Home Men Health Latest consensus statement provides guidance to be used of 177Lu-PSMA radionuclide therapy in mCRPC patients

Latest consensus statement provides guidance to be used of 177Lu-PSMA radionuclide therapy in mCRPC patients

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Latest consensus statement provides guidance to be used of 177Lu-PSMA radionuclide therapy in mCRPC patients

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has issued a brand new consensus statement to supply standardized guidance for the choice and management of metastatic castrate-resistant prostate cancer (mCRPC) patients being treated with 177Lu-PSMA radionuclide therapy. The statement, published within the July issue of The Journal of Nuclear Medicine, also reviews current clinical struggles physicians face during treatment with 177Lu-PSMA-617 radionuclide therapy.

Recently, the U.S. Food and Drug Administration approved 177Lu-PSMA-617 for the treatment of men with mCRPC after progressing on taxane-based chemotherapy and no less than one line of androgen receptor pathway inhibitors (ARPI). To develop the patient selection criteria and determine appropriate use scenarios, SNMMI assembled an autonomous workgroup to represent a multidisciplinary panel of health care providers with substantive knowledge in the usage of nuclear medicine in 177Lu-PSMA-617 radionuclide therapy. The workgroup conducted a review of the 4 prospective phase 2 and phase 3 trials that used 177Lu-PSMA-617 registered on clinicaltrials.gov to develop consensus recommendations.

When it comes to patient selection, workgroup members agreed that PSMA PET ought to be performed inside three months of treatment or since progression on the last therapy to be sure that the present disease state is represented. If disease progression or intervening therapy is obvious, PSMA PET ought to be repeated. Either 18F-DCFPyL or 68Ga-PSMA-11 might be used for PSMA PET imaging, and 18F-FDG PET will not be required as a typical patient selection tool. As well as, patients ought to be imaged with either contrast-enhanced CT or MRI to discover potential PSMA-negative disease. Baseline requirements for renal and bone marrow functions were also noted.

Treatment of mCRPC after chemotherapy and ARPI was considered appropriate, while treatment of mCRPC after ARPI and before chemotherapy was considered rarely appropriate. The working group also agreed that treatment of patients with metastatic castration-sensitive prostate cancer was rarely appropriate.

Moreover, the consensus statement addressed current clinical struggles that physicians face when administering 177Lu-PSMA-617 radionuclide therapy. These include the role of androgen receptor-targeted therapies, the role of 223Ra, treatment-related toxicities, when to contemplate cessation of treatment, exceptional responders and restarting treatment, and imaging during treatment.

“With the approval of 177Lu-PSMA-617, a brand new class of therapeutics is on the market to patients with prostate cancer. We stay up for the potential use of PSMA radionuclide therapy in pre-chemotherapy mCRPC or other settings pending the total results of ongoing trials,” noted the authors.

The total consensus statement on patient selection and appropriate use of 177Lu-PSMA-617 radionuclide therapy might be viewed on SNMMI’s website.

This text was made available online in June 2023.

Source:

Journal reference:

Hope, T. A., et al. (2023). SNMMI Consensus Statement on Patient Selection and Appropriate Use of 177Lu-PSMA-617 Radionuclide Therapy. Journal of Nuclear Medicine. doi.org/10.2967/jnumed.123.265952.

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