Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN
Rebecca Hassoun , Mark Tann , Justin Sims , Ashleigh Auxier , Sandra K. Althouse , Jennifer King , Nabil Adra
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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