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Al-Ibraheem A, Abdlkadir AS, Sweedat DA, Maus S, Al-Rasheed U, Salah S, Khriesh F, Juaidi D, Abu Dayek D, Istatieh F, Anwar F, Asrawi A, Abufara A, Al-Rwashdeh M, Abu-Hijlih R, Sharaf B, Ghanem R, Abdel-Razeq H, Mansour A. From Despair to Hope: First Arabic Experience of 177Lu-PSMA and 161Tb-PSMA Therapy for Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2024; 16:1974. [PMID: 38893095 PMCID: PMC11171070 DOI: 10.3390/cancers16111974] [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: 04/23/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The objective of this retrospective study is to assess the effectiveness and safety of two beta-emitting prostate-specific membrane antigen (PSMA) radioligands, [177Lu]Lu and [161Tb]Tb, in heavily treated patients with metastatic castration-resistant prostate cancer (mCRPC). A total of 148 cycles of beta-emitting PSMA radioligand therapy were given to 53 patients at a specialized cancer care center in Amman, Jordan. This treatment was offered following the exhaustion of all prior treatment modalities. Approximately half of the cases (n = 26) demonstrated an initial partial response to PSMA radioligand therapy. Moreover, roughly one-fourth of the patients (n = 13) exhibited a sustained satisfactory biochemical response, which qualified them to receive a total of six PSMA radioligand therapy cycles and maintain continued follow-up for additional treatment cycles. This was reflected by an adequate prostate-specific antigen (PSA) decline and a concomitant partial response evident on [68Ga]Ga-PSMA positron emission tomography/computed tomography imaging. A minority of patients (n= 18; 34%) experienced side effects. Generally, these were low-grade and self-limiting toxicities. This study endorses previous research evidence about PSMA radioligand therapy's safety and efficacy. It also provides the first clinical insight from patients of Arab ethnicity. This should facilitate and promote further evidence, both regionally and internationally.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan; (A.S.A.); (D.A.S.); (U.A.-R.); (D.J.); (D.A.D.); (F.I.)
- School of Medicine, University of Jordan, Al-Jubeiha, Amman 11942, Jordan
| | - Ahmed Saad Abdlkadir
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan; (A.S.A.); (D.A.S.); (U.A.-R.); (D.J.); (D.A.D.); (F.I.)
| | - Deya’ Aldeen Sweedat
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan; (A.S.A.); (D.A.S.); (U.A.-R.); (D.J.); (D.A.D.); (F.I.)
| | - Stephan Maus
- Department of Nuclear Medicine, Saarland University Medical Center, D-66421 Homburg, Germany;
| | - Ula Al-Rasheed
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan; (A.S.A.); (D.A.S.); (U.A.-R.); (D.J.); (D.A.D.); (F.I.)
| | - Samer Salah
- Department of Medicine, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (S.S.); (A.A.); (M.A.-R.); (B.S.); (H.A.-R.)
| | - Fadi Khriesh
- Department of Nuclear Medicine, Klinikum Fulda, Pacelliallee 4, 36039 Fulda, Germany;
| | - Diyaa Juaidi
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan; (A.S.A.); (D.A.S.); (U.A.-R.); (D.J.); (D.A.D.); (F.I.)
| | - Dina Abu Dayek
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan; (A.S.A.); (D.A.S.); (U.A.-R.); (D.J.); (D.A.D.); (F.I.)
| | - Feras Istatieh
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Al-Jubeiha, Amman 11941, Jordan; (A.S.A.); (D.A.S.); (U.A.-R.); (D.J.); (D.A.D.); (F.I.)
| | - Farah Anwar
- Department of Nuclear Medicine, Warith International Cancer Institute, Karbala 56001, Iraq;
| | - Aisha Asrawi
- Department of Nursing, King Hussein Cancer Center (KHCC), Amman 11941, Jordan;
| | - Alaa Abufara
- Department of Medicine, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (S.S.); (A.A.); (M.A.-R.); (B.S.); (H.A.-R.)
| | - Mohammad Al-Rwashdeh
- Department of Medicine, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (S.S.); (A.A.); (M.A.-R.); (B.S.); (H.A.-R.)
