In:
European Journal of Nuclear Medicine and Molecular Imaging, Springer Science and Business Media LLC, Vol. 49, No. 12 ( 2022-10), p. 4262-4270
Abstract:
Radioligand therapy (RLT) with 177 Lu-labeled prostate-specific membrane antigen (PSMA) ligands is associated with prolonged overall survival (OS) in patients with advanced, metastatic castration-resistant prostate cancer (mCRPC). A substantial number of patients, however, are prone to treatment failure. We aimed to determine clinical baseline characteristics to predict OS in patients receiving [ 177 Lu]Lu-PSMA I & T RLT in a long-term follow-up. Materials and methods Ninety-two mCRPC patients treated with [ 177 Lu]Lu-PSMA I & T with a follow-up of at least 18 months were retrospectively identified. Multivariable Cox regression analyses were performed for various baseline characteristics, including laboratory values, Gleason score, age, prior therapies, and time interval between initial diagnosis and first treatment cycle ( interval Diagnosis-RLT , per 12 months). Cutoff values for significant predictors were determined using receiver operating characteristic (ROC) analysis. ROC-derived thresholds were then applied to Kaplan–Meier analyses. Results Baseline C-reactive protein (CRP; hazard ratio [ HR ], 1.10, 95% CI 1.02–1.18; P = 0.01), lactate dehydrogenase (LDH; HR , 1.07, 95% CI 1.01–1.11; P = 0.01), aspartate aminotransferase (AST; HR , 1.16, 95% CI 1.06–1.26; P = 0.001), and interval Diagnosis-RLT ( HR , 0.95, 95% CI 0.91–0.99; P = 0.02) were identified as independent prognostic factors for OS. The following respective ROC-based thresholds were determined: CRP, 0.98 mg/dl (area under the curve [ AUC ], 0.80); LDH, 276.5 U/l ( AUC , 0.83); AST, 26.95 U/l ( AUC , 0.73); and interval Diagnosis-RLT , 43.5 months ( AUC , 0.68; P 〈 0.01, respectively). Respective Kaplan–Meier analyses demonstrated a significantly longer median OS of patients with lower CRP, lower LDH, and lower AST, as well as prolonged interval Diagnosis-RLT ( P ≤ 0.01, respectively). Conclusion In mCRPC patients treated with [ 177 Lu]Lu-PSMA I & T, baseline CRP, LDH, AST, and time interval until RLT initiation (thereby reflecting a possible indicator for tumor aggressiveness) are independently associated with survival. Our findings are in line with previous findings on [ 177 Lu]Lu-PSMA-617, and we believe that these clinical baseline characteristics may support the nuclear medicine specialist to identify long-term survivors.
Type of Medium:
Online Resource
ISSN:
1619-7070
,
1619-7089
DOI:
10.1007/s00259-022-05853-2
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2022
detail.hit.zdb_id:
2098375-X
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