The Prognostic Value of Posttreatment 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT in Metastatic Castration-Resistant Prostate Cancer Treated with 177Lu-PSMA-617 and NOX66 in a Phase I/II Trial (LuPIN)

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Download figure
Open in new tab
Download powerpoint
FIGURE 1.
(A and B) Quantitative analysis for patient with reduced PSMA TTV between baseline (A) and after treatment (B). (C and D) Quantitative analysis for progressing patient at baseline (C) and after treatment (D). In patients with high-volume disease, it can be difficult to visually identify extent of volume change. In this second case, volume increase is 25%.
Download figure
Open in new tab
Download powerpoint
FIGURE 2.
Kaplan–Meier curves for OS stratified by increase in PSMA TTV ≥ 30% from baseline (A), increase in ¹⁸F-FDG TTV ≥ 30% from baseline (B), increase in PSMA SUV_max from baseline (C), and increase in ¹⁸F-FDG SUV_max from baseline (D).
Download figure
Open in new tab
Download powerpoint
FIGURE 3.
Quantitative analysis of baseline and posttreatment PSMA and ¹⁸F-FDG PET images from same patient: baseline ⁶⁸Ga-PSMA PET (A), posttreatment ⁶⁸Ga-PSMA PET (B), baseline ¹⁸F-FDG PET (C), and posttreatment ¹⁸F-FDG PET (D). Arrows indicate lesion in iliac bone that reduced in volume and intensity on ⁶⁸Ga-PSMA PET but increased in volume and intensity of ¹⁸F-FDG PET.

TABLE 1.

Patient Characteristics

Characteristic	Substudy data
Age (y)	68 (65–74)
Eastern Cooperative Oncology Group performance status
0 or 1	32 (86%)
2	5 (14%)
PSA at screening (μg/L)	91 (41.3–380)
Hemoglobin (reference range, 130–180 g/L)	122 (112–131)
Alkaline phosphatase (reference range, 30–100 U/L)	124 (83–359)
Prior systemic treatments
Luteinizing hormone-releasing hormone agonist/antagonist	37 (100%)
Chemotherapy	37 (100%)
Docetaxel	37 (100%)
Cabazitaxel	34 (92%)
Androgen signaling inhibitor	37 (100%)
Cycles of ¹⁷⁷Lu-PSMA-617 administered	6 (4–6)
Exit diagnostic CT and bone scan	34 (92%)

Qualitative data are absolute counts and percentage; continuous data are median and interquartile range.

TABLE 2.

Univariable Cox Regression Analysis for Association with PSA PFS and OS

Variable	OS			PSA PFS
Variable	HR	95% CI	P	HR	95% CI	P
Increase in PSMA TTV (L)	6.2	2.0–19.2	0.002	2.9	1.4–6.1	0.01
Increase in PSMA SUV_max at trial exit	1.9	0.2–14.4	0.56	1.3	0.3–5.6	0.71
Increase in ¹⁸F-FDG TTV (L)	2.7	1.1–6.2	0.02	3.1	1.4–6.8	0.005
Increase in ¹⁸F-FDG SUV_max at trial exit	3.0	1.2–7.3	0.02	3.0	1.4–6.4	0.01
PSA progression at trial exit	5.8	2.1–16.1	<0.001	5.0	2.3–10.7	<0.001
Radiographic progression at trial exit	5.4	1.8–16	0.003	4.4	1.6–12	0.004

TABLE 3.

Multivariable Cox Regression Analysis for Association of Clinical and Imaging Parameters with OS

Variable at trial exit	HR	95% CI	P
Increase in PSMA TTV	5.1	1.5–17.1	0.008
Increase in ¹⁸F-FDG TTV	1.04	0.4–2.9	0.93
Increase in ¹⁸F-FDG SUV_max	1.3	0.4–4.5	0.67
PSA progression	3.5	1.1–10.9	0.03
Radiographic progression	1.8	0.5–6.0	0.36