progression-free survival, and overall survival (OS). Results: Of the 237 patients, the numbers in the high, intermediate, and low groups were 56 (23.6%), 163 (68.8%), and 18 (7.6%), respectively, for qPSG score and 106 (44.7%), 96 (40.5%), and 35 (14.8%), respectively, for vPSG score. The interreader reproducibility of the vPSG score was substantial (Fleiss weighted κ, 0.68). The more than 50% prostate-specific antigen decline was better in patients with a higher PSG score (high vs. intermediate vs. low, 69.6% vs. 38.7% vs. 16.7%, respectively, for qPSG [P < 0.001] and 63.2% vs 33.3% vs 16.1%, respectively, for vPSG [P < 0.001]). The median PSA progression-free survival of the high, intermediate, and low groups by qPSG score was 7.2, 4.0, and 1.9 mo (P < 0.001), respectively, by qPSG score and 6.7, 3.8, and 1.9 mo (P < 0.001), respectively, by vPSG score. The median OS of the high, intermediate, and low groups was 15.0, 11.2, and 13.9 mo (P = 0.017), respectively, by qPSG score and 14.3, 9.6, and 12.9 mo (P = 0.018), respectively, by vPSG score. Conclusion: The PSG score was prognostic for PSA response and OS after [177Lu]PSMA. The visual PSG score assessed on 3-dimensional maximum-intensity-projection PET images yielded substantial reproducibility and comparable prognostic value to the quantitative score.
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Affiliation(s)
- Masatoshi Hotta
- Ahmanson Translational Theranostics Division, UCLA, Los Angeles, California;
| | - Andrei Gafita
- Ahmanson Translational Theranostics Division, UCLA, Los Angeles, California
| | - Vishnu Murthy
- Ahmanson Translational Theranostics Division, UCLA, Los Angeles, California
| | - Matthias R Benz
- Ahmanson Translational Theranostics Division, UCLA, Los Angeles, California
| | - Ida Sonni
- Ahmanson Translational Theranostics Division, UCLA, Los Angeles, California
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Andrea Farolfi
- Ahmanson Translational Theranostics Division, UCLA, Los Angeles, California
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Manuel M Weber
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California; and
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, UCLA, Los Angeles, California
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, UCLA, Los Angeles, California
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17
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Kratochwil C, Fendler WP, Eiber M, Hofman MS, Emmett L, Calais J, Osborne JR, Iravani A, Koo P, Lindenberg L, Baum RP, Bozkurt MF, Delgado Bolton RC, Ezziddin S, Forrer F, Hicks RJ, Hope TA, Kabasakal L, Konijnenberg M, Kopka K, Lassmann M, Mottaghy FM, Oyen WJG, Rahbar K, Schoder H, Virgolini I, Bodei L, Fanti S, Haberkorn U, Hermann K. Joint EANM/SNMMI procedure guideline for the use of 177Lu-labeled PSMA-targeted radioligand-therapy ( 177Lu-PSMA-RLT). Eur J Nucl Med Mol Imaging 2023; 50:2830-2845. [PMID: 37246997 PMCID: PMC10317889 DOI: 10.1007/s00259-023-06255-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/25/2023] [Indexed: 05/30/2023]
Abstract
Prostate-specific membrane antigen (PSMA) is expressed by the majority of clinically significant prostate adenocarcinomas, and patients with target-positive disease can easily be identified by PSMA PET imaging. Promising results with PSMA-targeted radiopharmaceutical therapy have already been obtained in early-phase studies using various combinations of targeting molecules and radiolabels. Definitive evidence of the safety and efficacy of [177Lu]Lu-PSMA-617 in combination with standard-of-care has been demonstrated in patients with metastatic castration-resistant prostate cancer, whose disease had progressed after or during at least one taxane regimen and at least one novel androgen-axis drug. Preliminary data suggest that 177Lu-PSMA-radioligand therapy (RLT) also has high potential in additional clinical situations. Hence, the radiopharmaceuticals [177Lu]Lu-PSMA-617 and [177Lu]Lu-PSMA-I&T are currently being evaluated in ongoing phase 3 trials. The purpose of this guideline is to assist nuclear medicine personnel, to select patients with highest potential to benefit from 177Lu-PSMA-RLT, to perform the procedure in accordance with current best practice, and to prepare for possible side effects and their clinical management. We also provide expert advice, to identify those clinical situations which may justify the off-label use of [177Lu]Lu-PSMA-617 or other emerging ligands on an individual patient basis.
