Background
Methods
Patients
Administration
Toxicity assessment
Statistical analysis
Results
All patients (n = 140) | |
---|---|
Age | 72 (67–78) |
PSA (µg/L) | 86 (12–258) |
Hemoglobin (g/dL) | 11.9 (10.4–13.2) |
White blood cells (109/L) | 6.4 (5.0–7.8) |
Platelets (109/L) | 238 (188–286) |
eGFR (mL/min/1.73 m2) | 81.8 (68.0–93.7) |
Alkaline phosphatase (U/L) | 93 (67–200) |
LDH (U/L) | 240 (205–303) |
Gleason score* | |
< 8 | 42 (34) |
≥ 8 | 82 (66) |
ECOG performance status | |
0 | 42 (30) |
1 | 81 (58) |
2 | 17 (12) |
Sites of metastases | |
Bone | 125 (89) |
Uni-/oligo-/multifocal | 48 (34) |
Disseminated/diffuse | 77 (55) |
Lymph nodes | 125 (89) |
Visceral | 33 (24) |
Previous mCRPC therapies | |
Abiraterone | 87 (62) |
Enzalutamide | 75 (54) |
223Radium-dichloride | 45 (32) |
Docetaxel | 70 (50) |
Cabazitaxel | 27 (19) |
Other chemotherapies† | 7 (5) |
EBRT (bone metastases) | 49 (35) |
Hematologic laboratory values and adverse events
Baseline (%) | Intra-/posttherapeutic (%) | |||||||
---|---|---|---|---|---|---|---|---|
Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 1 | Grade 2 | Grade 3 | Grade 4 | |
Anemia | 85 (61) | 24 (17) | 2 (1) | 0 (0) | 77 (55) | 42 (30) | 10 (7) | 0 (0) |
Leukopenia | 10 (7) | 3 (2) | 0 (0) | 0 (0) | 27 (19) | 11 (8) | 5 (4) | 0 (0) |
Thrombocytopenia | 13 (9) | 2 (1) | 0 (0) | 0 (0) | 39 (28) | 3 (2) | 5 (4) | 1 (1) |
Course of patients with significant toxicity
Patient | Previous therapies | Toxicity (CTCmax) | Reversibility | Time to toxicity (weeks) | Time to reversibility (weeks) | Course of treatment/disease | ||
---|---|---|---|---|---|---|---|---|
Hb | WBC | Platelets | ||||||
1 | RP, Rx, ADT, DOCE, ABI, CABA | 3 | 3 | 3 | Yes | 8 | 12 | Recovery after transfusion (2xRBC) |
2 | ADT, DOCE, Ra-223 | 3 | 1 | 0 | Yes | 4 | 4 | Recovery after transfusion (2xRBC) |
3 | ADT, local Rx | 3 | 2 | 0 | Yes | 4 | 6 | Transfusion therapy, disease progression, death 18 months after PSMA therapy |
4 | RP, ADT, DOCE, ENZA | 2 | 1 | 3 | – | 8 | – | Lost to follow-up |
5 | ADT, bicalutamide, ABI, DOCE, Rx | 3 | 0 | 0 | Yes | 6 | 4 | Spontaneous recovery, discontinuation of RLT due to PD, continuation of ABI |
6 | ADT, ABI, Rx, DOCE, bicalutamide, ENZA | 3 | 3 | 3 | Yes | 8 | 8 | Recovery of all cell lines after 4xRBC, diagnosed with NSCLC after PR under RLT |
7 | RARP, Rx, ADT, ABSI, DOCE, ENZA | 3 | 1 | 0 | Yes | 4 | 6 | Continuation of RLT after transfusion (2xRBC) |
8 | ADT, bicalutamide, Ra-223 | 3 | 2 | 1 | Yes | 8 | 4 | Carbamazepin intoxication, discontinuation of RLT, spontaneous recovery |
