(213)Bi-PSMA-617 targeted alpha-radionuclide therapy in metastatic castration-resistant prostate cancer.
(213)Bi-PSMA-617 targeted alpha-radionuclide therapy in metastatic castration-resistant prostate cancer.
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DOI：
10.1007/s00259-017-3657-9
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发表时间：
2017-06
影响因子：
9.1
通讯作者：
Marx S
中科院分区：
文献类型：
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作者：
Sathekge M;Knoesen O;Meckel M;Modiselle M;Vorster M;Marx S
前列腺特异性膜抗原放射性配体治疗（PSMA-RLT）与177 Lu-PSMA作为转移性去势抵抗性前列腺癌（mCRPC）患者的安全治疗选择，具有很大的前景，并进行了适当的选择[1]。这种方法与68 Ga-PSMA PET/CT一起，是治疗诊断核医学的一个很好的例子[2]。然而，最近更结构化的数据显示，尽管对PSMARLT有显著的反应，但一些患者对177 Lu-放射性配体治疗是难治的[2，3]。幸运的是，最近的研究表明，使用225 Ac-PSMA的靶向α-放射治疗可使mCRPC患者显著受益[4]。类似地，213 Bi-DOTATOC可能能够打破对β发射体的辐射抗性，同时降低神经内分泌肿瘤弥漫性红骨髓浸润患者的血液学毒性[5]。我们介绍了213 Bi-PSMA-617在1例常规治疗下进展的mCRPC患者中的首次人体治疗概念。患者接受了两个周期的213 Bi-PSMA-617治疗，累积活性为592 MBq。11个月后用68 Ga-PSMA PET/CT重新分期显示出显著的分子成像反应。该患者还表现出生化应答（PSA水平从237 μg/L降至43 μg/L）。这一病例支持了需要进一步探索靶向α放射治疗的使用和供应。
Prostate-specific membrane antigen radioligand therapy (PSMA-RLT) with 177Lu-PSMA holds great promise as a safe treatment option in patients with metastasized castration-resistant prostate cancer (mCRPC) with appropriate selection [1]. This approach, together with 68Ga-PSMA PET/CT, is an excellent example of theranostic nuclear medicine [2]. However, more structured data have recently shown that despite a marked response to PSMARLT, some patients are refractory to 177Lu-radioligand therapy [2, 3]. Fortunately recent studies have demonstrated that targeted α-radiation therapy with 225Ac-PSMA can significantly benefit mCRPC patients [4]. Similarly, 213Bi-DOTATOC may be able to break the radioresistance to βemitters while simultaneously reducing haematological toxicity in patients with diffuse red marrow infiltration by neuroendocrine tumour [5]. We present the first-in-human treatment concept with 213Bi-PSMA-617 in a patient with mCRPC that was progressive under conventional therapy. The patient was treated with two cycles of 213Bi-PSMA-617 with a cumulative activity of 592 MBq. Restaging with 68Ga-PSMA PET/CT after 11 months showed a remarkable molecular imaging response. This patient also demonstrated a biochemical response (decrease in PSA level from 237 μg/L to 43 μg/L). This case supports the need further exploration on the use and supply of targeted α-radiation therapy.