How Early Can Imaging Assess Response in End-Stage Prostate Cancer?

How Early Can Imaging Assess Response in End-Stage Prostate Cancer?

medscape.com

How Early Can Imaging Assess Response in End-Stage Prostate Cancer?

Becky McCall
4 minutes

BARCELONA, Spain ― Using 177Lu-PSMA (prostate-specific membrane antigen) SPECT to monitor tumor response at week 12 after the third dose of the targeted radioligand 177Lu-PSMA-617 (Pluctivo, Novartis) has potential as an early predictive biomarker for men with end-stage metastatic castration-resistant prostate cancer (mCRPC), according to data reported at the European Association of Nuclear Medicine (EANM) 2022 meeting.

The same researcher suggests that 177Lu-PSMA SPECT, if used even earlier, after only 6 weeks, might also be a reliable biomarker.

Such early imaging biomarkers might help determine intensification or deintensification of therapy to the benefit of patients for whom time and quality of life have added importance.

For the week-12 study, Louise Emmett, MD, PhD, director of theranostics and nuclear medicine at St. Vincent's Hospital Sydney, in Australia, used SPECT to evaluate response to 177Lu-PSMA-617 in LuPIN, a phase 1/2 trial of a combination of 177Lu-PSMA-617 with the added radiation sensitizer NOX66 (idronoxil) in men with mCRPC.

"177Lu-SPECT-CT has potential as a biomarker in these patients with end-stage disease, but this needs to be validated in a larger number of patients and in combination with other biomarkers, such as prostate-specific antigen [PSA] and CT," remarked Emmett in an interview with Medscape Medical News.

Essentially, Emmett and colleagues found that an increase in total tumor volume (TTV) on quantitative 177Lu-SPECT/CT at 12 weeks (or start of cycle three) of treatment with 177Lu-PSMA-617 predicted shorter progression-free survival (PFS), suggesting 177Lu-SPECT/CT may play a future role as an imaging response biomarker.

In email correspondence with Medscape Medical News, Andrei Gafita, MD, a nuclear medicine physician from UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California, noted the "very important topic of treatment response assessment."

"Dr Emmet's work showed that 177Lu-PSMA SPECT has great potential to become a biomarker that could enable early response evaluation to 177Lu-PSMA radioligand therapy," he noted, adding, "It may greatly benefit particularly institutions where PSMA-PET/CT is not available or not reimbursed for the purpose of response evaluation."

Ken Herrmann, MD, associate professor of nuclear medicine at the University of Duisburg-Essen, Germany, also commented on the biomarker study. "Establishing quantitative post-177Lu PSMA administration SPECT as a new surrogate marker for assessing response to treatment has potential upsides, including the potential replacement of interim and post-therapy PSMA PET ― which is cost-saving, radiation exposure–saving, and is more convenient, as well as improving therapy guidance, such as determining whether a therapy holiday, continuation or discontinuation is warranted.

"I'm personally intrigued and excited in this approach," he said.

Adding NOX66 ― a Radiation Sensitizer ― to 177Lu-PSMA-617

Regarding the prolonging of the treatment effect of 177Lu-PSMA-617, Emmett, who is a physician-researcher, explained that "177Lu-PSMA-617 is really good, but it just doesn't work for all patients, and it doesn't work long enough. These men — and some are quite young — die too soon, and this happens again and again," she said in explaining what made this trial so important to her.

 

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