Single Center Experience with a 4-Week 177Lu-PSMA-617 Treatment Interval in Patients with Metastatic Castration-Resistant Prostate Cancer

Background: 177Lu-PSMA-617 is a promising theragnostic treatment for metastatic castration-resistant prostate cancer (mCRPC). However, both the optimal treatment dose and interval in mCRPC and the rate of identification of responders from non-responders among possible treatment candidates are unknown. Methods: 62 men with mCRPC who were treated with 177Lu-PSMA-617 during 1/2017−2/2019 were included in the study. Treatment responses, overall survival (OS) and progression free survival (PFS) were determined. The median follow-up time was 1.4 years (IQR 0.5−2.2). Tumor volume of metastases (MTV), SUVmax and tumor lesion activity (TLA) were quantitated from pre-treatment PSMA PET/CT images together with pre-treatment PSA. Results: An average of three treatment cycles (2−5) were given within a four-week interval. PFS was 4.9 months (2.4−9.6) and OS was 17.2 months (6−26.4). There were no major adverse events reported. A significant PSA response of >50% was found in 58.7% of patients, which was significantly associated with longer OS, p < 0.004. PSA response was not associated with staging PSMA-derived parameters. Conclusions: 177Lu-PSMA-617 treatment in four-week intervals was safe and effective. Almost 60% of patients had a significant PSA response, which was associated with better OS. Pre-treatment PSA kinetics or staging PSMA PET/CT-derived parameters were not helpful in identifying treatment responders from non-responders; better biomarkers are needed to aid in patient selection.

A comparative study on the effect of solvent on nucleophilic fluorination with [18F]fluoride: protic solvents as co-solvents in SN2 and SNAr reactions

The effect of solvent on nucleophilic substitution with cyclotron-produced [18F]fluoride was studied in polar aprotic (CH3CN and DMF) and protic solvent (t-BuOH and t-amyl alcohol) mixtures (CH3CN/co-solvent, 2:8) in a series of model compounds, 4-(R1-methyl)benzyl R2-benzoates, using a K2.2.2/[ 18F]KF phase transfer system (R1=–Cl, –OMs or –OH; R2=–Cl, –I or –NO2). 18F-fluorination of compounds 1–3, with chloride or mesylate as a leaving group in the benzylic position (R1), afforded the desired 4-([ 18F]fluoromethyl)benzyl analogues in all solvents during 15ߙmin reaction time. The highest radiochemical yields (RCY) in all the studied reaction temperatures (80, 120 and 160ºC) were achieved in CH3CN. Radiochemical yields in protic solvents were comparable to RCY in CH3CN only with the sulfonate ester 3 as a starting material. 18F-Fluorination of the benzylic halides 1 and 2 was not promoted in the same extent; in addition, labelled side-products were detected at higher reaction temperatures. Radiofluorination in tert-alcohols was also studied using [18F]CsF with and without added phase transfer catalyst, resulting in both conditions lower RCY when compared to K2.2.2/[18F]KF system. Protic solvents were not able to promote aromatic 18F-fluorination. 18F-Fluorination of compound 5, having para-activated nitro group in the aromatic position (R2), failed in tert-alcohols even at the highest temperature, but it was labelled successfully in DMF and to some extent in CH3CN.