177Lu-PSMA-617治疗转移性前列腺癌的安全性和疗效

摘要

Objective To investigate the safety and efficacy of 177Lu-prostate specific membrane antigen (PSMA)-617 in the treatment of metastatic castration-resistant prostate cancer (mCRPC).Methods From August 2017 to September 2018,11 patients(average age 70.6 years) with mCRPC who underwent 177Lu-PSMA-617 therapy in Nanjing First Hospital were studied.All patients underwent 68Ga-PSMA-11 PET/CT before therapy to assess the tumor radioactive uptake.Blood routine examination and renal function test results were documented before and after therapy to assess the safety.The efficacy was reflected by the changes of prostate specific antigen (PSA) levels and maximum standardized uptake value (SUVmax) on 68Ga-PSMA-11 PET/CT imaging.Paired t test and Wilcoxon's sign rank test were used to analyze the data.Results No acute side effects were observed after therapy of 177Lu-PSMA-617.There were no statistically significant differences after therapy in WBC counts,RBC counts,and PLT,as well as Hb levels (t values:-0.28-1.11,all P＞ 0.05).No kidney toxicity was found.The PSA level after 177Lu-PSMA-617 therapy was significantly lower than that before therapy (80.70 (14.29,1 538.00) μg/L vs 604.60 (88.41,3 980.00) μg/L;u =59,P =0.023).Of the 11 patients,only 2 had elevated PSA levels and disease progression,while the other 9 patients had varying decreases,of which 2/11 decreased by ＞30％ and 7/11 decreased by ＞50％.After therapy,SUVmax of metastatic lesions and metastatic lymph nodes were decreased in 9 and 2 patients respectively.Conclusions 177Lu-PSMA-617 has a good therapeutic value for mCRPC.It is safe and has no obvious side effects.%目的 探讨177Lu-前列腺特异膜抗原(PSMA)-617治疗转移性去势抵抗性前列腺癌(mCRPC)的安全性和有效性.方法 前瞻性研究2017年8月至2018年9月在本院接受177Lu-PSMA-617治疗的11例mCRPC患者(平均年龄70.6岁),所有患者治疗前行68Ga-PSMA-11 PET/CT检查,以评估肿瘤放射性摄取.分别记录患者治疗前后血常规、肾功能和血清前列腺特异抗原(PSA)等指标.通过血常规及肾功能的变化评估治疗的安全性,通过治疗前后PSA水平的变化和68Ga-PSMA-11PET/CT显像病灶最大标准摄取值(SUVmax)的改变评估治疗的有效性.采用配对t检验和符号秩和检验分析数据.结果 177Lu-PSMA-617治疗后,未见明显不良反应.所有患者的WBC计数、RBC计数、PLT及Hb在治疗前后差异均无统计学意义(t值:-0.28～1.11,均P＞0.05);未发现相关肾脏毒性.177Lu-PSMA-617治疗后患者PSA水平显著低于治疗前[80.70(14.29,1 538.00) μg/L与604.60(88.41,3 980.00) μg/L;u=59,P=0.023].仅2例发生PSA增高,疾病进展;余9例PSA下降,其中2例下降＞30％,7例下降＞50％.治疗后显像示9例转移病灶SUVmax明显降低,2例转移淋巴结SUVmax明显降低.结论 177Lu-PSMA-617对mCRPC有较好的治疗价值,且安全性较好.