| | - Ramiz Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center (KHCC), Amman 11941, Jordan;
| | - Baha’ Sharaf
- Department of Medicine, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (S.S.); (A.A.); (M.A.-R.); (B.S.); (H.A.-R.)
| | - Rami Ghanem
- Department of Surgery, King Hussein Cancer Center (KHCC), Amman 11941, Jordan;
| | - Hikmat Abdel-Razeq
- Department of Medicine, King Hussein Cancer Center (KHCC), Amman 11941, Jordan; (S.S.); (A.A.); (M.A.-R.); (B.S.); (H.A.-R.)
| | - Asem Mansour
- Department of Diagnostic Radiology, King Hussein Cancer Center (KHCC), Amman 11941, Jordan;
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Groener D, Wichert J, Adams M, Mader N, Klimek K, Nguyen Ngoc C, Baumgarten J, Happel C, Mandel P, Chun FKH, Tselis N, Grünwald F, Sabet A. Impact of [ 177Lu]Lu-PSMA-617 Radioligand Therapy on Reference Organ Uptake Assessed by [ 68Ga]Ga-PSMA-11-PET/CT. Cancers (Basel) 2023; 15:3878. [PMID: 37568694 PMCID: PMC10417367 DOI: 10.3390/cancers15153878] [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: 07/11/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
This study aims to assess the change in uptake to reference organs, including the liver, parotid and salivary glands after radioligand therapy (RLT) with [177Lu]Lu-PSMA-617 in relation to pretreatment imaging metrics. Eighty-five patients with mCRPC underwent [68Ga]Ga-PSMA-11 PET/CT imaging prior to (pre RLT PET) and after (post RLT PET) a median of 3 (IQR 2-6) RLT cycles with [177Lu]Lu-PSMA-617. PSMA-positive tumor burden was stratified into 4 groups based on modified PROMISE criteria (oligofocal, multifocal, disseminated, diffuse). Uptake (SUVmean, SUVmax) in liver tissue, parotid and submandibular glands was measured. A control group was established with 54 patients who had received two separate PET acquisitions following the same protocol (PET1, PET2) within 12 months for localized or oligofocal prostate cancer without RLT in the interim. Baseline uptake values (SUVmean, SUVmax) in parotid (10.8 ± 3.2, 16.8 ± 5.4) and submandibular glands (11.3 ± 2.8, 18.1 ± 4.7) are 2-fold compared to liver uptake (4.9 ± 1.4, 7.7 ± 2.0), with no significant change between PET 1 and PET 2 in the control group. In the RLT group, increasing tumor burden class is significantly associated with decreasing uptake in the liver (p = 0.013), parotid (p < 0.001) and submandibular glands (p < 0.001); this tumor sink effect by respective tumor burden is widely maintained after RLT (p = 0.011, p < 0.001, p < 0.001). RLT has a significant impact on salivary gland uptake with decreasing values per patient in all groups of disease burden change (up to -30.4% in submandibular glands, p < 0.001), while liver tissue shows rising values in patients with declining tumor burden throughout RLT (+18.6%, p = 0.020). Uptake in liver tissue and salivary glands on [68Ga]Ga-PSMA-11 PET/CT imaging is inversely related to tumor burden prior to and following RLT with [177Lu]Lu-PSMA-617. Per patient, salivary gland uptake is further reduced throughout RLT independently from tumor burden, while changes in liver uptake remain burden-dependent. Liver and salivary gland uptake-derived metrics and segmentation thresholds may thus be of limited value when used as reference for response assessment to RLT.
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Affiliation(s)
- Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Jennifer Wichert
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Magdalena Adams
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Konrad Klimek
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Christina Nguyen Ngoc
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Justus Baumgarten
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (P.M.); (F.K.H.C.)
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (P.M.); (F.K.H.C.)
| | - Nikolaos Tselis
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany;
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany; (D.G.); (J.W.); (M.A.); (N.M.); (K.K.); (C.N.N.); (J.B.); (C.H.)
