Introduction
Methods
Search strategy
PSMA immunohistochemistry
PSMA PET/CT imaging
Results
Salivary gland cancer
Cancer type | Subtype | PSMA expression Tumor cells IHC | PSMA expression Vasculature IHC | PSMA PET imaging | Proportion of patients possibly eligible for future PSMA-RLT studies |
---|---|---|---|---|---|
Salivary gland cancer | Adenoid cystic carcinoma | N = 135 PSMA + : 93% (125/135) Positive cells: range: < 1–90% N = 24 PSMA + : 83% (20/24) Positive cells: range: 5–100% | Primary tumor [29] N = 14 PSMA + : 0% (0/14) Metastases [29] N = 9 PSMA + : 0% (0/9) | N = 8 PET tracer uptake: 100% (8/8) SUVmax: range: 1.1 to 30.2* N = 26 PET tracer uptake: 100% (26/26) SUVmax: range: 1.1 to 30.2* | 93% of adenoid cystic carcinoma patients; tumor/liver ratio > 1 in 13/14 patients [29] Percentage of patients with tumor/liver ratio > 1.5 not reported |
Salivary duct carcinoma | Primary tumor [29] N = 9 PSMA + : 44% (4/9) Positive cells: range: < 1–50% Metastases [29] N = 1 PSMA + : 0% (0/1) | Primary tumor [29] N = 9 PSMA + : 89% (8/9) Metastases [29] N = 1 PSMA + : 100% (1/1) | Primary/recurrent tumor [29] N = 3 PET tracer uptake: 100% (3/3) SUVmax: range: 0.3 to 25.9* Metastases [29] N = 9 PET tracer uptake: 100% (3/3) SUVmax: range: 0.3 to 25.9* | 40% of salivary duct carcinoma patients; tumor/liver ratio > 1 in 4/10 patients [29] Percentage of patients with tumor/liver ratio > 1.5 not reported | |
Glioblastoma | - | N = 8 PSMA + : 0% (0/8) | N = 128 PSMA + : 72% (92/128) | N = 46 PET tracer uptake: 100% (46/46) SUVmax: range: 2.1 to 24.6 | 13% of glioblastoma patients tumor/liver ratio > 1.5 in 2/15 patients [54] |
Thyroid cancer | Differentiated thyroid cancer | N = 209 PSMA + : 0% (0/209) Metastases [58] N = 9 PSMA + : 0% (0/9) | N = 258 PSMA + : 74% (192/258) Metastases [58] N = 9 PSMA + : 100% (9/9) | N = 9 PET tracer uptake: 100% (9/9) SUVmax: range: 1.4 to 13.7 N = 29 PET tracer uptake: 100% (29/29) SUVmax: range: 0.9 to 101.8 | Especially in metastatic disease, high tracer uptake has been reported [75] Some patients might be eligible for PSMA-RLT |
Anaplastic thyroid cancer | N = 15 PSMA + : 0% (0/15) | N = 19 PSMA + : 63% (12/19) | N = 2 PET tracer uptake: 100% (2/2) SUVmax: 6.0‡ Metastases [72] N = 1 PET tracer uptake: + SUVmax: NR | Insufficient data | |
Medullary thyroid cancer | Primary tumor [59] N = 10 PSMA + : 0% (0/10) | N = 126 PSMA + : 83% (104/126) | N = 2 PET tracer uptake: 100% (2/2) SUVmax‡: 4.5 Metastases [70] N = 1 PET tracer uptake: + SUVmax: 19.7 | Insufficient data Imaging data of one metastatic patient indicate sufficient tracer uptake of metastases | |
Renal cell carcinoma | Clear cell | N = 12 PSMA + : 0% (0/12) | N = 299 PSMA + : 79% (236/299) Metastases [134] N = 20 PSMA + : 75% (15/20) | N = 28 PET tracer uptake: 96% (27/28) SUVmax: range: 1.7 to 39.4 N = 36 PET tracer uptake: 89% (32/36) SUVmax: range: 0.9 to 48 | In metastatic patients high tracer uptake has been reported. Some patients might be eligible for PSMA-RLT |
Papillary | - | N = 59 PSMA + : 27% (16/59) | N = 4 PET tracer uptake: 50% (2/4) SUVmax: range: 3.6 to 5.1 Metastases [84] N = 3 PET tracer uptake: 67% (2/3) SUVmax: range: 1.8 to 4.1 | Available data shows relatively low tracer uptake | |
NS† | - | - | N = 7 PET tracer uptake: 71% (5/7) SUVmax‡: 18.3 N = 3 PET tracer uptake: 67% (2/3) SUVmax: range: 0.5 to 6.2 | Available data shows relatively low tracer uptake in metastatic patients | |
Hepatocellular carcinoma | - | N = 282 PSMA + : 24% (69/282) Positive cells: NR | N = 282 PSMA + : 83% (235/282) | N = 117 PET tracer uptake: 96% (112/117) SUVmax: range: 3.7 to 55.4 N = 16 PET tracer uptake: 100% (16/16) SUVmax: 2.2–21.3 | 100% of hepatocellular carcinoma patients; tumor/liver ratio > 1.5 in 15/15 patients [94] |
Lung cancer | NSCLC—adenocarcinoma | N = 141 PSMA + : 15% (21/141) Positive cells: NR | N = 141 PSMA + : 45% (63/141) | N = 3 PET tracer uptake: 100% (3/3) SUVmax: range: 4.8 to 5.6 | Available PSMA imaging data indicates relatively low tracer uptake |
