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. 2025 Mar 17:12:1538507.
doi: 10.3389/fmed.2025.1538507. eCollection 2025.

Study of predictive factors for response to 177LU-PSMA in patients with metastatic castration-resistant prostate cancer

Hugo Peslier  1 , Valérie Seegers  2 , Pierre-Alban Dufour  1
Affiliations

Study of predictive factors for response to 177LU-PSMA in patients with metastatic castration-resistant prostate cancer

Hugo Peslier et al. Front Med (Lausanne). .

Abstract

Introduction: Metastatic castration-resistant prostate cancer (mCRPC) is an aggressive disease with a poor prognosis and few therapeutic options. In recent years, 177Lu-PSMA, a novel radioligand therapy, has shown promising results in patients who have failed conventional therapies. However, around 30% of patients do not respond adequately to this treatment. In this retrospective cohort study, we examined clinical, biological, and 68Ga-PSMA PET/CT-derived factors associated with poor treatment response.

Materials and methods: We conducted a retrospective cohort study including 63 patients treated at ICO Angers for progressive mCRPC following Novel Hormonal Agents and taxane-based chemotherapy. The primary endpoint was early treatment discontinuation, defined as stopping therapy at or before the 4th cycle. Secondary endpoints included PSA response and overall survival.

Results: A total of 63 patients were included in the study. Factors associated with early treatment discontinuation included a BMI < 25 kg/m2, PSA doubling time < 2 months, hemoglobin levels <10 g/dL, albumin levels <35 g/L, lactate dehydrogenase (LDH) levels >250 IU/L and alkaline phosphatase (ALP) levels >125 IU/L. On 68Ga-PSMA PET/CT imaging, low SULmax, high Total Tumor Volume, and a low PSG score were also linked to early treatment discontinuation.

Conclusion: This study identified several clinical, biological, and 68Ga-PSMA PET/CT-derived factors associated with early treatment discontinuation. Patients with poor overall health, aggressive or extensive disease, or low PSMA expression are at higher risk of treatment failure.

Keywords: 177Lu-PSMA; PSG score; SULmax; mCRPC; predictive factors; therapeutic response; total tumor volume.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
177Lu-PSMA treatment regimen and monitoring at ICO Angers.
Figure 2
Figure 2
Overall survival of the study population.
See this image and copyright information in PMC

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