177Lu-Prostate-Specific Membrane Antigen Ligand After 223Ra Treatment in Men with Bone-Metastatic Castration-Resistant Prostate Cancer: Real-World Clinical Experience

Oliver Sartor, Christian la Fougère, Markus Essler, Samer Ezziddin, Gero Kramer, Jörg Ellinger, Luke Nordquist, John Sylvester, Giovanni Paganelli, Avivit Peer, Martin Bögemann, Jeffrey Meltzer, Per Sandström, Frank Verholen, Daniel Y Song, Oliver Sartor, Christian la Fougère, Markus Essler, Samer Ezziddin, Gero Kramer, Jörg Ellinger, Luke Nordquist, John Sylvester, Giovanni Paganelli, Avivit Peer, Martin Bögemann, Jeffrey Meltzer, Per Sandström, Frank Verholen, Daniel Y Song

Abstract

We analyzed real-world clinical outcomes of sequential α-/β-emitter therapy for metastatic castration-resistant prostate cancer (mCRPC). Methods: We assessed safety and overall survival in 26 patients who received 177Lu-prostate-specific membrane antigen ligand (177Lu-PSMA) after 223Ra in the ongoing noninterventional REASSURE study (223Ra α-Emitter Agent in Nonintervention Safety Study in mCRPC Population for Long-Term Evaluation; NCT02141438). Results: Patients received 223Ra for a median of 6 injections and subsequent 177Lu-PSMA for a median of 3.5 mo (≥ the fourth therapy in 69%). The median time between 223Ra and 177Lu-PSMA treatment was 8 mo (range, 1-31 mo). Grade 3 hematologic events occurred in 9 of 26 patients (during or after 177Lu-PSMA treatment in 5/9 patients; 8/9 patients had also received docetaxel). Median overall survival was 28.0 mo from the 223Ra start and 13.2 mo from the 177Lu-PSMA start. Conclusion: Although the small sample size precludes definitive conclusions, these preliminary data, especially the 177Lu-PSMA treatment duration, suggest that the use of 177Lu-PSMA after 223Ra is feasible in this real-world setting.

Keywords: 177Lu-prostate-specific membrane antigen; 223Ra; metastatic castration-resistant prostate cancer; real-world evidence; treatment sequence.

© 2022 by the Society of Nuclear Medicine and Molecular Imaging.

Figures

Graphical abstract
Graphical abstract
FIGURE 1.
FIGURE 1.
Anticancer therapies administered before 177Lu–PSMA. All patients received 223Ra.
FIGURE 2.
FIGURE 2.
Time since end of 223Ra to start of 177Lu-PSMA ligand and duration of 177Lu-PSMA therapy.

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