NSCLC—squamous cell carcinoma | N = 151 PSMA + : 19% (29/151) Positive cells: NR | N = 151 PSMA + : 64% (97/151) | - | Insufficient data | |
NSCLC—large cell carcinoma | N = 70 PSMA + : 20% (14/70) Positive cells: NR | N = 70 PSMA + : 70% (49/70) | - | Insufficient data | |
NSCLC—NS† | Primary tumor [38] N = 5 PSMA + : 0% (0/5) | N = 13 PSMA + : 100% (13/13) | N = 9 PET tracer uptake: 100% (9/9) SUVmax: range: 3.7–7.0 Metastases [110] N = 1 PET tracer uptake: yes SUVmax: 4.4 | Available PSMA imaging data indicates relatively low tracer uptake | |
Small cell lung cancer | Primary tumor [104] N = 30 PSMA + : 0% (0/30) | Primary tumor [104] N = 30 PSMA + : 70% (21/30) | - | Insufficient data | |
Breast cancer | Invasive carcinoma of no special type | N = 56 PSMA + : 46% (26/56) Positive cells: NR | N = 312 PSMA + : 67% (209/312) | N = 2 PET tracer uptake: 100% (2/2) SUVmax: range: 3.2 to 9.7 | Insufficient data Available PSMA imaging data indicates relatively low tracer uptake |
Invasive lobular carcinoma | Primary tumor [38] N = 1 PSMA + : - | N = 65 PSMA + : 42% (27/65) | - | Insufficient data | |
NS† | Primary tumor [114] N = 17 PSMA + : 29% (5/17) Positive cells: NR Metastases [114] N = 12 PSMA + : 75% (9/12) Positive cells: NR | N = 110 PSMA + : 70% (77/110) N = 23 PSMA + : 96% (22/23) | N = 14 PET tracer uptake: 57% (8/14) SUVmax: range: NR Mean SUVmax¶: 2.45 N = 19 PET tracer uptake: 89% (17/19) SUVmax: range: NR Mean SUVmax¶: 6.86 | Available PSMA imaging data indicates relatively low tracer uptake |
Cancer | Subtype | Author, year | Number of patients | Radioligand | Injected activity, number of cycles | Efficacy* | Dosimetry | Comments |
---|---|---|---|---|---|---|---|---|
Salivary gland cancer | Adenoid cystic carcinoma | Klein Nulent et al. 2017. [30] | N = 1 | [177Lu]Lu-PSMA-617 | NR | NR | NR | Article mentions that one patient was undergoing [177Lu]Lu-PSMA treatment. But further details have not been reported |
Adenoid cystic carcinoma | Simsek et al. 2019. [34] | N = 1 | [177Lu]Lu-PSMA | 7.5 GBq 1 cycle | Pain reduction | Scan after 24 h, showed intense uptake of metastases | PSMA ligand not specified Second dose was intended but canceled to malignancy-induced hypercalcemia | |
Adenoid cystic carcinoma and Salivary duct carcinoma | Study protocol: recruiting | Intended:N = 10 | [177Lu]Lu-PSMA-I&T | 7.4 GBq 2–4 cycles | NA | Will be performed after 1 h, 24 h, 48 h, 72 h and 7d | Clinical study: NCT04291300 Recruiting | |
Glioblastoma | - | Kunikowska et al. 2020. [53] | N = 1 | [177Lu]Lu-PSMA-617 | 8.4 GBq 1 cycle | NR | Scans after 3 h, 24 h, 48 h, 7d and 14 d. Calculated tumor absorbed dose: 14.07 Gy | There were no efficacy related outcomes reported |
- | Kumar et al. 2020. [55] | N = 1 | [177Lu]Lu-PSMA-617 | 3.7 GBq 3 cycles | - improvement performance status - symptom improvement - tumor reduction: from 17 mL to 5.4 mL | NR | ||
Thyroid cancer | Papillary thyroid carcinoma | De Vries et al. 2020. [77] | N = 2 | [177Lu]Lu-PSMA-617 | 6 GBq 2 cycles | Patient 1: Partial temporary response of lung and liver metastases PFS: 7 months Patient 2: No response | NR | Both patients were heavily pretreated |
Radioactive iodine-refractory differentiated thyroid carcinoma | Assadi et al. 2019 [76] | N = 1 | [177Lu]Lu-PSMA | 7.4 GBq 1 cycle | NR | NR | PSMA ligand not specified Patient deceased 2 weeks post-therapy of sudden cardiac arrest | |
Renal cell carcinoma | - | - | - | - | - | - | - | |
Hepatocellular carcinoma | - | Hirmas et al. 2021 [102] | N = 2 | [177Lu]Lu-PSMA-617 | 5.9–6.2 GBq 1 cycle | NR | Intra-therapeutic SPECT/CT based dosimetry revealed low tumor radiation dose | Treatment was discontinued in both patients after low radiation doses based on SPECT/CT dosimetry |
Lung cancer | - | - | - | - | - | - | - | |
Breast cancer | Unknown, triple negative | Tolkach et al. 2018 | N = 1 | [177Lu]Lu-PSMA | 7.5 GBq 2 cycles | No response | NR | PSMA ligand not specified Treatment was well tolerated, no side effects. Clinical follow-up showed severe progress after the second cycle, so no further cycles applied |