First patient exceeding 5-year complete remission after 225Ac-PSMA-TAT

Image of the month Prostate-specific membrane antigen (PSMA)-targeted alpha-therapy with 225Ac-PSMA-617 has demonstrated promising anti-tumor activity in advanced-stage, metastatic castration-resistant prostate cancer [1]. This image presents one of our first patients, suffering from progressing bone and lymph-node metastases after short (<1y) response to hormonal interventions and denosumab. Due to coronary 3-vessel-disease with dilative cardiomyopathy, taxanes were considered contra-indicated (EF <35% after aortic-valve surgery, infarction treated with percutaneous-coronary-intervention/stents, catheter ablation of pro-arrhythmic scare and implantation of cardioverter-defibrillator and pacemaker). In July/Sept/Nov 2014 he received 3 cycles of mean 8.4 MBq 225Ac-PSMA-617 at PSA levels of 39.7, 7.7 and 0.32 ng/ml, respectively. Since January 2015 the PSA is below the detection limit. His baseline PSMA-PET/CT is illustrated by maximum-intensity-projection and representative cross-sectional slices highlighting primary tumor, bone and lymph-node metastases (a). Since January 2015 PSMA PET/CT examinations performed regularly in 6 month intervals as well as the corresponding five year follow-up were without pathological findings (b). The patient developed chronic xerostomia and with some delay creatinine increased from 1.3 mg/dl in October 2015 to 3.3 mg/dl in January 2019. This could partially be related to the renal radiation-expose of PSMA-therapy, probably in combination with cardio-renal syndrome, diabetes and hypertension. This interesting image illustrates that single patients can achieve long-lasting complete remission following 225Ac-PSMA-617. Well in line with the patient presented in this image, exceptional high response-rates to 225Ac-PSMA-617 were recently reported for a larger cohort of chemo-naïve patients [2]. However, adverse late-effects must be kept in mind when applying radio-ligand therapy to patients with earlier stage disease.

RATHKE H;  BRUCHERTSEIFER Frank;  KRATOCHWIL Clemens;  KELLER Hanno;  GIESEL Frederik;  APOSTOLIDIS Christos;  HABERKORN Uwe;  MORGENSTERN Alfred; 

2021-03-17

SPRINGER

JRC120545

1619-7070 (online),   

https://link.springer.com/article/10.1007%2Fs00259-020-04875-y,    https://publications.jrc.ec.europa.eu/repository/handle/JRC120545,   

10.1007/s00259-020-04875-y (online),