Neurologic Symptoms After 177Lu-Prostate-Specific-Membrane Antigen-617 Therapy: A Single-Center Experience

Article Figures & Data

TABLE 1.

Characteristics of Patients Presenting with Neurologic Complaints

Characteristic	Data
Age at start of treatment (y)
Overall	Median, 70 (range, 58–90)
≥65–84	92% (46)
≥85	10% (5)
Gleason score at diagnosis
6	4% (2)
7	38% (19)
8	12% (6)
9	36% (18)
10	8% (4)
Unknown	2% (1)
Mean follow-up time ± SD (mo)	12.04 ± 2.87
Time from diagnosis to first cycle of ¹⁷⁷Lu-PSMA-617 (mo)	Median, 68.37 (range, 15.9–354.2)
ECOG
0 or 1	96% (48)
≥2	4% (2)
History of hypertension	30% (15)
History of diabetes mellitus	10% (5)
Sites of metastases
Bone	82% (41)
Lymph node	68% (34)
Liver	2% (2)
Lung	6% (3)
Number of bone metastases
1–4	2% (1)
5–10	8% (4)
>10	72% (36)
Previous systemic therapies
Androgen deprivation therapy	100% (50)
Taxane chemotherapy (docetaxel, cabazitaxel)	100% (50)
Androgen biosynthesis inhibitors (abiraterone)	80% (40)
Androgen receptor inhibitors (enzalutamide, bicalutamide, apalutamide, darolutamide)	100% (50)
Carboplatin	38% (19)
Immunotherapy (sipuleucel-T)	8% (4)
²²³Ra	8% (4)
Total cycles of ¹⁷⁷Lu-PSMA-617
2	4% (2)
3	14% (7)
4	22% (11)
5	22% (11)
6	38% (19)

ECOG = Eastern Cooperative Oncology Group.
Data are percentage followed by number in parentheses (total n = 50), unless otherwise specified.

TABLE 2.

Investigated Neurologic Symptoms

Neurologic finding	Percentage of patients (total n = 185)	Onset time (mo)^*
Dysgeusia^†	14.6% (27)	4.2 (0.8–8.6)
Dizziness	6% (11)	0^‡
Paresthesia	3.2% (6)	3.5 (0.5–10)
Headache	2.7% (5)	0^‡
Weakness in extremities	1.1% (2)	5.25 (1.5–9)
Cerebral ischemic event	1.1% (2)	11 (8.6–13.4)
Gait instability^§	0.5% (1)	4.0
Vision disturbance^‖	0.5% (1)	5.6
Seizure	0	—
Syncope/presyncope	0	—

↵* Median and range for onset of neurologic symptoms after first day of initial cycle of ¹⁷⁷Lu-PSMA-617 therapy.
↵† Includes altered hypogeusia and altered taste such as foul, salty, rancid, or metallic taste sensation.
↵‡ Reported during or immediately after ¹⁷⁷Lu-PSMA-617 therapy.
↵§ Includes loss of balance or tendency to fall easily.
↵‖ Includes reduced vision, decreased visual field, sudden vision loss, and double vision (diplopia).

TABLE 3.

Neurologic Symptoms Observed and Graded According to Common Terminology Criteria for Adverse Events

Neurologic finding	All grades	Grade 1	Grade 2	Grade 3	Grade 4
Dysgeusia	14.6% (27)	0	14.6% (27)	—	—
Dizziness	6% (11)	4.9 (9)	0.5% (1)	0.5% (1)	—
Paresthesia	3.2% (6)	2.7% (5)	0.5% (1)	0	—
Headache	2.7% (5)	1.1% (2)	1.62% (3)	0	—
Weakness in extremities	1.1% (2)	1.1% (2)	0	0	—
Cerebral ischemic event	1.1% (2)	0	1.1% (2)	0	0
Gait instability	0.5% (1)	0	0.5% (1)	0	—
Vision disturbance	0.5% (1)	0.5% (1)	0	0	0