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Rathore R, Rangrej SB, Kieme I, Carvalho V, King K, Amadou Y, McKinley J, Masawi A. Treatment of Advanced Metastatic Prostate Cancer Using Molecular-Targeted Therapy: Radioligand Lutetium-177 Prostate-Specific Membrane Antigen. Cureus 2023; 15:e37778. [PMID: 37214073 PMCID: PMC10195000 DOI: 10.7759/cureus.37778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
This study investigates the predicting factors of the biochemical response and survival of patients with advanced metastatic prostate cancer who underwent therapy with radioligand lutetium-177 (177Lu)-prostate-specific membrane antigen (PSMA), often referred to as [177Lu]Lu-PSMA. This study is a review of the previous literature. This study included articles published in the last 10 years in the English language. According to the literature review, treatment with [177Lu]Lu-PSMA has a positive impact on prostate-specific antigen (PSA) within the first cycle and a negative impact on lymph node metastasis. There is a plausible positive impact on PSA after multiple cycles and performance status and a negative impact on visceral metastasis. In conclusion, the reviews show that treatment with [177Lu]Lu-PSMA in patients with castration-resistant prostate cancer is beneficial in reducing PSA and metastasis.
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Affiliation(s)
- Rajni Rathore
- Pharmacology and Therapeutics, Saint James School of Medicine, Arnos Vale, VCT
| | - Shahid B Rangrej
- Anatomy/Research, Saint James School of Medicine, Arnos Vale, VCT
| | - Ian Kieme
- Medical School, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Katie King
- Medical School, Saint James School of Medicine, Arnos Vale, VCT
| | - Yacoubou Amadou
- Medical School, Saint James School of Medicine, Arnos Vale, VCT
| | - John McKinley
- Medical School, Saint James School of Medicine, Arnos Vale, VCT
| | - Audrey Masawi
- Medical School, Saint James School of Medicine, Arnos Vale, VCT
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Lv Z, Wang X, Zhu C, Wang K. The global status of research in prostate cancer bone metastasis: A bibliometric and visualized analysis. Front Med (Lausanne) 2022; 9:931422. [PMID: 35991630 PMCID: PMC9381755 DOI: 10.3389/fmed.2022.931422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Prostate cancer (PCa) is a serious threat to the health of elderly aged groups. It is very important to understand the occurrence and development of PCa for early diagnosis, treatment and metastasis control. This study aims to elucidate the international frontier research direction and literature distribution through bibliometric and visual analyses of PCa bone metastasis. Methods Data were obtained from the Web of Science core collection database, which collected 2,246 papers related to PCa bone metastasis from 1 January 2012 to 31 December 2021. The collected data were analyzed using the VOSviewer software for citation, co-authorship, co-citation, bibliometric coupling, and co-occurrence. Results Over the past decade, published papers have increased annually. The United States of America has published 890 papers with 29,161 citations, far more than any other country, and it has the most extensive collaboration with other countries. For example, 33 articles by Saad Fred were cited 2,721 times, and 91 articles from the University of Texas MD Anderson CANC CTR were cited 3,037 times, the most cited author and organization. Peng Xinsheng and Duke UNIV comprise the most active collaborative author and organization, respectively. The most co-cited journal was CANCER RES, with 3,195 citations. Studies of PCa bone metastasis can be divided into four categories: “basic research,” “auxiliary diagnosis and treatment,” “clinical trial,” and “prognosis.” Conclusion Our results provide a comprehensive overview of the research priorities and future directions of PCa bone metastasis, which can further accurately guide researchers in diagnosis, treatment, and personalized prevention.
