When Would I Consider Using This Treatment
Lutetium-177 therapy is only used on men who suffer from cancer that has originated in the prostate and who have exhausted other previous lines of treatment. It has proven itself to be an effective therapy for managing metastatic prostate cancer or cancer of the prostate after other types of treatment have failed.
Nearly all types of prostate cancer will produce excessive PSMA, however, prior to starting the therapy, a diagnostic scan is performed to ensure the Lutetium-177 radiation will target the right areas during treatment.
Greater Accuracy And Changing Treatment
Approximately 300 men were enrolled in the Australian trial, all with newly diagnosed localized prostate cancer , and all were considered to have high-risk disease. For all men in the trial, the planned treatment was either surgery or radiation therapy to the prostate only.
Half the men were randomly assigned to initially undergo a CT and bone scan, and the other half to PSMA PET-CT.
Based on the imaging, PSMA PET-CT was 27% more accurate than the standard approach at detecting any metastases . Accuracy was determined by combining the scans sensitivity and specificity, measures that show a tests ability to correctly identify when disease is present and not present.
PSMA PET-CT was more accurate for both metastases found in lymph nodes in the pelvis and in more distant parts of the body, including bone. Radiation exposure was also substantially lower with PSMA PET-CT than with the conventional approach.
The trial investigators also tracked how imaging results influenced clinicians treatment choices. Based on imaging findings, the initial treatment plan was changed for 15% of men who underwent conventional imaging compared with 28% of men who underwent PSMA PET-CT.
Another key finding, Dr. Hofman noted, was that PSMA PET-CT was much less likely to produce inconclusive, or equivocal, results .
Thats important, he continued, because if you have a scan with equivocal findings, it often leads to more scans or biopsies or other tests.
Which Patients Will Most Benefit From 177lu
The TheraP study was the first randomized controlled trial to compare 177Lu-PSMA-617 with cabazitaxel in men with metastatic castration-resistant prostate cancer. A total of 200 patients were randomly assigned 1:1 to 177Lu-PSMA-617 or to cabazitaxel .
Previously published findings show that 177Lu-PSMA-617 improved the prostate-specific antigen 50% response rate , along with improved PSA progression-free survival , and radiographic PFS compared with cabazitaxel in this patient group. It showed that 66% vs 37% of patients met PSA50-RR.
In the study presented here today, Buteau analyzed the PSMA and FDG-PET scans obtained before administration of treatments to the 200 randomly assigned patients. “The study effectively aimed to validate prior biomarker work, targeting the top one third of patients with these imaging parameters,” said Buteau.
For the PSMA predictive biomarker, the PSA50-RR in patients with a mean standardized uptake value of 10 or greater was 91% with 177Lu-PSMA-617 vs 47% with cabazitaxel.
“What’s remarkable is these are deep PSA drops. Over 60% of them had an over 90% drop in PSA value. In comparison to people who had a mean SUV less than 10, for which 52% responded on 177Lu-PSMA-617 in vs 32% on cabazitaxel,” he reported.
These results translate to an odds ratio of 2.2 in patients with a mean SUV of less than 10 or less but an OR of 12.2 in those with mean SUV of 10 or greater.
“So the higher PSMA intensity, then the better the response,” said Buteau.
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Top Story In Advanced Prostate Cancer: The Promise Of Psma Pet
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What does that mean?
Complications You Have To Know About
The implementation of therapy into clinical practice shows that no serious complications are to be feared. However, despite all efforts, the therapy can lead to complications. Since the treatment is experimental, previously unknown risks, and complications cannot be ruled out. These may include:
- Theoretical allergic reactions after drug administration, including anaphylactic shock .
- Occasionally minor hair loss in the weeks following therapy.
- Changes in taste .
- Fatigue and exhaustion .
Repeated therapy may affect renal function, so it should be checked before each course. In some cases, it may lead to a permanent loss of renal function with the need for dialysis. In addition, the continuous course of therapy may decrease saliva production and facilitate the appearance of the so-called dry mouth, which, in turn, can lead to the higher incidence of tooth decay. Temporary changes in taste may also occur as a result of treatment.
Generally, radiation is related to a risk of secondary malignancies, but such incidences with PSMA therapy are quite rare.
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Benefits Of Prostate Cancer Treatment With Lutetium
PSMA therapy have many advantages over other metastatic prostate cancer treatment techniques, primarily over chemotherapy and hormonal therapy. PSMA therapy is usually used when hormonal therapy and chemotherapy fail to give the desired results or if the patient refuses them because of poor tolerance.
The most important advantages are
- Selective action on malignant cells. Healthy tissues are not irradiated, which is especially important during the treatment of bone metastases located close to the bone marrow.
- The possibility of destruction of metastases in any part of the body, including Liver and bone metastases that are resistant to other treatments.
- Good tolerance of therapy and absence of irreversible side effects. PSMA therapy is suitable for debilitated men with advanced cancer.
- Adjustable therapeutic courses. If one procedure is not enough for controlling the malignant process, it can be safely repeated.