9 | ADT, palliative Rx, ABI, ENZA, DOCE, CABA, 5-FU | 1 | 1 | 3 | Yes | 3 | 6 | Continuation of RLT after spontaneous recovery of platelet count, 3 more cycles, PD |
10 | RP, ADT, DOCE, ABI, ENZA | 3 | 2 | 1 | Yes | 8 | 8 | Continuation of RLT after transfusion (2xRBC) |
11 | RP, salvage Rx, ADT, DOCE, Ra-223, ABI | 3 | 3 | 2 | Yes | 4 | 12 | Transfusion therapy in 4 week intervals (2 × 2 RBC) |
12 | RARP, Rx, ADT, DOCE, ABI, CABA, carboplatin, etoposid, mitoxandrone, 5-FU | 1 | 3 | 3 | No | 8 | – | Transfusion of thrombocytes (2xBP), hepatic disease progression |
13 | RP, salvage Rx, ADT, Ra-223, ABI | 3 | 0 | 4 | No | 7 | – | Transfusion (RBC, BP) disease progression, death 8 weeks after last cycle |
Analysis of predisposing factors for hematologic adverse events
Significant toxicity (grade ≥ 3) | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Any | Anemia | Leukopenia | Thrombocytopenia | |||||||||
OR | 95%CI | p | OR | 95%CI | p | OR | 95%CI | p | OR | 95%CI | p | |
A | ||||||||||||
Bone metastases | ||||||||||||
Presence | 1.49 | 0.18–12.32 | 0.71 | 1.09 | 0.13–9.22 | 0.94 | – | – | – | – | – | – |
Disseminated/diffuse | 5.08 | 1.08–23.86 | 0.04 | 3.54 | 0.73–17.29 | 0.12 | – | – | – | – | – | – |
Baseline hematologic values | ||||||||||||
Grade ≥ 2 myelosuppression | 3.50 | 1.08–11.32 | 0.04 | 4.00 | 1.08–14.85 | 0.04 | 2.44 | 0.39–15.28 | 0.34 | 1.81 | 0.32–10.38 | 0.51 |
Previous mCRPC therapies | ||||||||||||
Taxane-based chemotherapy | 4.62 | 1.23–17.28 | 0.02 | 3.45 | 0.86–13.93 | 0.08 | 10.7 | 0.93–124.74 | 0.06 | 11.37 | 1.11–116.98 | 0.04 |
223Ra-dichloride | 0.93 | 0.27–3.20 | 0.91 | 1.45 | 0.39–5.41 | 0.58 | 1.43 | 0.23–8.85 | 0.70 | 0.43 | 0.46–3.61 | 0.42 |
EBRT (bone metastasis) | 2.36 | 0.75–7.67 | 0.14 | 1.96 | 0.54–7.11 | 0.31 | 2.90 | 0.47–17.99 | 0.25 | 1.91 | 0.37–9.58 | 0.44 |
Significant toxicity (grade ≥ 3) | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Any | Anemia | Leukopenia | Thrombocytopenia | |||||||||
rs | p | rs | p | rs | p | rs | p | |||||
B | ||||||||||||
Baseline laboratory | ||||||||||||
ALP | 0.23 | 0.01 | 0.17 | 0.05 | 0.19 | 0.03 | 0.19 | 0.03 | ||||
LDH | 0.16 | 0.07 | 0.10 | 0.25 | 0.14 | 0.11 | 0.16 | 0.06 | ||||
eGFR | –0.07 | 0.40 | –0.17 | 0.84 | –0.14 | 0.09 | –0.19 | 0.03 | ||||
Administered activity | ||||||||||||
Cumulative | 0.09 | 0.32 | 0.08 | 0.33 | 0.05 | 0.54 | 0.11 | 0.21 | ||||
Per cycle | –0.05 | 0.29 | –0.07 | 0.12 | 0.01 | 0.85 | –0.03 | 0.58 |
Discussion
Study | Ref | n | Cycles | Ligand | Activity (GBq/cycle, range) | Anemia grade 1/2 | Leukopenia/*neutropenia grade 1/2 | Thrombocytopenia grade 1/2 | Anemia grade 3/4 | Leukopenia/*neutropenia grade 3/4 | Thrombocytopenia grade 3/4 |
