Archives → 2022 → Vol. 62, № 3 → pp. 250-263
Article
Radioligand Therapy of Patients with Castrate-resistant Prostate Cancer
Nemtsova E.R., Pankratov A.A., Morozova N.B., Tischenko V.K., Petriev V.M., Krylov V.V., Shegay P.V., Ivanov S.A., Kaprin A.D.
National Medical Research Centre of Radiology of the Ministry of Health of the Russian Federation, Obninsk, Russia
Abstract
Prostate cancer is a serious social and medical problem all over the world. It is the 5th in the total structure of cancer morbidity and the 2nd in the structure of morbidity and mortality of men with neoplasms. Androgen-deprivation therapy is not sufficiently efficient for the treatment of patients with metastatic castrate-resistant prostate cancer. That is why the development of novel methods for treatment of patients with this disease is very important. Radioligand therapy of metastatic castrate-resistant prostate cancer using small molecular ligands with high affinity to prostate specific membrane antigen (PSMA) conjugated with β- and α-emitting isotopes is currently under development and thorough study. 177Lu-PSMA-617 radiopharmaceutical on the basis of PSMA-617 ligand is one of the most promising radionuclide medicines. The decay of 177Lu results in emitting both β– particles and γ-rays. Hence, it may be used for therapy and SPECT diagnostics of malignancies as well. 177Lu-PSMA-617 is now in various phases of cli-nical trials in many countries, but it has not been registered yet. Most of the medical centers use the standard activity of 6 or 7.5 GBq per cycle (6 or 8 weeks between cycles), which causes less than 10% of serious adverse events (mainly hematological). Grade 3 anemia and thrombocytopenia develop in about 10% of patients, dry mouth of 1st or 2nd degree – in 66%, and transient nausea of 1st or 2nd degree – in 48% of patients. The positive effect of RLT has been attested: pain relief – in 33–70% of patients, improvement of life quality – in 60%, an increase in Karnovsky’s status – in 74%. The biochemical response after RLT was detected in more than half of the patients, of which in 45% of cases PSA decreased by more than 50%, and in most cases – after the first course; a partial response, as shown by imaging methods, was observed in more than a third of patients.
Keywords
Radioligand therapy, radionuclides, metastatic castrate-resistant prostate cancer, prostate specific membrane antigen
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