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Predicting Outcomes in Advanced Prostate Cancer: Focus on Lu-177–PSMA-617 Radioligand Therapy

By: Sarah Campen, PharmD
Posted: Tuesday, August 30, 2022

A study published in BMC Urology identified several pretherapeutic parameters that may be associated with overall survival in patients with metastatic castration-resistant prostate cancer receiving systemic lutetium-177 prostate-specific membrane antigen–617 (Lu-177–PSMA-617) radioligand therapy. Of note, increased pretherapeutic lactase dehydrogenase(LDH) levels were strongly associated with reduced overall survival, indicating a poor prognosis. “Our findings suggest a major relevance of pretherapeutic blood parameters and the presence of hepatic metastases in the prognosis of overall survival,” stated Ulf Lützen, MD, of the University Hospital of Schleswig-Holstein, Kiel, Germany, and colleagues.

In this retrospective, single-center analysis, 52 patients received a total of 146 cycles of Lu-177–PSMA-617 radioligand therapy. The median overall survival was compared with pretherapeutic serologic parameters and the extent of metastatic spread.

The median overall survival of all patients was 55.6 weeks. Overall survival was strongly reduced in patients who had hepatic metastases compared with other sites of metastatic spread (28.3 vs. 84.4 weeks). There was also a strong discrepancy in survival of patients presenting with increased baseline LDH levels higher than 250 U/L (42.0 vs. 99.4 weeks, P < .001) and elevated C-reactive protein levels higher than 5 mg/L (42.0 vs. 116.1 weeks, P < .001).

Decreased pretherapeutic hemoglobin levels were associated with significantly lower survival as well (hazard ratio = 0.698, P = .001). Of note, a decline in prostate-specific antigen (PSA) levels after one therapy cycle did not significantly correlate with an increased survival, indicating that PSA levels may not be a reliable intratherapeutic predictor of response to Lu-177–PSMA-617 radioligand therapy.

Disclosure: The authors reported no conflicts of interest.

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