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. 2024 May 23;16(11):1974.
doi: 10.3390/cancers16111974.

From Despair to Hope: First Arabic Experience of 177Lu-PSMA and 161Tb-PSMA Therapy for Metastatic Castration-Resistant Prostate Cancer

Akram Al-Ibraheem  1   2 , Ahmed Saad Abdlkadir  1 , Deya' Aldeen Sweedat  1 , Stephan Maus  3 , Ula Al-Rasheed  1 , Samer Salah  4 , Fadi Khriesh  5 , Diyaa Juaidi  1 , Dina Abu Dayek  1 , Feras Istatieh  1 , Farah Anwar  6 , Aisha Asrawi  7 , Alaa Abufara  4 , Mohammad Al-Rwashdeh  4 , Ramiz Abu-Hijlih  8 , Baha' Sharaf  4 , Rami Ghanem  9 , Hikmat Abdel-Razeq  4 , Asem Mansour  10
Affiliations

From Despair to Hope: First Arabic Experience of 177Lu-PSMA and 161Tb-PSMA Therapy for Metastatic Castration-Resistant Prostate Cancer

Akram Al-Ibraheem et al. Cancers (Basel). .

Abstract

The objective of this retrospective study is to assess the effectiveness and safety of two beta-emitting prostate-specific membrane antigen (PSMA) radioligands, [177Lu]Lu and [161Tb]Tb, in heavily treated patients with metastatic castration-resistant prostate cancer (mCRPC). A total of 148 cycles of beta-emitting PSMA radioligand therapy were given to 53 patients at a specialized cancer care center in Amman, Jordan. This treatment was offered following the exhaustion of all prior treatment modalities. Approximately half of the cases (n = 26) demonstrated an initial partial response to PSMA radioligand therapy. Moreover, roughly one-fourth of the patients (n = 13) exhibited a sustained satisfactory biochemical response, which qualified them to receive a total of six PSMA radioligand therapy cycles and maintain continued follow-up for additional treatment cycles. This was reflected by an adequate prostate-specific antigen (PSA) decline and a concomitant partial response evident on [68Ga]Ga-PSMA positron emission tomography/computed tomography imaging. A minority of patients (n= 18; 34%) experienced side effects. Generally, these were low-grade and self-limiting toxicities. This study endorses previous research evidence about PSMA radioligand therapy's safety and efficacy. It also provides the first clinical insight from patients of Arab ethnicity. This should facilitate and promote further evidence, both regionally and internationally.

Keywords: 161Tb-PSMA; 177Lu-PSMA; PRLT; PSA; PSMA therapy; PSMA-RLT; mCRPC; prostate cancer; radioligand therapy; specific membrane antigen.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A group of normal anterior and posterior planar scintigraphic images of a single patient for (A) [177Lu]Lu-prostate-specific membrane antigen (PSMA) and (B) [161Tb]Tb-PSMA therapies. Notably, there is an unremarkable difference in the physiologic distribution of both therapeutic agents within the lacrimal glands, salivary glands, hepatobiliary, genitourinary, and gastrointestinal systems.
Figure 2
Figure 2
Flowchart illustrating the process of patient selection.
Figure 3
Figure 3
Waterfall plot illustrating the initial patterns of response in prostate-specific antigen (PSA) levels.
Figure 4
Figure 4
(A) Schematic summary for patients exhibiting initial PSA response as depicted by PSA percentile trending plots. (B) Graphical representation of the total number of patients who qualified for further [177Lu]]Lu-PSMA RLT cycles.
Figure 5
Figure 5
Waterfall plot illustrating the best biochemical response achieved in prostate-specific antigen (PSA) trends.
Figure 6
Figure 6
Waterfall plot illustrating the initial patterns of response in alkaline phosphatase levels.
See this image and copyright information in PMC

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