[177Lu]放射配体治疗Taxane-Naïve与紫杉烷治疗转移性去势抵抗性前列腺癌的疗效结局:系统回顾和荟萃分析。

IF 9.1 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Nuclear Medicine Pub Date : 2023-08-01 DOI:10.2967/jnumed.123.265414
Swayamjeet Satapathy, Ranjit K Sahoo, Chandrasekhar Bal
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引用次数: 3

摘要

177Lu-前列腺特异性膜抗原(PSMA)抑制剂([177Lu]Lu-PSMA)的放射配体治疗(RLT)目前被批准用于至少1种紫紫烷和1种雄激素受体途径抑制剂进展后的转移性去势抵抗性前列腺癌(mCRPC)患者。然而,既往化疗对[177Lu]Lu-PSMA-RLT结果的影响是有争议的,各种研究显示不一致的结果。本研究旨在精确评估既往紫杉烷化疗对mCRPC患者在Lu-PSMA-RLT后的疗效和生存结局的影响[177Lu]。方法:本综述遵循系统评价和荟萃分析的首选报告项目(PRISMA)指南。在PubMed, Scopus和Embase中使用相关关键词进行搜索,并包括截至2022年12月的文章。终点包括前列腺特异性抗原(PSA)反应率(RR)、无进展生存期(progression-free survival)和总生存期(OS)。在可行的情况下,将患者的个人数据汇总。从单篇文章中提取单因素优势比(ORs)和风险比(hr),并通过荟萃分析得出汇总估计值和95% ci。结果:纳入13篇文章,2068例患者。在6篇文章(553例患者)中,taxane-naïve患者在[177Lu]Lu-PSMA-RLT后生化反应的几率显著提高(合并OR为1.82;95% ci, 1.21-2.71)。3篇文章的个体患者数据荟萃分析显示,taxane-naïve与紫杉烷治疗患者的PSA RR显著高于紫杉烷治疗患者(57.1% vs 39.5%;差异,17.6%;95% ci, 5.6%-28.9%)。此外,taxane-naïve状态也是显著更好的无进展生存期的预测因子(5篇文章;1027例;合并HR为0.60;95% CI, 0.51-0.69)和OS(8篇文章;1594例;合并HR为0.54;[177Lu]Lu-PSMA-RLT后95% CI, 0.43-0.68)。没有证据表明存在发表偏倚。结论:既往未接受紫杉烷治疗的mCRPC患者在接受[177Lu]Lu-PSMA-RLT治疗后的预后明显优于接受紫杉烷治疗的患者。目前需要在taxane-naïve环境下评估[177Lu]Lu-PSMA-RLT的进一步试验。
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[177Lu]Lu-PSMA-Radioligand Therapy Efficacy Outcomes in Taxane-Naïve Versus Taxane-Treated Patients with Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Metaanalysis.

Radioligand therapy (RLT) with 177Lu-prostate-specific membrane antigen (PSMA) inhibitors ([177Lu]Lu-PSMA) is currently approved for patients with metastatic castration-resistant prostate cancer (mCRPC) after progression with at least 1 taxane and 1 androgen-receptor-pathway inhibitor. However, the impact of prior chemotherapy on [177Lu]Lu-PSMA-RLT outcomes is debatable, with various studies showing inconsistent results. This study was conducted to precisely evaluate the impact of prior taxane chemotherapy on response and survival outcomes in mCRPC patients after [177Lu]Lu-PSMA-RLT. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches in PubMed, Scopus, and Embase were made using relevant key words, and articles up to December 2022 were included. The endpoints included prostate-specific antigen (PSA) response rate (RR), progression-free survival, and overall survival (OS). Individual patient data were pooled when feasible. Univariate odds ratios (ORs) and hazard ratios (HRs) were extracted from the individual articles, and pooled estimates and 95% CIs were generated using metaanalysis. Results: Thirteen articles comprising 2,068 patients were included. In 6 articles (553 patients), taxane-naïve patients had significantly better odds of biochemical response after [177Lu]Lu-PSMA-RLT (pooled OR, 1.82; 95% CI, 1.21-2.71). Individual patient data metaanalysis for PSA RRs in 3 articles revealed a significantly higher PSA RR in the taxane-naïve versus taxane-treated patients (57.1% vs. 39.5%; difference, 17.6%; 95% CI, 5.6%-28.9%). Further, taxane-naïve status was also a predictor of significantly better progression-free survival (5 articles; 1,027 patients; pooled HR, 0.60; 95% CI, 0.51-0.69) and OS (8 articles; 1,594 patients; pooled HR, 0.54; 95% CI, 0.43-0.68) after [177Lu]Lu-PSMA-RLT. There was no evidence of publication bias. Conclusion: mCRPC patients with no prior taxanes had significantly better outcomes after [177Lu]Lu-PSMA-RLT than did taxane-treated patients. Further trials evaluating [177Lu]Lu-PSMA-RLT in the taxane-naïve setting are now required.

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来源期刊
Journal of Nuclear Medicine
Journal of Nuclear Medicine 医学-核医学
CiteScore
13.00
自引率
8.60%
发文量
340
审稿时长
1 months
期刊介绍: The Journal of Nuclear Medicine (JNM), self-published by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), provides readers worldwide with clinical and basic science investigations, continuing education articles, reviews, employment opportunities, and updates on practice and research. In the 2022 Journal Citation Reports (released in June 2023), JNM ranked sixth in impact among 203 medical journals worldwide in the radiology, nuclear medicine, and medical imaging category.
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