Lutetium-177-PSMA-617 Effective for Advanced Prostate Cancer

A new study confirms Lutetium177-PSMA-617 is effective for advanced prostate cancer, even after Radium-223. However, low platelet counts may indicate a poorer response to treatment.

Lutetium-177-PSMA-617 (177Lu-PSMA-617), a type of targeted radiation therapy, is effective for men with advanced prostate cancer, even if they were previously treated with another radiation therapy called Radium-223 (223Ra). However, the study also suggests that low platelet count (a type of blood cell important for clotting) may be a sign that the treatment will not work as well ().

Researchers looked at 233 men with advanced prostate cancer that had spread to other parts of the body (metastatic castration-resistant prostate cancer, or mCRPC). These men had been treated with 177Lu-PSMA-617 at five European medical centers.

27 patients had already been treated with Radium-223 (223Ra) before starting Lutetium-177 therapy.
206 patients had never received Radium-223 and went straight to Lutetium-177 therapy.

The researchers found that Lutetium-177 worked equally well in both groups, showing a 54% response rate (meaning the cancer either shrank or stopped growing). This is important because it shows that patients can still benefit from Lutetium-177 even if they had prior radiation treatment with Radium-223.

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‘Patients with #ProstateCancer who received Radium-223 before #Lutetium177 had a higher mortality rate (86%) compared to those who did not (51%). Treatment sequencing plays a crucial role in patient outcomes. #medindia’

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Longer Delay Before Treatment and Better Outcomes:

Patients who waited longer before starting Lutetium-177 had better results. Those who started the therapy later had a median survival of 17 months, compared to 8.5 months for those who started it sooner.

This suggests that delaying Lutetium-177 therapy until it is truly needed might be beneficial.

Low Platelet Count Predicts Poor Response:

Patients with low platelet counts (a type of blood cell that helps with clotting) did not respond as well to treatment. This suggests that checking platelet levels before starting therapy could help doctors predict how well the treatment will work.

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Higher Death Rate in Patients Who Had Radium-223 First:

The death rate was higher in patients who had previously received Radium-223 (86%) compared to those who had never received it (51%).

Researchers are not sure why this is the case, but they noted that the Radium-223 group had more aggressive disease and fewer had received hormone therapy (androgen deprivation therapy and androgen receptor inhibitors), which could have affected survival rates.

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Lutetium-177 Therapy Was Generally Safe:

No new safety concerns were reported. However, anemia (low red blood cell count) was common, especially in those who had received Radium-223 before.

22.2% of patients in the Radium-223 group developed severe anemia and needed blood transfusions.

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This study provides important guidance for doctors and patients when deciding on the best order for radiation-based treatments in advanced prostate cancer.

Lutetium-177-PSMA-617 is effective, even if patients have already received Radium-223.
Checking platelet levels before treatment may help predict how well it will work.
Delaying Lutetium-177 therapy until necessary may improve outcomes.
Doctors need to consider the best sequence of treatments to maximize survival.

However, more research is needed to fully understand why patients who had Radium-223 first had worse survival rates and to determine the best way to use these therapies together.

Reference:

ACTIVITY OF 177Lu-PSMA-617 IN PATIENTS WITH ADVANCED PROSTATE CANCER AND BRAIN METASTASES - (https://www.clinical-genitourinary-cancer.com/article/S1558-7673(25)00011-4/abstract)

Source-Medindia