RT Journal Article
SR Electronic
T1 Long-Term Nephrotoxicity of <sup>177</sup>Lu-PSMA Radioligand Therapy
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP jnumed.123.265986
DO 10.2967/jnumed.123.265986
A1 Steinhelfer, Lisa
A1 Lunger, Lukas
A1 Cala, Lisena
A1 Pfob, Christian H.
A1 Lapa, Constantin
A1 Hartrampf, Philipp E.
A1 Buck, Andreas K.
A1 Schäfer, Hannah
A1 Schmaderer, Christoph
A1 Tauber, Robert
A1 Brosch-Lenz, Julia
A1 Haller, Bernhard
A1 Meissner, Valentin H.
A1 Knorr, Karina
A1 Weber, Wolfgang A.
A1 Eiber, Matthias
YR 2023
UL http://jnm.snmjournals.org/content/early/2023/10/19/jnumed.123.265986.abstract
AB β-emitting 177Lu targeting prostate-specific membrane antigen (PSMA) is an approved treatment option for metastatic castration-resistant prostate cancer. Data on its long-term nephrotoxicity are sparse. This study aimed to retrospectively evaluate post–177Lu-PSMA estimated glomerular filtration rate (eGFR) dynamics for at least 12 mo in a cohort of metastatic castration-resistant prostate cancer patients. Methods: The institutional databases of 3 German tertiary referral centers identified 106 patients who underwent at least 4 cycles of 177Lu-PSMA and had at least 12 mo of eGFR follow-up data. eGFR (by the Chronic Kidney Disease Epidemiology Collaboration formula) at 3, 6, and 12 mo after 177Lu-PSMA radioligand therapy was estimated using monoexponentially fitted curves through available eGFR data. eGFR changes were grouped (≥15%–&lt;30%, moderate; ≥30%–&lt;40%, severe; and ≥40%, very severe). Associations between eGFR changes (%) and nephrotoxic risk factors, prior treatment lines, and number of 177Lu-PSMA cycles were analyzed using multivariable linear regression. Results: At least moderate eGFR decreases were present in 45% (48/106) of patients; of those, nearly half (23/48) had a severe or very severe eGFR decrease. A higher number of risk factors at baseline (−4.51, P = 0.03) was associated with a greater eGFR decrease. Limitations of the study were the retrospective design, lack of a control group, and limited number of patients with a follow-up longer than 1 y. Conclusion: A considerable proportion of patients may experience moderate or severe decreases in eGFR 1 y from initiation of 177Lu-PSMA. A higher number of risk factors at baseline seems to aggravate loss of renal function. Further prospective trials are warranted to estimate the nephrotoxic potential of 177Lu-PSMA.