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Affiliation(s)
- Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147, Essen, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University Munich (TUM), 81675, Munich, Germany
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, VIC, Australia
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Amir Iravani
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Phillip Koo
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Liza Lindenberg
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Richard P Baum
- Curanosticum Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, Wiesbaden, Germany
| | - Murat Fani Bozkurt
- Hacettepe University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño (La Rioja), Spain
| | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Flavio Forrer
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Rodney J Hicks
- The University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging / Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Levent Kabasakal
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Mark Konijnenberg
- Radiology & Nuclear Medicine Department, Erasmus MC, Rotterdam, The Netherlands
| | - Klaus Kopka
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
- Technical University Dresden, School of Science, Faculty of Chemistry and Food Chemistry; German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT) Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, RWTH Aachen University Medical Faculty, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Wim J G Oyen
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Milan, Italy
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Heiko Schoder
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Lisa Bodei
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefano Fanti
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ken Hermann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147, Essen, Germany
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18
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Calais J, Eulau SM, Gardner L, Hauke RJ, Kendi AT, Shore ND, Zhao S. Incorporating radioligand therapy in clinical practice in the United States for patients with prostate cancer. Cancer Treat Rev 2023; 115:102524. [PMID: 36933329 DOI: 10.1016/j.ctrv.2023.102524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
Prostate cancer (PC) is the second most commonly diagnosed cancer in the United States. Advanced PC evolves to metastatic castration-resistant PC (mCRPC). Theranostics combining prostate-specific membrane antigen-targeted positron emission tomography imaging and radioligand therapy (RLT) represents a precision medicine approach to PC treatment. With the recent approval of lutetium Lu 177 (177Lu) vipivotide tetraxetan for men with mCRPC, the utilization of RLT will increase. In this review, we suggest a framework for incorporating RLT for PC into clinical practice. A search of PubMed and Google Scholar was performed using keywords related to PC, RLT, prostate-specific membrane antigen, and novel RLT centers. The authors also provided opinions based on their clinical experience. The setup and operation of an RLT center requires the diligence and cooperation of a well-trained multidisciplinary team committed to patient safety and clinical efficacy. Administrative systems should ensure that treatment scheduling, reimbursement, and patient monitoring are efficient. For optimal outcomes, the clinical care team must have an organizational plan that delineates the full range of required tasks. Establishing new RLT centers for treatment of PC is possible with appropriate multidisciplinary planning. We provide an overview of the key elements to consider when establishing a safe, efficient, and high-quality RLT center.
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Affiliation(s)
- Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA.
| | - Stephen M Eulau
- Swedish Cancer Institute at Swedish Medical Center, 1221 Madison Street, Seattle, WA, USA.
| | - Linda Gardner
- Department of Nuclear Medicine, University of California, Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA.
| | - Ralph J Hauke
- Nebraska Cancer Specialists, 17201 Wright Street, Suite 200, Omaha, NE 68130, USA.
| | - Ayse T Kendi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Neal D Shore
- Carolina Urologic Research Center/GenesisCare, US, Myrtle Beach, SC 29572, USA.
| | - Song Zhao
- Swedish Cancer Institute at Swedish Medical Center, 1221 Madison Street, Seattle, WA, USA.
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19
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Beyer T, Czernin J, Freudenberg L, Giesel F, Hacker M, Hicks RJ, Krause BJ. A 2022 International Survey on the Status of Prostate Cancer Theranostics. J Nucl Med 2023; 64:47-53. [PMID: 35953304 DOI: 10.2967/jnumed.122.264298] [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: 04/21/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 01/07/2023] Open
Abstract
Growing interest in PSMA imaging using [68Ga]- or [18F]-labeled ligands and PSMA-based radioligand therapy (RLT) of prostate cancer (PCa) prompted us to survey the global community on their experiences and expectations. Methods: A web-based survey was composed to interrogate areas specific to PET imaging, the clinical value chain, and RLT applications. International responses were collected in early 2022. In total, over 300 valid responses were received and evaluated. Results: Most responses (83%) were given by nuclear medicine specialists with extensive experience in PET. At 22% of sites, PCa ranked "top" in cancer-type-specific PET indications, with an average and median of 15% and 10% of all cases, respectively. The most frequently used PSMA PET tracers were [68Ga]PSMA (32%) and [18F]PSMA-1007 (31%). Users reported a steady growth in PSMA PET and RLT over the past 5 y, averaging 50% and 82%, respectively, with a further 100% median growth projected over the next 5 y. Of note, more respondents indicated cognizance of personalized dosimetry than actually used it routinely. The most commonly identified barriers to future growth in PCa theranostics were radiopharmaceutical supply, reimbursement, staff availability, and buy-in of medical oncologists. Conclusion: Despite enthusiasm, this survey indicates variable adoption of PSMA imaging and RLT globally. Several challenges need to be addressed by the medical community, authorities, and patient advocacy groups in integrating PSMA-targeted theranostics into personalized medicine.