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Affiliation(s)
- Zongwei Lv
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xia Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunming Zhu
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Chunming Zhu,
| | - Kefeng Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
- Kefeng Wang,
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Hematologic toxicity profile and efficacy of [ 225Ac]Ac-PSMA-617 α-radioligand therapy of patients with extensive skeletal metastases of castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging 2022; 49:3581-3592. [PMID: 35384462 DOI: 10.1007/s00259-022-05778-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/20/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Actinium-225-labeled prostate-specific membrane antigen ([225Ac]Ac-PSMA-617) is safe and effective in the treatment of metastatic castration-resistant prostate cancer (mCRPC). No study has specifically assessed its safety in patients with extensive skeletal metastases of mCRPC. We aimed to investigate the hematologic toxicity and efficacy of [225Ac]Ac-PSMA-617 therapy in patients with extensive skeletal metastases of mCRPC. METHODS We retrospectively reviewed the medical record of patients treated with [225Ac]Ac-PSMA-617 for mCRPC. We included patients with a superscan pattern of skeletal metastases and those with 20 or more multifocal sites of skeletal metastases on baseline [68 Ga]Ga-PSMA-11 PET/CT. We reviewed the levels of hemoglobin, white blood cell (WBC), and platelet prior to each cycle of treatment and determined the presence of impaired bone marrow function at baseline and the grade of toxicity in the hematologic parameters induced by treatment. We evaluated the predictors of hematologic toxicity using binary logistic regression analysis. We also determined the presence of renal dysfunction before or during treatment. We assessed response to treatment using prostate-specific antigen response and the progression-free survival (PFS) and overall survival (OS). RESULTS A total of 106 patients were included. Skeletal metastasis was in the superscan pattern in 34 patients (32.1%) and multifocal in 72 patients (67.9%). The median treatment cycle was 4 (range = 1-9). Ninety-eight patients (92.5%) had abnormal baseline hematologic parameters. One patient had grade 4 thrombocytopenia. Grade 3 anemia, leukopenia, and thrombocytopenia were seen in 1 (0.9%), 3 (2.8%), and 2 (1.9%) patients, respectively. Age, the number of treatment cycles, and the presence of renal dysfunction were significant predictors of hematologic toxicity. Eighty-five patients (80.2%) achieved PSA response. The median PFS and OS of the study population were 14:00 (95%CI: 8.15-19.86) months and 15.0 (95%CI: 12.8-17.2) months, respectively. CONCLUSIONS [225Ac]Ac-PSMA-617 induces a good anti-tumor effect in about 80% of patients with extensive skeletal metastases of mCRPC with a rare incidence of severe hematologic toxicity. Age, number of treatment cycles, and the presence of renal dysfunction were significant risk factors for hematologic toxicity of [225Ac]Ac-PSMA-617 therapy.
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Safety and Efficacy of 177Lutetium-PSMA-617 Radioligand Therapy Shortly after Failing 223Radium-Dichloride. Cancers (Basel) 2022; 14:cancers14030557. [PMID: 35158825 PMCID: PMC8833613 DOI: 10.3390/cancers14030557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/20/2023] Open
Abstract
Bone-seeking 223Radium-dichloride (223Ra) is an established treatment prolonging survival and reducing morbidity in selected patients with metastatic castration-resistant prostate cancer (mCRPC) with skeletal involvement. Radioligand therapy with 177Lutetium-PSMA-617 (177Lu-PSMA-617) has been increasingly implemented in patients with mCRPC failing conventional treatment options. In this study, the safety and efficacy of 177Lu-PSMA-617 in patients with progressive bone involvement under treatment with 223Ra was assessed. Twenty-eight men (median age 73 years, range 63–89 years) with progressive mCRPC, who started 177Lu-PSMA-617 within 8 weeks after the last 223Ra administration, received a median of 4 (IQR 3–6) and a total of 120 cycles of 223Ra and a median of 4 (IQR 2–7) cycles 177Lu-PSMA-617 with a mean treatment activity of 6.5 ± 1.2 GBq per cycle, reaching a mean cumulative activity of 30.7 ± 23.4 GBq. A PSA response (≥50% PSA decline 12 weeks after the first 177Lu-PSMA-617 cycle) was observed in 18/28 (64.3%) patients and imaging-based partial remission (PR) was observed in 11/28 (39.3%) patients. Median imaging-based progression-free survival (PFS) was 10 (95% CI, 6–14) months and median overall survival (OS) was 18 (95% CI, 14–22) months. Patients with low bone tumor burden (2–20 lesions) had a significantly longer OS (28 vs. 14 months, p < 0.045) compared to patients with a high tumor burden (>20 lesions). Grade ≥ 3 hematological toxicity was observed in six patients after their last treatment cycle with anemia, leukopenia and thrombocytopenia in 5/28 (17.9%), 4/28 (14.3%) and 6/28 (21.4%) patients, respectively. In progressive bone-metastatic mCRPC patients, prompt initiation of 177Lu-PSMA-617 after failing 223Ra is effective with an acceptable toxicity profile.
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