Extended PSMA therapy safe and effective for prostate cancer patients, research finds

Medical Xpress / Society of Nuclear Medicine & Molecular Imaging / Journal of Nuclear Medicine ^ | June 4, 2024 | Robert Seifert et al

[ConservativeMind]

Extended prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical therapy (177Lu-PSMA) beyond six cycles is an effective and well-tolerated treatment for metastatic castration-resistant prostate cancer patients, according to new research.

Selected patients who received extended treatment—either continuously or following a treatment break—experienced a favorable median survival of 31.3 months from the first administration.

Said Wolfgang P. Fendler, MD., "It may be beneficial to extend the use of 177Lu-PSMA, however, systematic data on safety and the antitumor effect of 177Lu-PSMA radiopharmaceutical therapy beyond six cycles is scarce."

The multicenter retrospective analysis included 111 metastatic castration-resistant prostate cancer patients who received more than six cycles of 177Lu-PSMA. Forty-three patients (38.7%) received continuous 177Lu-PSMA treatment and 68 (71.3%) received rechallenge treatment after a therapy break of at least four months.

Researchers assessed overall survival, prostate-specific antigen (PSA) decline, PSMA PET response, and adverse events to determine the safety and efficacy of extended 177Lu-PSMA therapy.

Overall survival from the initiation of 177Lu-PSMA therapy was 23.2 months for the continuous treatment group and 40.2 months for the rechallenge group; the median overall survival for both groups was 31.3 months. The PSA decline of more than 50% and the initial partial response rate on PSMA PET was significantly higher in the rechallenge group than in the continuous treatment group. Rates of grade three to four toxicity were comparable between both groups.

"This study represents the inaugural multicenter investigation of extended 177Lu-PSMA therapy, encompassing up to 13 cycles of treatment, continuously or following a treatment break. Dose reduction and discontinuation rates due to adverse events were low and patients achieved durable responses after treatment pause," said Tugce Telli, MD.

"Given the limited treatment options for metastatic castration-resistant prostate cancer, the extension or retreatment of 177Lu-PSMA therapy beyond six cycles may be a valuable option for patients."

[ConservativeMind]

It appears the extra treatments worked far better when having breaks of four months between therapy occasions, but both non-stop and pausing groups did well, with the pausing groups having high percentages of PSA reduction and close to double the survival time during the trial, as I read it.

[ConservativeMind]

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[WASCWatch]

I am currently on 120 mg of Xtandi per day. Stopped the Lupron injections 10 months ago. PSA is still undetectable as of four weeks ago. Had 8 mets when I was originally diagnosed almost 10years ago.

[ifinnegan]

10 years. Good to hear.

How long did you take lupron and why the switch to Xtandi?

[PGalt]

Thanks for posting. Life/health BUMP!

[steve8714]

What about the radiation risk of other cancers, like Myeloma?

[brianr10]

Had to have been the worst moment of your life. It was for me.