Factors predicting biochemical response and survival benefits following radioligand therapy with [177Lu]Lu-PSMA in metastatic castrate-resistant prostate cancer: a review

Reyhaneh Manafi-Farid; Sara Harsini; Bahare Saidi; Hojat Ahmadzadehfar; Ken Herrmann; Alberto Briganti; Jochen Walz; Mohsen Beheshti

doi:10.1007/s00259-021-05237-y

Factors predicting biochemical response and survival benefits following radioligand therapy with [¹⁷⁷Lu]Lu-PSMA in metastatic castrate-resistant prostate cancer: a review

Eur J Nucl Med Mol Imaging. 2021 Nov;48(12):4028-4041. doi: 10.1007/s00259-021-05237-y. Epub 2021 Mar 6.

Authors

Reyhaneh Manafi-Farid¹, Sara Harsini^{1

2}, Bahare Saidi¹, Hojat Ahmadzadehfar³, Ken Herrmann⁴, Alberto Briganti⁵, Jochen Walz⁶, Mohsen Beheshti^{7

8}

Affiliations

¹ Research Center for Nuclear Medicine, Tehran University of Medical sciences, Tehran, Iran.
² Association of Nuclear Medicine and Molecular Imaging (ANMMI), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
³ Department of Nuclear Medicine, Klinikum Westfalen, Dortmund, Germany.
⁴ Department of Nuclear Medicine, University Hospital, Essen, Germany.
⁵ Urological Research Institute, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
⁶ Department of Urology, Institute Paoli-Calmettes Cancer Centre, Marseille, France.
⁷ Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria. m.beheshti@salk.at.
⁸ Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany. m.beheshti@salk.at.

Abstract

Background: Prostate cancer (PC) is one of the most common cancers in men. Although the overall prognosis is favorable, the management of metastatic castration-resistant prostate cancer (mCRPC) patients is challenging. Usually, mCRPC patients with progressive disease are considered for radioligand therapy (RLT) after exhaustion of other standard treatments. The prostate-specific membrane antigen (PSMA) labeled with Lutetium-177 ([¹⁷⁷Lu]Lu-PSMA) has been widely used, showing favorable and successful results in reducing prostate-specific antigen (PSA) levels, increasing quality of life, and decreasing pain, in a multitude of studies. Nevertheless, approximately thirty percent of patients do not respond to [¹⁷⁷Lu]Lu-PSMA RLT. Here, we only reviewed and reported the evaluated factors and their impact on survival or biochemical response to treatment to have an overview of the potentialprognostic parameters in [¹⁷⁷Lu]Lu-PSMA RLT.

Methods: Studies were retrieved by searching MEDLINE/PubMed and GoogleScholar. The search keywords were as follows: {("177Lu-PSMA") AND ("radioligand") AND ("prognosis") OR ("predict")}. Studies discussing one or more factors which may be prognostic or predictive of response to [¹⁷⁷Lu]Lu-PSMA RLT, that is PSA response and survival parameters, were included.

Results: Several demographic, histological, biochemical, and imaging factors have been assessed as predictive parameters for the response to thistreatment; however, the evaluated factors were diverse, and the results mostly were divergent, except for the PSA level reduction after treatment, which unanimously predicted prolonged survival.

Conclusion: Several studies have investigated a multitude of factors to detect those predicting response to [¹⁷⁷Lu]Lu-PSMA RLT. The results wereinconsistent regarding some factors, and some were evaluated in only a few studies. Future prospective randomized trials are required to detect theindependent prognostic factors, and to further determine the clinical and survival benefits of [¹⁷⁷Lu]Lu-PSMA RLT.

Keywords: Predictive factors; Prognosis; Radioligand therapy; Response to therapy; [177Lu]Lu-PSMA.

Publication types

Review

MeSH terms

Dipeptides
Heterocyclic Compounds, 1-Ring
Humans
Male
Prognosis
Prostatic Neoplasms, Castration-Resistant* / radiotherapy
Quality of Life*
Treatment Outcome

Substances

Dipeptides
Heterocyclic Compounds, 1-Ring