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Affiliation(s)
- Thomas Beyer
- QIMP Team, Centre Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | | | - Frederik Giesel
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany; Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Rodney J Hicks
- The Department of Medicine, St Vincent's Hospital, the University of Melbourne, Melbourne, Australia; and
| | - Bernd J Krause
- Rostock University Medical Centre, Department of Nuclear Medicine, Rostock, Germany
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20
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Yang H, Gao Z, Xu X, Liu C, Hu S, Zhang J, Song S. Dosimetry estimation and preliminary clinical application of [ 99mTc]Tc-HYNIC-PSMA-XL-2 in prostate cancer. Ann Nucl Med 2023; 37:60-69. [PMID: 36346503 DOI: 10.1007/s12149-022-01804-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Molecular imaging of prostate-specific membrane antigen (PSMA) inhibitors has become a favorite for prostate cancer (PCa). This study aimed to estimate the dosimetry and the preliminary clinical application of the [99mTc]Tc-HYNIC-PSMA-XL-2, which is a novel imaging tracer invented by our team that can specifically targets PSMA for PCa and its metastases. METHODS The single-photon emission computed tomography (SPECT) whole-body (WB) planar images were collected on 6 patients at 0.5, 1.0, 2.0, 4.0 and 8.0 h after 99mTc-PSMA-XL-2 injection, respectively. The SPECT/computed tomography (CT) scan was carried out immediately following the WB planar image scan performed after 2.0 h. The volumes of interest (VOIs) of the bladder, heart wall, intestines, kidneys, liver, lungs, and spleen were segmented in the SPECT/CT images. VOIs of the salivary glands and the whole body were drawn in SPECT planar images. The dosimetry toolkit was used to process the data and project the SPECT/CT images onto planar images. The dosimetry analysis was performed using the IDAC-Dose dosimetry software. Furthermore, other PCa patients were enrolled to study the preliminary clinical application of [99mTc]Tc-HYNIC-PSMA-XL-2. RESULTS The clearance of [99mTc]Tc-HYNIC-PSMA-XL-2 is primarily by the hepatobiliary and intestinal system, due to its lipophilic characteristic. The effective half-life of [99mTc]Tc-HYNIC-PSMA-XL-2 is about 3.90 h. High absorbed doses were observed in the salivary glands (1.93E-02 ± 3.88E-03 mSv/MBq), kidneys (1.63E-02 ± 7.32E-03 mSv/MBq) and spleen (1.21E-02 ± 2.64E-03 mSv/MBq). The total body effective dose was 4.84E-03 ± 9.30E-05 mSv/MBq. The preliminary clinical case indicated that [99mTc]Tc-HYNIC-PSMA-XL-2 SPECT/CT could detect the primary prostate lesion, lymph node and bone metastases comprehensively. CONCLUSION [99mTc]Tc-HYNIC-PSMA-XL-2 is a safe SPECT/CT tracer, which can detect prostate malignant lesions without interference from the bladder. In addition, the malignant lesions of the lymph node and bone of PCa patients also can be detected efficiently.
