177Lu-Prostate-Specific Membrane Antigen Ligand After 223Ra Treatment in Men with Bone-Metastatic Castration-Resistant Prostate Cancer: Real-World Clinical Experience

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FIGURE 1.
Anticancer therapies administered before ¹⁷⁷Lu–PSMA. All patients received ²²³Ra.
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FIGURE 2.
Time since end of ²²³Ra to start of ¹⁷⁷Lu-PSMA ligand and duration of ¹⁷⁷Lu-PSMA therapy.

TABLE 1

Baseline Disease Characteristics

Time point	Characteristic	Finding	Data
Initial diagnosis	Gleason score	≤6	3 (12)
		7	9 (35)
		8–10	12 (46)
		Unknown	2 (8)
	Stage (American Joint Committee on Cancer criteria)	I	5 (19)
		IIB	1 (4)
		III	3 (12)
		IV	13 (50)
		Missing	4 (15)
Start of ²²³Ra therapy	Time from diagnosis of mCRPC (mo)		20 (6–48)
	Time from diagnosis of bone metastases (mo)		23 (3–40)
	Extent of disease*	<6 lesions	2 (8)
		6–20 lesions	7 (29)
		>20 lesions	11 (46)
		Superscan	2 (8)
		Missing	2 (8)
	Primary tumor status	Unresected	11 (42)
		Resected, status of residual tumor unknown	3 (12)
		R0 complete resection, all margins histologically negative	6 (23)
		R1 incomplete resection, microscopic margin involvement	5 (19)
		Missing	1 (4)
	Laboratory values	Prostate-specific antigen (ng/mL) (n = 21)	127 (8–1,319)
		Alkaline phosphatase (U/L) (n = 20)	147 (45–769)
		Lactate dehydrogenase (U/L) (n = 14)	228 (112–393)
		Hemoglobin (g/dL) (n = 23)	13 (9–15)

*Baseline scan data available for 24/26 patients.
Qualitative data are number and percentage (n = 26 unless indicated otherwise); continuous data are median and range.

TABLE 3

Grade 3 Hematologic Adverse Events After Start of ²²³Ra Therapy*

	Incidence (n = 26)
Patients with events^†	Overall	Starting before ¹⁷⁷Lu-PSMA treatment	Starting during or after ¹⁷⁷Lu-PSMA treatment^‡
Any	9 (35%)	5 (19%)	5 (19%)
Leukopenia	0	0	0
Neutropenia	0	0	0
Pancytopenia	1 (4%)	0	1 (4%)
Thrombocytopenia	3 (12%)	2 (8%)	1 (4%)
Anemia	6 (23%)	3 (12%)	4 (15%)

*No grade ≥4 events were recorded.
^†Patients may have had >1 event at different times; these patients are counted only once in “Any” row and “Overall” column.
^‡Grade 3/4 hematologic toxicity data were systematically recorded only up to 6 mo after completion of ²²³Ra therapy; data are therefore not consistently available for patients who received ¹⁷⁷Lu-PSMA after this window.
Qualitative data are number and percentage.