Clinical genitourinary cancer · 2026
LuRa: Efficacy and Safety of Radium-223 Following [177Lu]Lu-PSMA-617 in Patients With Metastatic Castration-Resistant Prostate Cancer.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Zarka Jabra, Juthani Ronit, Sartor Oliver, Muniz Miguel, Kase Adam M, Riaz Irbaz B, Naqvi Arsalan, Heath Elisabeth, Orme Jacob J, Scharf Zachary, Belge Bilgin Gokce, Kwon Eugene D, Jang Albert, Tarhini Ali, Johnson Geoffrey B, Kendi Ayse Tuba, Thorpe Matthew P, Patnaik Mrinal S, Kusne Yael, Jacene Heather, Ravi Praful, Childs Daniel S
Аннотация
INTRODUCTION/BACKGROUND: Approval of [177Lu]Lu-PSMA-617 has changed the usual sequencing of treatments for metastatic castration-resistant prostate cancer (mCRPC). There is limited data on outcomes and safety of therapies used after its administration.
METHODS: We conducted a retrospective, multi-institutional analysis including patients with mCRPC who received Radium-223 (Ra-223) after [177Lu]Lu-PSMA-617. Patients from Mayo Clinic and Dana-Farber Cancer Institute were evaluated for multiple efficacy and tolerability endpoints, with particular attention given to hematologic toxicities and skeletal-related events.
RESULTS: Among 21 patients analyzed, 19% (n = 4) completed all 6 planned Ra-223 cycles. Reasons for early treatment discontinuation included: disease progression (n = 13, 62%) and toxicity (n = 2, 10%). Hematologic toxicity included grade ≥ 3 anemia and thrombocytopenia in 33% (n = 7) and 19% (n = 4) of patients, respectively, and 38% (n = 8) required transfusions, all of which occurred within 30 days following the final Ra-223 cycle. Four patients (19%) developed new skeletal-related events after starting Ra-223. One PSA50 response was observed and ≥ % reduction in alkaline phosphatase levels occurred in 42% of patients (n=9). The median PSA progression-free survival was 2.5 months (95% CI; 1.4 - 3.8 months). The median overall survival was 10.6 months (95% CI; 5.2 - 20.4 months) and 76% (n = 16) of patients survived six months beyond their first dose of Ra-223.
CONCLUSION: These data suggest that Ra-223 after [177Lu]Lu-PSMA-617 is feasible with efficacy even amongst heavily pre-treated patients. The observed hematologic toxicities and fractures underscore the need for careful patient selection and monitoring.
METHODS: We conducted a retrospective, multi-institutional analysis including patients with mCRPC who received Radium-223 (Ra-223) after [177Lu]Lu-PSMA-617. Patients from Mayo Clinic and Dana-Farber Cancer Institute were evaluated for multiple efficacy and tolerability endpoints, with particular attention given to hematologic toxicities and skeletal-related events.
RESULTS: Among 21 patients analyzed, 19% (n = 4) completed all 6 planned Ra-223 cycles. Reasons for early treatment discontinuation included: disease progression (n = 13, 62%) and toxicity (n = 2, 10%). Hematologic toxicity included grade ≥ 3 anemia and thrombocytopenia in 33% (n = 7) and 19% (n = 4) of patients, respectively, and 38% (n = 8) required transfusions, all of which occurred within 30 days following the final Ra-223 cycle. Four patients (19%) developed new skeletal-related events after starting Ra-223. One PSA50 response was observed and ≥ % reduction in alkaline phosphatase levels occurred in 42% of patients (n=9). The median PSA progression-free survival was 2.5 months (95% CI; 1.4 - 3.8 months). The median overall survival was 10.6 months (95% CI; 5.2 - 20.4 months) and 76% (n = 16) of patients survived six months beyond their first dose of Ra-223.
CONCLUSION: These data suggest that Ra-223 after [177Lu]Lu-PSMA-617 is feasible with efficacy even amongst heavily pre-treated patients. The observed hematologic toxicities and fractures underscore the need for careful patient selection and monitoring.