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Research ArticleFEATURED ARTICLE OF THE MONTH
Open Access

mCRPC Patients Receiving 225Ac-PSMA-617 Therapy in the Post–Androgen Deprivation Therapy Setting: Response to Treatment and Survival Analysis

Mike Sathekge, Frank Bruchertseifer, Mariza Vorster, Ismaheel O. Lawal, Otto Knoesen, Johncy Mahapane, Cindy Davis, Amanda Mdlophane, Alex Maes, Kgomotso Mokoala, Kgomotso Mathabe, Christophe Van, de Wiele and Alfred Morgenstern
Journal of Nuclear Medicine October 2022, 63 (10) 1496-1502; DOI: https://doi.org/10.2967/jnumed.121.263618
Mike Sathekge
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
2Nuclear Medicine Research Infrastructure, Pretoria, South Africa;
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Frank Bruchertseifer
3European Commission, Joint Research Centre, Karlsruhe, Germany;
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Mariza Vorster
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
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Ismaheel O. Lawal
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
2Nuclear Medicine Research Infrastructure, Pretoria, South Africa;
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Otto Knoesen
4Nuclear Technology Products, Pelindaba, South Africa;
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Johncy Mahapane
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
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Cindy Davis
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
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Amanda Mdlophane
2Nuclear Medicine Research Infrastructure, Pretoria, South Africa;
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Alex Maes
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
5Katholieke University Leuven, Kortrijk, Belgium;
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Kgomotso Mokoala
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
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Kgomotso Mathabe
6Department of Urology; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa; and
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Christophe Van
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de Wiele
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
7Ghent University, Ghent, Belgium
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Alfred Morgenstern
1Department of Nuclear Medicine; University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa;
3European Commission, Joint Research Centre, Karlsruhe, Germany;
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  • FIGURE 1.
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    FIGURE 1.

    Waterfall plot demonstrating percentage change in PSA levels after treatment with 225Ac-PSMA-617 in patient cohort (x-axis = number of patients; y-axis = percentage change).

  • FIGURE 2.
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    FIGURE 2.

    Kaplan–Meier curves of PSA-based OS of the entire cohort (PSA decline of ≥ 50% [green curve] and percentage of PSA decline < 50% [blue curve]) (A), PFS of the entire cohort (PSA decline of ≥ 50% [green curve] and percentage of PSA decline < 50% [blue curve]) (B), and PFS stratified by platelet counts (platelet counts < 293,000/mL [blue curve] and platelet counts > 293,000 [green curve]) (C).

Tables

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    TABLE 1

    Patient Characteristics

    CharacteristicValue
    No. of patients included53
    Median age (y)63.4
    Eastern Cooperative Oncology Group score of 0 or 1 (n)42
    Eastern Cooperative Oncology Group score of 2 (n)11
    Median PSA level (ng/mL)466
    Median alkaline phosphatase level (IU/L)188
    Median hemoglobin value (g/dL)11.5
    Bone metastases (n)47
    Lymph node metastases (n)36
    Visceral metastases (n)6
     Lung1
     Liver5
     Brain1
    Local therapy to prostate (n)
     Prostatectomy31
     Radiotherapy11
     No local therapy11
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    TABLE 2

    Toxicity Profiles of 53 Patients Treated with 225Ac-PSMA-617

    CharacteristicGrade I–IIGrade IIIGrade IV
    Xerostomia43 (81%)00
    Anemia7 (13%)1 (2%)0
    Leukopenia4 (7%)1 (2%)0
    Thrombocytopenia5 (9%)00
    Renal failure7 (13%)2 (4%)1 (2%)
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    TABLE 3

    Univariate Analysis of Relationship Between Studied Variables and Survival

    VariablePFSOS
    Age0.1800.748
    Eastern Cooperative Oncology Group score0.0770.772
    Gleason score0.5960.774
    Previous local radiotherapy0.3040.916
    Baseline PSA level0.9720.888
    PSA ≥ 50% decline<0.001*<0.001*
    PSA undetectable0.014*0.132
    Visceral metastases0.9370.772
    Lymph node involvement0.2890.942
    Bone metastases0.4590.186
    No. of treatment cycles0.6500.097
    ALP0.7270.886
    Hemoglobin0.0900.132
    Platelet count0.041*0.602
    White blood cell count0.3730.605
    Radiologic response0.006*0.407
    PSMA-negative0.026*0.418
    • ↵* P < 0.05.

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Journal of Nuclear Medicine: 63 (10)
Journal of Nuclear Medicine
Vol. 63, Issue 10
October 1, 2022
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mCRPC Patients Receiving 225Ac-PSMA-617 Therapy in the Post–Androgen Deprivation Therapy Setting: Response to Treatment and Survival Analysis
Mike Sathekge, Frank Bruchertseifer, Mariza Vorster, Ismaheel O. Lawal, Otto Knoesen, Johncy Mahapane, Cindy Davis, Amanda Mdlophane, Alex Maes, Kgomotso Mokoala, Kgomotso Mathabe, Christophe Van, de Wiele, Alfred Morgenstern
Journal of Nuclear Medicine Oct 2022, 63 (10) 1496-1502; DOI: 10.2967/jnumed.121.263618

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mCRPC Patients Receiving 225Ac-PSMA-617 Therapy in the Post–Androgen Deprivation Therapy Setting: Response to Treatment and Survival Analysis
Mike Sathekge, Frank Bruchertseifer, Mariza Vorster, Ismaheel O. Lawal, Otto Knoesen, Johncy Mahapane, Cindy Davis, Amanda Mdlophane, Alex Maes, Kgomotso Mokoala, Kgomotso Mathabe, Christophe Van, de Wiele, Alfred Morgenstern
Journal of Nuclear Medicine Oct 2022, 63 (10) 1496-1502; DOI: 10.2967/jnumed.121.263618
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Keywords

  • 225Ac-PSMA
  • ADT
  • therapy response
  • PSA response
  • prostate carcinoma
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