Article Figures & Data
Figures
- FIGURE 1.
(A) Flowchart of patient selection for overall survival analysis. (B) Examination sequence for subgroup analysis (PSMA PET/CT or MRI before radionuclide treatment = baseline, after 177Lu-PSMA = restaging, and after SIRT = final staging).
- FIGURE 2.
Discordant response of liver metastases to 177Lu-PSMA in patient 6, who was treated with 6 cycles of 177Lu-PSMA. Shown are CT or MRI (top) and PET/CT or MRI (bottom) images. (A) Before start of 177Lu-PSMA therapy, major liver metastases were seen in both lobes (arrow). (B) After treatment with 4 cycles of 177Lu-PSMA, metastases were decreasing (dashed circle). (C) Small liver metastases were also detected in segment V. (D) However, after 2 additional cycles, metastases were progressive and showed only modest PSMA uptake caused by dedifferentiation (arrowheads).
- FIGURE 3.
Evaluation of 177Lu-PSMA and SIRT efficacy. (A) 177Lu-PSMA achieved only discordant responses by liver metastases; therefore, changes in size for best- and worst-responding lesions were compared (only patients with multiple liver metastases at baseline were included [n = 7]). (B) Overall, liver metastases responded significantly differently to 177Lu-PSMA therapy. Treatment with 177Lu-PSMA therapy was efficient only in patients with strong 68Ga-PSMA-11 uptake by liver metastases. SUVmean of lesions was reported separately for progressive disease (PD), stable disease (SD), and partially responding (PR) liver metastases (only patients with 68Ga-PSMA-11 radionuclide were included [n = 8]). (C) Overall survival of patients treated with 177Lu-PSMA alone (median, 5.7 mo; blue) did not significantly differ from that of patients treated with combination of 177Lu-PSMA and SIRT (median, 8.4 mo; red).
- FIGURE 4.
Response of liver metastases to 177Lu-PSMA and SIRT in patient 1, who was treated with 4 cycles of 177Lu-PSMA initially, followed by SIRT. Shown are CT (top), PET/CT (middle), and whole-body maximum-intensity projection (bottom) images before therapy (A), after 4 cycles of 177Lu-PSMA (B), and after 90Y-SIRT (C). Compared with pretherapy scan, liver metastases were progressive after 177Lu-PSMA and extrahepatic metastases were regressive (arrows). After SIRT, liver metastases had responded and had no relevant PSMA expression (dashed cycles). However, extrahepatic metastases were severely progressive, as can be seen on the maximum-intensity projection.
Tables
Parameters LMPSMA alone LMPSMA+SIRT All patients Patient count (n) 31 5 36 Age (y) 71.9 (66.9–73.7) 73.8 (64.8–78.7) 72.4 (67.6–73.5) Gleason score 8 8 8 Median PSA baseline (ng/mL) 363.0 [4.9–6,970] 49.5 [5.9–1,199] 355.5 [4.9–6,970] Median alkaline phosphatase (U/L) 229.0 [47–1,028] 81.0 [70–355] 223.5 [47–1,028] Median lactate dehydrogenase (U/L) 448 [160–7,802] 389 [192–442] 435 [160–7,802] PSMA radioligand therapy Average number of cycles 2 (2.0–3.6) 3 (2.7–4.0) 2.5 (2.2–3.6) Cycles total 89 17 106 Average duration interval 7.7 (6.5–8.5) 7.5 (2.9–16.9) 7.5 (6.7–9.3) Average activity (GBq) 6.2 (6.1–6.4) 6.4 (5.7–7.5) 6.2 (6.2–6.5) ECOG PS (n) 0–1 21 (67.8%) 4 (80%) 25 (69.4%) 2 8 (25.8%) 1 (20%) 9 (25.0%) 3 2 (6.4%) 0 (0%) 2 (5.0%) Site of metastases (n) Bone 31 (100%) 3 (60%) 34 (94.4%) Lymph node 24 (77.4%) 4 (80%) 28 (77.7%) Lung 8 (25.8%) 0 (0%) 8 (22.2%) Other 1 (3.2%) 0 (0%) 1 (2.7%) Previous therapy for mCRPC (n) Docetaxel 29 (93.5%) 3 (60%) 32 (88.8%) Cabazitaxel 14 (45.2%) 2 (40%) 16 (44.4%) Abiraterone 26 (83.8%) 4 (80%) 30 (83.3%) Enzalutamide 25 (80.6%) 4 (80%) 29 (80.5%) Abiraterone and enzalutamide 22 (70.1%) 3 (60%) 25 (69.4%) 223Ra 6 (19.3%) 1 (20%) 7 (19.4%) EBRT, bone 17 (54.8%) 2 (40%) 19 (52.8%) LMPSMA alone = liver metastasis–only PSMA therapy; LMPSMA+SIRT = liver metastasis PSMA therapy and SIRT; PSA = prostate-specific antigen; ECOG PS = Eastern Cooperative Oncology Group performance status; EBRT = external-beam radiation therapy.
Data in parentheses are 95% CIs or percentages; data in square brackets are ranges.
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