Abstract 5529
Background
The treatment of mCRPC is a major medical challenge. The beta-emitting Lu-177-PSMA radioligand therapy (RLT) is a new option but its antitumor effect can decrease over time. The aim of this retrospective analysis was to investigate safety and efficacy of the alpha emitting Ac-225-PSMA-617 RLT in mCRPC after Lu-177-PSMA failure.
Methods
At data analysis 03/19 18 patients (pts) underwent Ac-225-PSMA-617 RLT between 10/17 and 12/18. All pts had previously received second line antihormonal treatment and 17/18 pts taxane based chemotherapy. All pts had shown progression after Lu-177-PSMA therapy (median 2 cycles). High PSMA-expression of the tumor lesions in PSMA-PET/CT before Ac-225-PSMA-617 was mandatory. Pts were treated at 8 weekly intervals until progression or intolerable side effects. Prostate-specific antigen (PSA) and blood cell count were measured every 2-3 weeks. We report updated data of hematological and non-hematological side effects, biochemical response and a subgroupanalysis.
Results
A total of 36 cycles of Ac-225-PSMA-617 (median dose 8 MBq, range 4,4–12.8) were applied. 7 pts received only 1 cycle, 5 pts 2 cycles, 5 pts 3 cycles and 1 patient 4 cycles. Baseline PSA was 822 ng/ml (range 49–4073). ECOG score was grade 0, 1 and 2 in 3, 13 and 2 pts. 15/18 pts showed any PSA-decline, 5/18 a PSA-decline of more than 50% and 3 pts no PSA-decline at any time. 6 weeks after treatment 12/18 showed any PSA decline and 4/18 a PSA-decline of > 50%. Grade 1 xerostomia occurred in 17 and grade 2 in 1 patient. 6/18 pts (33%) requested to stop treatment due to xerostomia. 2 pts developed grade 2 renal insufficiency, 5 pts grade 3-4 anemia, 2 pts grade 3-4 thrombocytopenia and 2 pts 3-4 leucopenia. 7/18 pts died during the observation period (median overall survival 9,6 months). The PSA-progression free survival was 1,3 months. In a subgroupanalysis of 9 pts with a rapid progression under a previous Lu-177-PSMA treatment 7 pts achieved any PSA-decline and 4 pts a decline of more than 50%.
Conclusions
In this small cohort Ac-225-PSMA-617 RLT showed antitumor effect in mCRPC after Lu-177-PSMA failure even after rapid tumour progression. However, treatment had to be stopped in one third of the pts due to xerostomia.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
4692 - Immune cell biomarkers on neo-adjuvant chemo-immunotherapy treatment for resectable stage IIIA NSCLC patients
Presenter: Raquel Laza-Briviesca
Session: Poster Display session 3
Resources:
Abstract
1707 - Clinical utility of precision immunoprofiling and monitoring of the tumor microenvironment using flow cytometry and CyTOF in patients with advanced NSCLC treated with atezolizumab: results from a phase II study for biomarker analysis (EPOC1702)
Presenter: Keisuke Kirita
Session: Poster Display session 3
Resources:
Abstract
3594 - Tumor mutation burden (TMB), PD-L1, IFN-γ signaling identify subgroups of patients (pts) who benefit from durvalumab (D, anti-PDL1) or D and tremelimumab (T, anti-CTLA4) treatment in urothelial bladder cancer (UC)
Presenter: Christophe Massard
Session: Poster Display session 3
Resources:
Abstract
744 - The decrease of TMB, TNB and HLA expression are the Mechanism of Drug Resistance of NSCLC to immunosuppressive PD-1/PD-l1.
Presenter: Sheng Yu
Session: Poster Display session 3
Resources:
Abstract
2350 - Eosinophilia during treatment of immune checkpoint inhibitors (ICIs) predicts succeeding onset of immune-related adverse events (irAEs)
Presenter: Rika Kizawa
Session: Poster Display session 3
Resources:
Abstract
5930 - A transcriptomic immunologic signature predicts favorable outcome in neoadjuvant chemotherapy treated triple negative breast tumors.
Presenter: Javier Pérez-peña
Session: Poster Display session 3
Resources:
Abstract
6127 - Alterations of TMB and TCR repertoires during Chemotherapy in East Asian lung cancer patients without TKI-related driver gene mutations
Presenter: Lele Song
Session: Poster Display session 3
Resources:
Abstract
1310 - Association of SCFA in gut microbiome and clinical response in solid cancer patients treated with andi-PD-1 antibody.
Presenter: Motoo Nomura
Session: Poster Display session 3
Resources:
Abstract
2286 - Extracellular matrix and tissue derived metabolites in a liquid biopsy identifies endotypes of metastatic melanoma patients with differential response to immune checkpoint inhibitor treatment
Presenter: Nicholas Willumsen
Session: Poster Display session 3
Resources:
Abstract
4107 - Pathologic scoring of pre-treatment H&E biopsies predicts overall survival in patients with metastatic clear cell renal cell carcinoma receiving nivolumab monotherapy
Presenter: Julie Stein
Session: Poster Display session 3
Resources:
Abstract