What is Lu PSMA (Lutetium-Prostate Specific Membrane Antigen) Therapy?

Lu177 PSMA Therapy is a treatment for patients with prostate cancer, especially those who have become refractory to conventional therapy. Lutetium PSMA therapy helps to slow down the growth of the cancer cells, reduce the size of the tumours and most importantly improve the quality of life of the patients by reducing the pain caused by the cancer.

Many prostate cancers, in particular those that have spread or become resistant to hormonal therapies, express a unique receptor on their cell surface called Prostate Specific Membrane Antigen (PSMA). When Prostate Cancer metastasizes i.e. spreads to other parts of the body, the PSMA receptor is expressed over the sites of metastases as well.

How does Lu PSMA Therapy Work?

Lutetium-177 is a radioactive substance that emits beta radiation, a destructive kind of radiation. Lutetium-177 is bound to a small peptide which attaches to the PSMA receptor expressed on the cancer cell surface. The Lutetium 177 – PSMA complex, thus attached to the prostate cancer cell, then emits killing radiation causing cell death of the cancer cell. Since the penetration of the emitted beta particle is very small, the surrounding normal cells are spared.

How is the Therapy Done?

Lu177 PSMA is administered intravenously. The patient is admitted to the hospital for 24 hours. A kidney function scan called a MAG3/EC scan is done prior to the administration of the Lu177 PSMA.

What are the Side Effects of Lu PSMA Therapy?

Lu177 PSMA is well tolerated. The most common side effects are a slightly dry mouth, fatigue and nausea. There may also be a slight fall in the white blood cells and platelets about 2 – 3 weeks after the Lu177 PSMA administration.

What is the Response Rate With Lu PSMA Therapy?

The response rates of Lu177 PSMA depend on the tumour biology of prostate cancer, the initial Gleason Score, the extent of disease and the responses to prior therapies. Typically, more than 70% of patients demonstrate a reduction in S. PSA and a shrinkage of tumours following Lu177 PSMA therapy.

When would the doctor consider using this Therapy?

Lu PSMA Therapy is a very specific therapy and is used for managing metastatic Prostate Cancer or when Prostate Cancer is no longer responsive to other types of treatment.

What are the Treatment Schedules with Lu PSMA Therapy?

Most patients undergo three-four treatment cycles at intervals of 8-12 weeks. The number of cycles and the interim duration may vary between individuals depending on the response and interim assessments.

Why should I choose the nuclear medicine therapy center at Fortis Memorial & Research Institute (FMRI), Gurugram (Haryana, India)?

The Nuclear Medicine Therapy Centre at FMRI was one of the first institutes to offer Radio-ligand Therapy with Lu PSMA, and today, the center receives patients from the country and from across the world.

Targeted Alpha PSMA Therapy for Metastatic Prostate Cancer Treatment in India

WHAT IS TARGETED ALPHA PSMA THERAPY?

Targeted Alpha PSMA Therapy is a targeted, selective internal cellular level radiotherapy to control advanced prostate and cancer. Targeted Alpha PSMA Therapy uses alpha-emitting radioisotopes like Actinium 225 and is a safe, effective therapy with very minimal side-effects. Being highly selective, targeted alpha therapy, often called Magic Bullet therapy has the potential to revolutionize the way metastatic prostate cancer is treated in the future.

The Nuclear Oncology Experts Team operating out of Fortis Memorial & Research Institute (FMRI), Gurugram, Haryana, India was the pioneer of this therapy in India and Asia. The centre is currently the only centre performing this therapy in India on a regular basis.

WHAT ARE THE SIDE-EFFECTS OF TARGETED ALPHA PSMA THERAPY?

The most common side-effect of Targeted Alpha PSMA Therapy is dry mouth (Xerostomia), While some patients may find it distressing, most patients do not report a very significant impact on their lifestyle due to the xerostomia.

There is usually no bone marrow suppression, nor any damage to the kidney or liver functions due to Targeted Alpha PSMA therapy.

WHERE IS THE AC225 SOURCED FROM?

The Actinium 225 is sourced from Mssrs ITG Germany. The product is approved by the European Medicines Association as well as the Indian Pharmacopia. The highly purified peptides are sourced from ABX Germany. The labelling of Actinium 225 with the peptide is done in house using Good Manufacturing Techniques. The highest standards of quality assurance are maintained at every level.

WHAT ARE THE BENEFITS FROM TARGETED ALPHA PSMA THERAPY?

After completing almost 50 treatment cycles at the centre, the Nuclear Oncology Experts Team is extremely excited with the initial results. With each therapy cycle, most of the patients who have undertaken the treatment have experienced a remarkable improvement in their quality of life with reduced symptoms and pain. Apart from this, the team has also seen an associated biochemical response with a fall in serum PSA levels, indicating a reduction in total tumour burden in the body. Most patients also show a prolonged duration of response with a few patients being in near-complete biochemical and clinical remission for over a year. They continue in clinical remission and as more time goes by the impact of Ac225 PSMA Therapy on the overall survival of patients would become clearer.

The team has performed Ga68 PSMA scans before the next due cycles to monitor radiological responses and have witnessed some encouraging results – nearly 70% tumour reduction in a single cycle in some patients.

Pre-therapy PSMA Scan with disease in Prostate Gland

Pre-therapy PSMA Scan with disease in Prostate Gland, Retroperitoneal Lymph Nodes & Lungs (seen as black spots)

After one cycle of Ac225 PSMA Therapy, the patient had a remarkable reduction in the active tumour from the lungs (black spots in the image on the left), Retroperitoneal Lymph Nodes, as well as shrinkage of tumour in the Prostate Gland.