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The ^sup 68^Ga/^sup 177^Lu theragnostic concept in PSMA targeting of castration-resistant prostate cancer: correlation of SUV^sub max^ values and absorbed dose estimates

Introduction A targeted theragnostic approach based on increased expression of prostate-specific membrane antigen (PSMA) on PC cells is an attractive treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). Methods Ten consecutive mCRPC patients were selected for 1...

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Published in:European journal of nuclear medicine and molecular imaging 2017-05, Vol.44 (5), p.788
Main Authors: Scarpa, Lorenza, Buxbaum, Sabine, Kendler, Dorota, Fink, Katharina, Bektic, Jasmin, Gruber, Leonhard, Decristoforo, Clemens, Uprimny, Christian, Lukas, Peter, Horninger, Wolfgang, Virgolini, Irene
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Language:English
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Summary:Introduction A targeted theragnostic approach based on increased expression of prostate-specific membrane antigen (PSMA) on PC cells is an attractive treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). Methods Ten consecutive mCRPC patients were selected for 177Lu-PSMA617 therapy on the basis of PSMA-targeted 68Ga-PSMA-HBED-CC PET/CT diagnosis showing extensive and progressive tumor load. Following dosimetry along with the first therapy cycle restaging (68Ga-PSMA-HBED-CC and 18F-NaF PET/CT) was performed after 2 and 3 therapy cycles (each 6.1±0.3 GBq, range 5.4-6.5 GBq) given intravenously over 30 minutes, 9±1 weeks apart. PET/CT scans were compared to 177Lu-PSMA617 24-hour whole-body scans and contrast-enhanced dual-phase CT. Detailed comparison of SUVmax values and absorbed tumor doses was performed. Results 177Lu-PSMA617 dosimetry indicated high tumor doses for skeletal (3.4±1.9 Gy/GBq; range 1.1-7.2 Gy/GBq), lymph node (2.6±0.4 Gy/GBq; range 2.3-2.9 Gy/GBq) as well as liver (2.4±0.8 Gy/GBq; range 1.7-3.3 Gy/GBq) metastases whereas the dose for tissues/organs was acceptable in all patients for an intention-to-treat activity of 18±0.3 GBq. Three patients showed partial remission, three mixed response, one stable and three progressive disease. Decreased 177Lu-PSMA617 and 68Ga-PSMA-HBED-CC uptake (mean SUVmax values 20.2 before and 15.0 after 2 cycles and 11.5 after 3 cycles, p
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-016-3609-9