- High effectiveness. Over 95% of men respond to radionuclide therapy well.
Depending on the clinical situation, your physician may recommend PSMA therapy with Lutetium-177 or Actinium-225. The separate article is devoted to the comparison of the effectiveness of various radionuclides for the treatment of metastatic prostate cancer.
How Psma Lights Up Cancer Cells
In 2021, the U.S. Food and Drug Administration issued national approval to two new prostate cancer imaging tests based on similar technology. On a PET scan, the test lights up the cancerous cells that would otherwise be hidden, enabling doctors to precisely target treatment.
Both advances in imaging and therapy rely on targeting PSMA, which is not found on most normal cells but is overexpressed in cancer cells, especially those that have spread. The PSMA molecule was cloned at MSK in the early 1990s.
The Molecular Imaging and Therapy Service, led by Heiko Schöder, played a key role in the development and testing of a slightly different PSMA-directed imaging technology at MSK.
This advance is the result of years of work by the community of physicians promoting the use of PSMA agents, Dr. Schöder says. Its gratifying to see a collaborative effort result in a breakthrough that has the potential to make a difference for so many patients with advanced prostate cancer.
Before receiving the therapy, patients in the VISION trial were scanned with PSMA-directed PET imaging to make sure enough PSMA was present in the cells to make them likely to respond to the treatment. If so, they received the radioactive drug by injection over four to six sessions, spaced six weeks apart.
As a next step, Dr. Morris and colleagues are looking into using the PSMA-directed therapy earlier rather than only after the prostate cancer has spread.
Michael Morris
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An Emerging Treatment For Metastatic Prostate Cancer
A drug that delivers radioactive particles to prostate cancer cells increases overall survival for metastatic castration-resistant prostate cancer.
by Pamela Rafalow Grossman
RESULTS FROM THE VISION TRIAL, first presented at the American Society of Clinical Oncology virtual meeting on June 6, highlighted a treatment called prostate-specific membrane antigen therapy. Prostate-specific membrane antigen is a protein on most prostate cancer cells, says lead author of the study Michael J. Morris, a medical oncologist and the head of the Prostate Cancer Section at Memorial Sloan Kettering Cancer Center in New York City. Molecules that circulate through the body and attach to PSMA can be used to deliver treatment that can kill the prostate cancer cell. The drug, called 177Lu-PSMA-617, uses a PSMA-targeted molecule called PSMA-617 to deliver a radioactive moleculelutetium-177straight to prostate cancer cells, Morris says.
Participants who received 177Lu-PSMA-617 in addition to the approved standard of care survived a median of 15.3 months, compared to 11.3 months for those who received the standard of care alone. The addition of the 177Lu-PSMA-617 helped to increase imaging-based progression-free survival to a median 8.7 months, compared to 3.4 months in those patients who received standard therapy.
Pamela Rafalow Grossman is a writer and editor based in New York City.
High Psma Predicts Response To Targeted Therapy In Prostate Cancer
Becky McCall
BARCELONA High prostate-specific membrane antigen on whole-body positron emission tomography scans predicts a higher likelihood of favorable response to lutetium-177 PSMA-617 than to cabazitaxel in patients with metastatic castration-resistant prostate cancer that has progressed after docetaxel.
Dr James Buteau
The researchers also assessed a prognostic biomarker, fluorodeoxyglucose PET. A high volume of disease on FDG-PET was associated with a worse prognosis regardless of randomly assigned treatment, reported the lead researcher, James Buteau, MD, a nuclear medicine physician from the Peter MacCallum Cancer Centre, Melbourne, Australia.
These are the latest results of the TheraP trial presented at European Association of Nuclear Medicine 2022. The findings have implications for clinical practice. “In this study, we show that PSMA-PET a full body scan done prior to treatment with 177Lu-PSMA-617, predicts how the treatment will go,” remarked Buteau, who presented the findings.
“It’s a window into the future, so we can peek through and see how treatment will go for different patients, because the scans can help us decide who should definitely get treatment with 177Lu-PSMA-617, and who might benefit more from other treatments,” he added. “With FDG-PET, we also identify which patients will do worse and may benefit more from other strategies, like therapy combinations.”
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What Causes Prostate Cancer
Prostate cancer is the most common form of cancer in men over the age of 50. Currently, researchers are unable to determine exactly what causes prostate cancer. DNA changes that are inherited or caused by certain lifestyle choices are believed to play a role in why some individuals develop cancer and others do not. It is believed that inherited genes account for about 5 to 10 percent of prostate cancers. Exposure to radiation, chronic inflammation, exposure to cancer-causing chemicals, high levels of androgens, or insulin-like growth factor-1 are also all believed to cause gene changes which lead to cancer.
The Royal Marsden To Start Offering Lutetium Psma Therapy To Treat Advanced Prostate Cancer
Patients with advanced metastatic castration resistant prostate cancer to be offered an innovative molecular therapy which precisely targets cancerous cells reducing the exposure to the rest of the body.