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Affiliation(s)
- Hongxing Yang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Center for Biomedical Imaging, Fudan University, No. 270, Dong'an Road, Shanghai, 200032, China.,Shanghai Engineering Research Center for Molecular Imaging Probes, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Institute of Modern Physics, Fudan University, No. 220, Handan Road, Yangpu District, Shanghai, 200433, China
| | - Zhiqi Gao
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Center for Biomedical Imaging, Fudan University, No. 270, Dong'an Road, Shanghai, 200032, China.,Shanghai Engineering Research Center for Molecular Imaging Probes, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Institute of Modern Physics, Fudan University, No. 220, Handan Road, Yangpu District, Shanghai, 200433, China
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Center for Biomedical Imaging, Fudan University, No. 270, Dong'an Road, Shanghai, 200032, China.,Shanghai Engineering Research Center for Molecular Imaging Probes, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Institute of Modern Physics, Fudan University, No. 220, Handan Road, Yangpu District, Shanghai, 200433, China
| | - Chang Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Center for Biomedical Imaging, Fudan University, No. 270, Dong'an Road, Shanghai, 200032, China.,Shanghai Engineering Research Center for Molecular Imaging Probes, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Institute of Modern Physics, Fudan University, No. 220, Handan Road, Yangpu District, Shanghai, 200433, China
| | - Silong Hu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Center for Biomedical Imaging, Fudan University, No. 270, Dong'an Road, Shanghai, 200032, China.,Shanghai Engineering Research Center for Molecular Imaging Probes, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China.,Institute of Modern Physics, Fudan University, No. 220, Handan Road, Yangpu District, Shanghai, 200433, China
| | - Jianping Zhang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong'an Road, Xuhui District, Shanghai, 200032, China. .,Center for Biomedical Imaging, Fudan University, No. 270, Dong'an Road, Shanghai, 200032, China. .,Shanghai Engineering Research Center for Molecular Imaging Probes, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China. .,Institute of Modern Physics, Fudan University, No. 220, Handan Road, Yangpu District, Shanghai, 200433, China.
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong'an Road, Xuhui District, Shanghai, 200032, China. .,Center for Biomedical Imaging, Fudan University, No. 270, Dong'an Road, Shanghai, 200032, China. .,Shanghai Engineering Research Center for Molecular Imaging Probes, No. 270, Dong'an Road, Xuhui District, Shanghai, 200032, China. .,Institute of Modern Physics, Fudan University, No. 220, Handan Road, Yangpu District, Shanghai, 200433, China.
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21
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Perera M, Morris MJ. From Concept to Regulatory Drug Approval: Lessons for Theranostics. J Nucl Med 2022; 63:1793-1801. [PMID: 36456108 PMCID: PMC9730919 DOI: 10.2967/jnumed.121.263301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/03/2022] [Indexed: 12/13/2022] Open
Abstract
Radiopharmaceutical therapy is an emerging treatment modality that has demonstrated increasing importance as a significant component in the treatment of cancer. Prostate cancer (PCa) remains one of the commonest solid-organ tumors and is associated with significant societal burdens. Despite significant disease heterogeneity, PCa remains an ideal candidate for radiopharmaceutical therapy because of the prolonged disease course, metastatic disease tropism, and sensitivity to radiation therapy. To date, advanced PCa remains one of the most successful arenas for the development and approval of radiopharmaceutical agents. In this review, we aim to summarize the complex processes required to obtain regulatory approval for a novel agent and highlight the limitations and hurdles specific to the approval of radiopharmaceutical agents. In advanced PCa, we outline the importance of a framework for trial design with respect to defining disease state and acceptable outcome measures-as recommended by the Prostate Cancer Clinical Trials Working Group (PCWG). Finally, using the principles mandated by the Food and Drug Administration approval process and the framework provided by the PCWG, we outline experience with the successful approval of the radiopharmaceutical agents 223Ra and 177Lu-PSMA-617.
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Affiliation(s)
- Marlon Perera
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Michael J. Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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22
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[177Lu]Lu-PSMA-617 (PluvictoTM): The First FDA-Approved Radiotherapeutical for Treatment of Prostate Cancer. Pharmaceuticals (Basel) 2022; 15:ph15101292. [PMID: 36297404 PMCID: PMC9608311 DOI: 10.3390/ph15101292] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022] Open
Abstract
In March 2022, [177Lu]Lu-PSMA-617 (PluvictoTM) was approved by the FDA for the treatment of prostate cancer patients. Until now, the approval has been limited to patients with PSMA-positive metastatic castration-resistant prostate cancer who have previously received other therapy options (such as inhibition of the androgen receptor pathway and taxane-based chemotherapy). [177Lu]Lu-PSMA-617, which combines a PSMA-specific peptidomimetic with a therapeutical radionuclide, is used in a radioligand therapy that selectively delivers ionizing radiation to tumor cells, causing their death, while sparing the surrounding healthy tissue. In numerous clinical trials, the efficacy of [177Lu]Lu-PSMA-617 was demonstrated.
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