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Review
. 2024 Jun:127:102748.
doi: 10.1016/j.ctrv.2024.102748. Epub 2024 Apr 30.

Salivary toxicity from PSMA-targeted radiopharmaceuticals: What we have learned and where we are going

Miguel Muniz  1 , Charles L Loprinzi  2 , Jacob J Orme  3 , Regina M Koch  4 , Ahmed M Mahmoud  5 , Adam M Kase  6 , Irbaz B Riaz  7 , Jack R Andrews  8 , Matthew P Thorpe  9 , Geoffrey B Johnson  10 , Ayse T Kendi  11 , Eugene D Kwon  12 , Jones T Nauseef  13 , Alicia K Morgans  14 , Oliver Sartor  15 , Daniel S Childs  16
Affiliations
Review

Salivary toxicity from PSMA-targeted radiopharmaceuticals: What we have learned and where we are going

Miguel Muniz et al. Cancer Treat Rev. 2024 Jun.

Abstract

Clinical trials of prostate-specific membrane antigen (PSMA) targeted radiopharmaceuticals have shown encouraging results. Some agents, like lutetium-177 [177Lu]Lu-PSMA-617 ([177Lu]Lu-PSMA-617), are already approved for late line treatment of metastatic castration-resistant prostate cancer (mCRPC). Projections are for continued growth of this treatment modality; [177Lu]Lu-PSMA-617 is being studied both in earlier stages of disease and in combination with other anti-cancer therapies. Further, the drug development pipeline is deep with variations of PSMA-targeting radionuclides, including higher energy alpha particles conjugated to PSMA-honing vectors. It is safe to assume that an increasing number of patients will be exposed to PSMA-targeted radiopharmaceuticals during the course of their cancer treatment. In this setting, it is important to better understand and mitigate the most commonly encountered toxicities. One particularly vexing side effect is xerostomia. In this review, we discuss the scope of the problem, inventories to better characterize and monitor this troublesome side effect, and approaches to preserve salivary function and effectively palliate symptoms. This article aims to serve as a useful reference for prescribers of PSMA-targeted radiopharmaceuticals, while also commenting on areas of missing data and opportunities for future research.

Keywords: Dry mouth; Metastatic castration-resistant prostate cancer (mCRPC); PSMA-targeted radiopharmaceuticals; Salivary toxicity; Xerostomia.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.. Real-world example of the “tumor sink effect”
A. This patient exhibits a very high tumor volume, with extensive PSMA-positive osseous metastases evident on gallium-68-PSMA PET/CT. The majority of the radioligand is sequestered in the numerous sites of disease, resulting in minimal uptake in the salivary glands (arrow). B. This patient presents with a low volume of lymph node-only metastatic disease on baseline gallium-68-PSMA PET/CT. With a lower tumor burden, there is significantly greater radioligand uptake by the salivary glands (arrow), potentially leading to a higher degree of salivary toxicity. Created with BioRender.com
Figure 2.
Figure 2.. Recommended preventive and palliative measures for TRT-induced xerostomia (color)
Created with BioRender.com
See this image and copyright information in PMC

References

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