RadioLigand Therapy with [177Lu]Lu-PSMA-617 for Salivary Gland Cancers: Literature Review and First Compassionate Use in France

Abstract

Salivary gland cancers are rare tumors comprising a large group of heterogeneous tumors with variable prognosis. Their therapeutic management at a metastatic stage is challenging due to the lack of therapeutic lines and the toxicity of treatments. [¹⁷⁷Lu]Lu-PSMA-617 (prostate-specific membrane antigen) is a vectored radioligand therapy (RLT) initially developed to treat castration-resistant metastatic prostate cancer with encouraging results in terms of efficacy and toxicity. Many malignant cells could be treated with [¹⁷⁷Lu]Lu-PSMA-617 as long as they express PSMA as a consequence of androgenic pathway activation. RLT may be used when anti-androgen hormonal treatment has failed, particularly in prostate cancer. [¹⁷⁷Lu]Lu-PSMA-617 has been proposed in certain salivary gland cancers, though the expression of PSMA is demonstrated by a significant uptake using [⁶⁸Ga]Ga-PSMA-11 PET scan. This theranostic approach could be a new therapeutic option, warranting prospective investigation in a larger cohort. We review the literature on this subject and offer a clinical illustration of compassionate use in France as a perspective for administering [¹⁷⁷Lu]Lu-PSMA-617 in salivary gland cancer.

Keywords: [177Lu]Lu-PSMA-617; salivary gland cancer; vectored radioligand therapy.

Figure 1

[⁶⁸Ga]Ga-PSMA-11 PET-CT before (A) and after (B) 4 cycles of RLT by [¹⁷⁷Lu]Lu-PSMA-617 with left humeral head lesion (black and white arrow).