Mike Wenzel, Benedikt Hoeh, Carolin Siech, Florestan Koll, Clara Humke, Daniel Groener, Thomas Steuber, Markus Graefen, Tobias Maurer, Severine Banek, Felix K. H. Chun, Philipp Mandel
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Comparison was made against current standard of care with ARPI or docetaxel, irrespective of the previous used staging modality.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 269 patients, 11% received Lu-PSMA in first/second-line mCRPC vs. 57% ARPI vs. 33% docetaxel. Mostly no significant baseline differences between Lu-PSMA and ARPI patients were observed, while Lu-PSMA patients were significantly older, received less systematic treatments and ECOG1-2 proportions were higher, relative to docetaxel patients. In PFS (13.3 vs. 8.2 months, hazard ratio [HR]: 0.70, <i>p</i> = 0.16) and OS analyses (68.9 vs. 39.1 months, HR: 0.64, <i>p</i> = 0.2), Lu-PSMA was numerically more favorable than ARPI. In additional multivariable Cox regression models, Lu-PSMA was significant better regarding PFS and OS, relative to ARPI (both <i>p</i> < 0.05). Compared to docetaxel, also significant better PFS (13.3 vs. 8.1 months, HR: 0.46) and OS (68.9 vs. 27.3 months, HR: 0.34, both <i>p</i> < 0.01) was observed for Lu-PSMA treatment. The OS advantage was also observed after multivariable adjustment (<i>p</i> < 0.01).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>This retrospective single-center study including a substantial proportion of patients with treatment preference for Lu-PSMA suggests that Lu-PSMA therapy provides significantly more favorable PFS and OS outcomes in taxan-naïve mCRPC patients after previous ARPI treatment, relative to ARPI or docetaxel treatment and may be considered as an early mCRPC treatment option.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"27 1","pages":""},"PeriodicalIF":8.6000,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Lutetium-177 PSMA radioligand therapy in taxan-naive first- and second-line metastatic castration resistant prostate cancer after first-line ARPI therapy\",\"authors\":\"Mike Wenzel, Benedikt Hoeh, Carolin Siech, Florestan Koll, Clara Humke, Daniel Groener, Thomas Steuber, Markus Graefen, Tobias Maurer, Severine Banek, Felix K. 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引用次数: 0
摘要
目的：镥-177前列腺特异性膜抗原（Lu-PSMA）放射配体治疗是ema批准的用于雄激素受体途径抑制（ARPI）和紫杉醇化疗后转移性去势抵抗性前列腺癌（mCRPC）的治疗方法。然而，它对taxan-naïve患者的影响目前还在研究中。方法：我们依靠FRAMCAP数据库，详细阐述taxan-naïve mCRPC患者在既往ARPI治疗后的无进展（PFS）和总体（OS）的Lu-PSMA治疗结果。与ARPI或多西他赛的当前护理标准进行比较，而不考虑先前使用的分期方式。269例患者中，11%的患者在一线/二线mCRPC中接受了Lu-PSMA治疗，ARPI为57%，多西紫杉醇为33%。与多西他赛患者相比，Lu-PSMA和ARPI患者的基线差异大多不显著，但Lu-PSMA患者明显年龄较大，接受系统治疗较少，ECOG1-2比例较高。在PFS （13.3 vs. 8.2个月，风险比[HR]: 0.70, p = 0.16）和OS分析（68.9 vs. 39.1个月，HR: 0.64, p = 0.2）中，Lu-PSMA在数值上比ARPI更有利。在其他多变量Cox回归模型中，相对于ARPI， Lu-PSMA在PFS和OS方面显著优于ARPI （p < 0.05）。与多西他赛相比，Lu-PSMA治疗的PFS（13.3个月vs 8.1个月，HR: 0.46）和OS（68.9个月vs 27.3个月，HR: 0.34, p < 0.01）也有显著改善。多变量调整后，OS也有优势（p < 0.01）。结论该回顾性单中心研究纳入了相当比例的治疗偏好为Lu-PSMA的患者，表明相对于ARPI或多西他赛治疗，Lu-PSMA治疗在先前ARPI治疗后的taxan-naïve mCRPC患者的PFS和OS结果明显更好，可以考虑作为早期mCRPC的治疗选择。
Lutetium-177 PSMA radioligand therapy in taxan-naive first- and second-line metastatic castration resistant prostate cancer after first-line ARPI therapy
Purpose
Lutetium-177 Prostate-specific membrane antigen (Lu-PSMA) radioligand therapy is EMA-approved for metastatic castration resistant prostate cancer (mCRPC) after androgen receptor pathway inhibition (ARPI) and taxan-based chemotherapy. However, its effect in taxan-naïve patients is under current investigation.
Methods
We relied on the FRAMCAP database to elaborate Lu-PSMA therapy outcomes of progression-free (PFS) and overall (OS) in taxan-naïve mCRPC patients after previous ARPI treatment. Comparison was made against current standard of care with ARPI or docetaxel, irrespective of the previous used staging modality.
Results
Of 269 patients, 11% received Lu-PSMA in first/second-line mCRPC vs. 57% ARPI vs. 33% docetaxel. Mostly no significant baseline differences between Lu-PSMA and ARPI patients were observed, while Lu-PSMA patients were significantly older, received less systematic treatments and ECOG1-2 proportions were higher, relative to docetaxel patients. In PFS (13.3 vs. 8.2 months, hazard ratio [HR]: 0.70, p = 0.16) and OS analyses (68.9 vs. 39.1 months, HR: 0.64, p = 0.2), Lu-PSMA was numerically more favorable than ARPI. In additional multivariable Cox regression models, Lu-PSMA was significant better regarding PFS and OS, relative to ARPI (both p < 0.05). Compared to docetaxel, also significant better PFS (13.3 vs. 8.1 months, HR: 0.46) and OS (68.9 vs. 27.3 months, HR: 0.34, both p < 0.01) was observed for Lu-PSMA treatment. The OS advantage was also observed after multivariable adjustment (p < 0.01).
Conclusion
This retrospective single-center study including a substantial proportion of patients with treatment preference for Lu-PSMA suggests that Lu-PSMA therapy provides significantly more favorable PFS and OS outcomes in taxan-naïve mCRPC patients after previous ARPI treatment, relative to ARPI or docetaxel treatment and may be considered as an early mCRPC treatment option.
期刊介绍：
The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.
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