Dose escalation study of targeted alpha therapy with [225Ac]Ac-DOTA-substance P in recurrent glioblastoma – safety and efficacy

Glioblastoma is the most common and malignant primary brain tumour, with poor prognosis. Introduction of new treatment options is critically important. The study aimed to assess the appropriateness of escalation doses and toxicity of [ 225 Ac]Ac-DOTASP therapy. 21 patients (age of 43.0 ± 9.5 years), with histologically confirmed recurrent or conversion glioblastoma grade 4 following a standard therapy have been included in the study. 1-2 intracavitary port-a-cath systems were stereotactically inserted. Patients were treated with escalation dose protocol with 10, 20 and 30 MBq per cycle totally 1–6 doses of [ 225 Ac]Ac-DOTA-SP in 2-month intervals. Therapeutic response was monitored by clinical performance status and MRI imaging. Treatment was well tolerated with mostly mild temporary adverse effects (edema, epileptic seizures, aphasia, hemiparesis) mainly in the group of patients treated with 30 MBq of [ 225 Ac]Ac-DOTA-SP. Only one patient treated with 30 MBq revealed thrombopenia grade 3. There was no other grade 3 and 4 toxicity related to [225 Ac]Ac-DOTA-treatment in all groups. The median overall survival time from the primary diagnosis (OS-d) was 35.0 months and from the diagnosis of the recurrence/conversion (OS-r/c) was 13.2 months. From the start of treatment with [225 Ac]Ac-DOTA-SPthe median PFS was 2.4 months and the OS-t was 9.0 months.There were no statistically significant differences between the investigated dose escalation groups. Treatment of recurrent glioblastoma with [ 225 Ac]Ac-DOTA-SP is safe and well tolerated up to 30 MBq per cycle. The escalation dose protocol showed good tolerability. Only mild temporary adverse effects were observed. No remarkable haematological, kidney and liver toxicity was seen.

KROLICKI Leszek;  BRUCHERTSEIFER Frank;  KUNIKOWSKA Jolanta;  KOZIARA H;  PAWLAK Dariusz;  KULINSKI Radoslaw;  ROLA R;  MERLO A.;  MORGENSTERN Alfred; 

2022-03-28

SPRINGER

JRC124233

1619-7070 (online),   

https://link.springer.com/article/10.1007/s00259-021-05350-y,    https://publications.jrc.ec.europa.eu/repository/handle/JRC124233,   

10.1007/s00259-021-05350-y (online),