Real-world data for predictors of PSA response to Lu177-PSMA-617 in metastatic castration resistant prostate cancer.

Authors

null

Rebecca Hassoun

Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN

Rebecca Hassoun , Mark Tann , Justin Sims , Ashleigh Auxier , Sandra K. Althouse , Jennifer King , Nabil Adra

Organizations

Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN

Research Funding

No funding received
None.

Background: Lu177-PSMA-617 (Lu177) therapy is effective in a subgroup of patients with metastatic castration resistant prostate cancer (mCRPC). We evaluated PSA responses in subgroups of pts with mCRPC. Methods: Pts with mCRPC who progressed after androgen receptor pathway inhibitor (ARPI) and taxane chemotherapy (or who have refused chemotherapy) were treated with Lu177. Pts with ≥6 weeks follow-up after start of Lu177 therapy were included. Baseline clinical/molecular characteristics and PSMA PET parameters were analyzed and association with PSA30 response was evaluated. Results: 45 pts were included. Median age 71.7 (range, 58-90). At baseline PSMA PET: 37 pts had PSMA + disease in bone, 28 lymph nodes, 5 lungs, 4 liver, and 1 brain. 14 pts had 1 prior ARPI, 31 pts had ≥2 prior ARPI. 5 pts had no prior taxane regimen, 18 had 1 prior taxane, 14 had 2 prior taxanes and 8 had ≥3 taxane regimens. 10 pts had prior PARP inhibitor. With a median follow-up of 2.8 months (1.4-6.1) from starting Lu177 therapy, 21 (46.7%) pts achieved a PSA30 response, and 18 (40.0%) pts achieved a PSA50 response. 24 (53.3%) pts achieved any confirmed PSA response. Grade≥3 toxicity occurred in 3 pts. Conclusions: There is a trend with higher PSA30 and PSA50 response to Lu177 with higher SUVmean, less prior taxane exposure, and in pts with homologous recombination repair mutations (HRR).

Number and % of Pts Achieving PSA30 and PSA50 Response
Characteristic (N)PSA30 response, N (%)PSA30
p-value
PSA50 response, N (%)
Location of PSMA + mets
· Bone (37)
· Liver (4)
· Lymph node (28)
· Lung (5)

16 (43.2%)
3 (75.0%)
11 (39.3%)
3 (60.0%)

0.44
0.33
0.20
0.65

13 (35.1%)
2 (50.0%)
10 (35.7%)
2 (40.0%)
HRR mutation present (BRCA1, BRCA2, ATM, CHEK2, PALB2, CDK12, FANCA)
-Yes (15)
-No (30)




10 (66.7%)
11 (36.7%)




0.06




8 (53.3%)
10 (33.3%)
Prior ARPI
-1 (14)
-2 (26)
-≥3 (5)

3 (21.4%)
14 (53.8%)
4 (80.0%)

0.05

3 (21.4%)
11 (42.3%)
4 (80.0%)
Prior taxane chemo regimens
-0 (5)
-1 (18)
-2 (14)
-≥3 (8)

3 (60.0%)
9 (50.0%)
5 (35.7%)
4 (50.0%)

0.77

3 (60.0%)
8 (44.4%)
4 (28.6%)
3 (37.5%)
SUVmean quartiles
-≤10 (11)
-10.4-12.5 (11)
-13.7-16.0 (12)
-≥16.3 (11)

5 (45.5%)
3 (27.3%)
5 (41.7%)
8 (72.7%)

0.19

4 (36.4%)
3 (27.3%)
4 (33.3%)
7 (63.6%)
SUVmax quartiles
-≤23.0 (10)
-25.0-38.0 (12)
-40.0-60.0 (12)
-≥61.0 (11)

3 (30.0%)
6 (50.0%)
7 (58.3%)
5 (45.5%)

0.63

2 (20.0%)
5 (41.7%)
7 (58.3%)
4 (36.4%)
Number of PSMA + lesions
- < 20 (13)
-20-50 (16)
- > 50 (13)

6 (46.2%)
7 (43.75%)
6 (46.2%)

0.99

6 (46.2%)
5 (31.25%)
5 (38.5%)
Total lesion uptake
quartiles (SUV*mL)
-≤300 (9)
-341-1633 (10)
-1774-3427 (10)
-≥4151(9)


4 (44.4%)
5 (50.0%)
4 (40.0%)
5 (55.6%)


0.97


3 (33.3%)
5 (50.0%)
4 (40.0%)
4 (44.4%)

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer– Advanced/Castrate-Resistant

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e17044)

DOI

10.1200/JCO.2023.41.16_suppl.e17044

Abstract #

e17044

Abstract Disclosures

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