Pre- and intratherapeutic predictors of overall survival in patients with advanced metastasized castration-resistant prostate cancer receiving Lu-177-PSMA-617 radioligand therapy

Background

Systemic Lutetium-177 prostate-specific membrane antigen-617 radioligand therapy (Lu-177-PSMA-617-RLT) is a novel treatment approach in patients suffering from metastasized castration-resistant prostate cancer. Nonetheless, a therapeutic response may fail to appear in a proportion of patients. This study aims to identify routinely obtainable pre- and intratherapeutic parameters to allow a prediction of overall survival in patients receiving Lu-177-PSMA-617 radioligand therapy.

Methods

Between January 2015 and December 2020 52 patients treated with a total of 146 cycles Lu-177-PSMA-617-RLT were retrospectively analysed in a single-center trial. The median overall survival time (OS) was compared to pre-therapeutic serological parameters, the extend of metastatic spread and previously performed therapies using Kaplan-Meier estimators and multivariate Cox-regression. Bonferroni-Holm correction was performed on all statistical tests.

Results

The median OS of all patients was 55.6 weeks. Multivariate Cox-regression revealed significant lower survival for decreased pretherapeutic hemoglobin levels (HR 0.698 per g/dl; 95%-CI 0.560-0.872; p = 0.001), increased lactate dehydrogenase (LDH) levels (HR 1.073 per 25 U/l; 95%-CI 1.024-1.125; p = 0.003) and the presence of hepatic metastasis (HR 6.981; 95%-CI 2.583-18.863; p < 0.001). Increased pretherapeutic c-reactive protein (CRP), alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) levels were also associated with a shorter survival.

Conclusion

Pre-therapeutic hemoglobin and LDH levels, as well as the presence of hepatic metastasis are independent predictors of overall survival in patients receiving Lu-177-PSMA-617-RLT. CRP, ALP and GGT levels cloud be utilized as additional decision aids when a Lu-177-PSMA-617-RLT is intended. Trial Registration Not applicable (retrospective observational study).

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Additional data

Published in:
BMC urology
Publisher:
Springer Science and Business Media LLC
Publishing place:
London
Vol.:
22
No.:
1
ISSN:
1471-2490
Date Issued:
2022
URN:
urn:nbn:de:gbv:8:3-2023-00661-3
DOI:
10.1186/s12894-022-01050-3
Other identifier (pubmed):
35788220
Language:
English
Type of Resource:
Text
Keywords:
Humans; Liver Neoplasms; Lutetium; Radioisotopes; Heterocyclic Compounds, 1-Ring; Prostate-Specific Antigen; Dipeptides; Retrospective Studies; Male; Prostatic Neoplasms, Castration-Resistant; Survival analysis; Lu-177-psma-617; Radioligand Therapy, Castration-resistant Prostate Cancer
Classification:
Published version
DDC subject of DNB:
610 Medical sciences, health
Hosting institution:
Faculties, Faculty of Medicine
Hosting institution:
Affiliated Institutes, University Hospital Schleswig-Holstein (UKSH)

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