---|---|---|---|---|---|---|---|---|---|---|---|
Ahmadzadehfar et al. 2015 | [10] | 10 | 10 | PSMA-617 | 5.6 | 1 (10%) | 3 (30%) | 2 (20%) | 1 (10%) | 0 | 0 |
Ahmadzadehfar et al. 2016 | [11] | 24 | 46 | PSMA-617 | 6 (4.1–7.1) | 7 (29%) | 5 (21%) | 4 (17%) | 2 (8%) | 0 | 0 |
Barber et al. 2019 | [35] | 84/83 | n/a | PSMA-617,-I&T | 6.3 (5.7–6.8) | 81(96%)/73(88%) | 22(26%)/23(28%) | 21(25%)/27(33%) | 1(1%)/7(8%) | 0/2(2%) | 1(1%)/3(4%) |
Baum et al. 2016 | [12] | 56 | 125 | PSMA-I&T | 5.8 | n/a | n/a | n/a | 0 | 0 | 0 |
Bräuer et al. 2017 | [13] | 59 | 159 | PSMA-617 | 6.1 (5.9–6.3) | n/a | n/a | n/a | 11 (19%) | 2 (4%) | 2 (4%) |
Derlin et al. 2020 | [34] | 31/40 | n/a | PSMA-617 | 6.0–7.4 | 9 (29%)/6 (15%) | 5 (16%)/4(10%) | 3(10%)/4(10%) | 0 | 0 | 0 |
Emmett et al. 2018 | [36] | 14 | n/a | PSMA-617 | 6.0–8.0 | 2 (14%) | n/a | 1/14 (7%) | 0 | 0 | 0 |
Fendler et al. 2016 | [14] | 30 | 30 | PSMA-617 | 3.7 or 6 | n/a | n/a | n/a | 1 (3%) | 3 (3%) | 0 |
Heck et al. 2016 | [15] | 22 | 43 | PSMA-I&T | 3.7–7.4 | 3 (14%) | 1*(5%) | 5 (23%) | 0 | 0 | 0 |
Heck et al. 2018 | [9] | 100 | 317 | PSMA-I&T | 7.4 | n/a | n/a | n/a | 9 (9%) | 6* (6%) | 4 (4%) |
Hofman et al. 2018 | [8] | 30 | 86 | PSMA-617 | 7.5 | 4 (13%) | 11* (37%) | 8 (27%) | 4 (13%) | 11* (37%) | 4 (13%) |
Hofman et al. 2021 | [44] | 98 | n/a | PSMA-617 | 6.0–8.5 | 19 (19%) | 10 (10%) | 18 (18%) | 8 (8%) | 1 (1%) | 11 (11%) |
Kratochwil et al. 2016 | [16] | 30 | 70 | PSMA-617 | 3.7–6.0 | 9 (30%) | 8 (27%) | 4 (18%) | 1 (5%) | 0 | 1 (5%) |
Paganelli et al. 2020 | [37] | 43 | n/a | PSMA-617 | 3.7–5.5 | 28 (65%) | 3*(6.9%) | 3(6.9%) | 2 (4.8%) | 0 | 0 |
Rahbar et al. 2016 | [18] | 74 | 74 | PSMA-617 | 6.0 | 26 (35%) | 9 (12%) | 16 (22%) | 1(1%) | 0 | 1 (1%) |
Rahbar et al. 2016 | [38] | 28 | 50 | PSMA-617 | 5.9 | 3 (14%) | 3 (14%) | 5 (23%) | 0 | 0 | 0 |
Rathke et al. 2018 | [39] | 40 | 120 | PSMA-617 | 4–9.3 | 0 | 8 (20%) | 2 (5%) | 0 | 1 (3%) | 2 (5%) |
Scarpa et al. 2017 | [40] | 10 | 29 | PSMA-617 | 6 (5.4–6.5) | n/a | n/a | n/a | 0 | 0 | 0 |
Seifert et al. 2020 | [41] | 37/41 | n/a | PSMA-617 | 6.0/7.5 | (35%)/(27%) | (49%)/(49%) | (41%)/(34%) | (22%)/(24%) | (8%)/(2%) | (8%)/(2%) |
Violet et al. 2019 | [42] | 50 | n/a | PSMA-617 | 7.5 | 9 (18%) | 12* (24%) | 14 (28%) | 5 (10%) | 3* (6%) | 5 (10%) |
Yadav et al. 2016 | [43] | 31 | 65 | PSMA-617 | 1.1–7.4 | 9 (31%) | n/a | 1 (3%) | 1 (3%) | n/a | 0 |
Yadav et al. 2020 | [48] | 90 | 281 | PSMA-617 | 1.1–7.8 | 72 (78%) | 10 (11%) | 14 (16%) | 2 (2%) | 1 (1%) | 1 (1%) |