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Karimzadeh A, Hansen K, Hein S, Haller B, Heck MM, Tauber R, D Alessandria C, Eiber M, Rauscher I. Impact of baseline 18F-flotufolastat PET bone tumor volume for prognosticating severe hematologic toxicity in patients with metastatic castration-resistant prostate Cancer receiving 177Lu-PSMA-targeted radioligand therapy. Eur J Nucl Med Mol Imaging 2025:10.1007/s00259-025-07200-7. [PMID: 40383857 DOI: 10.1007/s00259-025-07200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 03/06/2025] [Indexed: 05/20/2025]
Abstract
PURPOSE This retrospective analysis evaluated the prognostic value of baseline 18F-flotufolastat-PET bone tumor metrics for severe hematologic toxicity in metastatic castration-resistant prostate cancer (mCRPC) patients treated with [177Lu]Lu-PSMA-I&T. METHODS Data from 182 mCRPC patients with baseline 18F-flotufolastat-PET scans and complete hematologic profiles were analyzed. Bone lesions were semiautomatically delineated, and clinical parameters (e.g., pretreatments, lab results) were assessed. Hematologic adverse events (AEs) were defined per Common Terminology Criteria for Adverse Events version 5.0, with grades 3-4 considered severe. Cox regression was used to identify prognostic factors for AEs. RESULTS Baseline bone tumor volume prognosticated leukocytopenia (HR 1.03 per 100 ml, p = 0.036), while the number of bone lesions was prognostic for anemia (HR 1.04 per 10 lesions, p < 0.001) and severe anemia (HR per 10 lesions 1.05, p = 0.009). Higher baseline hemoglobin correlated with reduced leukocytopenia (HR 0.74, p = 0.002), thrombocytopenia (HR 0.80, p = 0.033), and severe anemia (HR 0.52, p < 0.001). Baseline kidney dysfunction was linked to anemia (HR 2.46, p = 0.002) and severe anemia (HR 3.81, p = 0.023). Prior [223Ra]Radiumdichloride treatment prognosticated severe thrombocytopenia (HR 6.43, p = 0.021). CONCLUSION Baseline 18F-flotufolastat-PET metrics and pretherapeutic clinical parameters are key prognostic factors for severe hematologic toxicity in mCRPC patients treated with [177Lu]Lu-PSMA-I&T.
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Affiliation(s)
- Amir Karimzadeh
- Department of Nuclear Medicine, School of Medicine and Health, TUM University Hospital, Munich, Germany.
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Kimberley Hansen
- Department of Nuclear Medicine, School of Medicine and Health, TUM University Hospital, Munich, Germany
| | - Stefan Hein
- Department of Nuclear Medicine, School of Medicine and Health, TUM University Hospital, Munich, Germany
| | - Bernhard Haller
- School of Medicine and Health, Institute of AI and Informatics in Medicine, Technical University of Munich, TUM University Hospital, Munich, Germany
| | - Matthias M Heck
- Department of Urology, School of Medicine and Health, TUM University Hospital, Munich, Germany
| | - Robert Tauber
- Department of Urology, School of Medicine and Health, TUM University Hospital, Munich, Germany
| | - Calogero D Alessandria
- Department of Nuclear Medicine, School of Medicine and Health, TUM University Hospital, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine and Health, TUM University Hospital, Munich, Germany
- Bavarian Cancer Research Center, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine and Health, TUM University Hospital, Munich, Germany
- Bavarian Cancer Research Center, Munich, Germany
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Jadvar H, Iravani A, Bodei L, Calais J. Challenges with 177Lu-PSMA-617 Radiopharmaceutical Therapy in Clinical Practice. J Nucl Med 2024:jnumed.124.268023. [PMID: 39299786 DOI: 10.2967/jnumed.124.268023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/21/2024] [Indexed: 09/22/2024] Open
Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine and Molecular Imaging Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California;
| | - Amir Iravani
- Division of Nuclear Medicine, Department of Radiology, University of Washington, Seattle, Washington
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Jeremie Calais
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
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Trikalinos NA, Kim H, Vijayan A, Amurao M, Prasad V. Use of approved Lu-177 radiopharmaceuticals in patients with end-stage renal disease: A review of the literature and proposed treatment algorithm. J Neuroendocrinol 2024; 36:e13393. [PMID: 38622851 DOI: 10.1111/jne.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
Peptide receptor radionuclide therapy (PRRT) can be a very useful treatment for patients with neuroendocrine neoplasms and metastatic castration-resistant prostate cancer but it is routinely avoided in those with advanced kidney disease because it can adversely affect the renal function. Accordingly, no clear guidelines exist on the use of PRRT for patients on hemodialysis (HD). We performed a literature review to identify publications on HD patients who received PRRT with Lutetium-177 (Lu177) Dotatate and Y-90 and obtained information on Lu177 pharmacokinetics and early testing data from the manufacturer. We also perused the most recent North American Neuroendocrine Tumor Society (NANETS)/European Neuroendocrine Tumor Society (ENETS) recommendations. Seven relevant publications with a total of 15 patients were included. Patients received dose-adjusted fractions of PRRT with HD occurring usually within 24 h. There were no immediate or long-term serious adverse events attributed to the radioligand, although data was limited. Using available evidence and input from a multidisciplinary group, we have created an institutional workflow. Dose-adjusted PRRT can be offered to patients undergoing HD under careful, multidisciplinary supervision.
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Affiliation(s)
- Nikolaos A Trikalinos
- Department of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anitha Vijayan
- Intermountain Kidney Services, Intermountain Health, Murray, Utah, USA
| | - Maxwell Amurao
- Office of Radiation Safety, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Vikas Prasad
- Department of Nuclear Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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