Lutetium-177 PSMA is an innovative therapy used to treat metastatic castration resistant prostate cancer. The therapy works to reduce the tumour size and prevents the tumour from increasing, whilst also helping to improve the symptoms that these tumours might cause.
PSMA is naturally found on the surface of prostate cells in someone with prostate cancer there is an increase of PSMA expression. If the prostate cancer has spread to other parts of the body the PSMA will also be present in those areas. When administered intravenously the Lutetium-177 PSMA ligand will travel to those areas where the PSMA is present and emits radiation that will destroy the cancer cells the treatment is targeted to the cancer with very little radiation exposure to other parts of the body.
The Royal Marsden will offer PSMA therapy, which will be administered by an expert multi-disciplinary team. Nuclear Medicine consultants, Urologist consultants, specialised Nuclear Medicine nurses, Ward nurses, Nuclear Medicine Technologists, and Nuclear Medicine Physics team will work together to ensure the best treatment and care.
All the potential side effects and the necessary precautions will be carefully explained to patients during the clinic appointment with the Nuclear Medicine consultant.
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What Is Psma Pet Scan
The conventional imaging methods typically used for prostate cancer patents, including CT, MRI, and bone scan, have limitations when it comes to disease detection, according to Steve Huang, MD, Nuclear Medicine Department, Cleveland Clinic.
Compared with other imaging options, PSMA PET scan has greater sensitivity and can detect metastases sooner, allowing clinicians to better serve patients and make treatment decisions earlier, he says. PSMA PET scan makes it possible to see a smaller volume of prostate cancer cells, which allows oncologists to localize the disease and determine the best approach to treatment.
PSMA, or prostate-specific membrane antigen, is a protein on the surface of many prostate cancer cells, and it has been shown that radiotracers targeting PSMA can identify early, low-volume sites of lymph node or distant metastases of prostate cancer, says Dr. Tendulkar.
The first PSMA-targeted PET imaging drug for prostate cancergallium 68 PSMA-11 was approved by the FDA in 2020 for patients with suspected prostate cancer recurrence and metastasis. This approval was based on phase 3 clinical trials that demonstrated a significant increase in accuracy for the detection of prostate cancer compared with standard imaging modalities. In 2021, a second FDA approval followed for Pylarify® for the same indication.
Improving Prostate Cancer Classification And Treatment
The finding could also help doctors more accurately predict how a prostate tumor might behave in certain people. PSMA is easily detectable on PET scans. Such images could allow researchers to reliably detect the presence of cancer and to understand the cancers aggressiveness.
This could help with prognoses and help doctors make better treatment decisions, Dr. Grimm says. For example, there are some men with aggressive prostate cancer that doesnt have much PSMA expression, which may not need to be treated that aggressively.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
What Is Lutetium Psma Therapy
You may be offered lutetium-177 PSMA therapy , or Prostate-Specific Membrane Antigen therapy if you have advanced prostate cancer. Its a type of Peptide Receptor Radionuclide Therapy .
Lutetium PSMA therapy aims to improve your symptoms and reduce the size of your tumours. It can also slow their growth. Afterwards, some people experience a long period of remission, but it doesnt cure your cancer.
Its used when cancer has metastasised . It can help when other treatments have failed, are causing significant harm or side-effects.
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What Happens If My Psma Pet Scan Detects Tumors
It depends on the specifics of each individual patients cancer. Your care team will discuss possible treatments with you. This may involve therapy targeting specific areas of cancer, systemic therapy, or both.
You may be a candidate for a new theranostic treatment called lutetium-177 PSMA therapy , a companion treatment that also targets the PSMA molecule, but is made of a stronger type of radiation that kills the cancer cells.
Snmmi Applauds Fda Approval Of New Metastatic Prostate Cancer Treatment
Reston, VAWith todays U.S. Food and Drug Administration approval of 177Lu-PSMA-617a radiopharmaceutical therapy to treat metastatic castration-resistant prostate cancer the Society of Nuclear Medicine and Molecular Imaging celebrates one of the greatest success stories in nuclear medicine history. The therapy, developed after years of extensive research, has been shown to reduce the risk of death by 38 percent and reduce the risk of progression by 60 percent in mCRPC patients treated with 177Lu-PSMA-617.
The new therapy depends on the use of PET scans to identify and treat patients whose metastatic prostate cancers express PSMA . We are delighted by the FDA approval of this transformational, innovative therapy for men with advanced metastatic castrate resistant prostate cancer, said SNMMI president Richard L. Wahl, MD, FACNM. We are proud of the society members who contributed substantially to this new theranostic paradigm, as well as all of the authors who published articles on this therapy in The Journal of Nuclear Medicine.
The FDA granted Priority Review for 177Lu-PSMA-617 in September 2021 based on positive data from the multi-center Phase III VISION study, which measured overall survival and progression-free survival in mCRPC patients whose disease progressed despite treatment.
177Lu-PSMA-617 is manufactured by Novartis.
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