医学
恩扎鲁胺
谷氨酸羧肽酶Ⅱ
前列腺癌
肿瘤科
多西紫杉醇
卡巴齐塔塞尔
内科学
放射性配体
癌症
雄激素剥夺疗法
雄激素受体
受体
作者
Sue Ping Thang,John Violet,Shahneen Sandhu,Amir Iravani,Tim Akhurst,Grace Kong,Aravind Ravi Kumar,Declan Murphy,Scott Williams,Rodney J. Hicks,Michael S. Hofman
标识
DOI:10.1016/j.euo.2018.11.007
摘要
Prostate-specific membrane antigen (PSMA) is overexpressed in metastatic castration-resistant prostate cancer (mCRPC) and represents a target for imaging and therapy. We undertook a prospective trial of 177Lu-PSMA-617 radioligand therapy in men with high PSMA expression who progressed after standard therapies. To determine outcomes for men screened for the trial but not treated because of low PSMA expression. Patients screened with 68Ga-PSMA-11 and 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography in a prospective trial. Patients ineligible for enrolment with low PSMA expression or FDG-positive PSMA-negative (discordant FDG-avid) disease were assessed. Subsequent treatments received were recorded. Kaplan-Meier analysis was used to determine overall survival from date of screening. Sixteen patients (24%) had low PSMA expression (n = 8) or discordant FDG-avid disease (n = 8). The median prostate-specific antigen doubling-time was 2.1 mo. Eleven patients had Gleason ≥8 disease. All patients had previously progressed after docetaxel, 44% after cabazitaxel, and 94% after abiraterone and/or enzalutamide. Nine patients had subsequent systemic antitumour treatment. Fifteen patients died, with median OS of 2.5 mo (95% confidence interval 1.7–5.0). Study limitations include uncertainty for imaging thresholds that define low PSMA expression. It is also possible that theranostic therapy could have improved survival in this cohort. Low PSMA expression or discordant FDG-avid disease in patients with mCRPC who progress after conventional therapies identifies a group with poor prognosis and short survival. The 177Lu-PSMA-617 radioligand may be an effective therapy for patients with advanced prostate cancer who progress after standard therapies. In this report we looked at outcomes for patients who were not eligible for this novel therapy on the basis of low prostate-specific membrane antigen uptake on screening positron emission tomography scans. We found that their outcomes were poor, with short survival.
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