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.

Transarterial Radioembolization (TARE) as a Treatment for Liver Transplant Candidates

Summary (10 sec read)

Transarterial Radioembolization (TARE) with Yttrium-90 (Y-90) is a crucial treatment for liver transplant candidates with hepatocellular carcinoma (HCC). It effectively downstages tumors, prevents progression during wait times, and improves post-transplant survival. TARE outperforms TACE, offering better tolerance, fewer side effects, and enhanced cost-effectiveness.

Transarterial Radioembolization (TARE) with Yttrium-90 (Y-90) is an effective treatment for hepatocellular carcinoma (HCC) patients awaiting liver transplantation. By delivering targeted radiation to tumors via the hepatic artery, TARE reduces tumor size while preserving surrounding liver tissue, making it a valuable downstaging and bridging therapy option for transplant candidates.

TARE’s Role in Downstaging and Bridging to Transplantation

Liver transplantation is the gold-standard treatment for patients with HCC, but due to the scarcity of donor organs, candidates often wait months or even years. Tumor progression during this waiting period can make patients ineligible for transplantation. TARE helps prevent tumor growth, ensuring that patients remain within transplant eligibility criteria.
• A study in The Oncologist highlighted that TARE successfully downstages 30%–50% of patients with intermediate and advanced HCC, allowing them to meet the Milan or UCSF criteria for transplantation (https://academic.oup.com/oncolo/article/29/2/117/7490834).
• Research published in Radiographics found that TARE-treated patients had significantly lower dropout rates from transplant waitlists compared to those receiving Transarterial Chemoembolization (TACE) (https://pubs.rsna.org/doi/full/10.1148/rg.2021210014).
• According to a PubMed Central (PMC) study, TARE resulted in a 45% reduction in tumor burden, significantly increasing transplant eligibility (https://pmc.ncbi.nlm.nih.gov/articles/PMC5497664/).

By effectively controlling tumor progression, TARE enhances the probability of successful transplantation, providing a crucial advantage over other locoregional therapies.

Survival and Recurrence Rates Post-Transplantation

Post-transplant survival and tumor recurrence are major concerns for HCC patients undergoing pre-transplant therapies. Studies indicate that TARE not only extends survival before transplantation but also enhances long-term post-transplant outcomes.
• A study published in J Liver Cancer reported that patients who underwent TARE before liver transplantation exhibited a 5-year survival rate exceeding 70%, similar to non-cancerous transplant recipients (https://www.e-jlc.org/journal/view.php?number=489).
• Another PMC study found that “TARE-treated patients had a reduced recurrence rate of 15%–20% post-transplant, compared to 25%–30% for patients receiving TACE (https://pmc.ncbi.nlm.nih.gov/articles/PMC5497664/).
• Research from The Oncologist also showed that TARE has a longer median survival of 30 months compared to 16 months with TACE” (https://academic.oup.com/oncolo/article/29/2/117/7490834).

The ability of TARE to not only extend survival but also lower recurrence rates post-transplant makes it a preferred therapy for patients awaiting transplantation.

Advantages Over Other Locoregional Therapies

TARE has distinct benefits over conventional locoregional treatments such as TACE and radiofrequency ablation (RFA).
• Lower Side Effect Profile: Unlike TACE, which causes post-embolization syndrome (fever, nausea, and severe pain), TARE is better tolerated, with fewer complications (https://pubs.rsna.org/doi/full/10.1148/rg.2021210014).
• Preservation of Liver Function: According to J Liver Cancer, “TARE minimizes damage to non-cancerous liver tissue, making it a safer choice for patients with borderline liver function (https://www.e-jlc.org/journal/view.php?number=489).
• Improved Tumor Control: A meta-analysis in PMC reported that “TARE-treated patients had a median overall survival of 19–30 months, compared to 11–16 months for TACE patients (https://pmc.ncbi.nlm.nih.gov/articles/PMC5497664/).

These advantages make TARE an essential tool for managing HCC in transplant candidates.

TARE as a Cost-Effective Option

Apart from its clinical benefits, TARE is also a cost-effective option for HCC patients.
• A Radiographics study noted that “TARE reduces the need for repeated hospitalizations and additional procedures, lowering overall treatment costs (https://pubs.rsna.org/doi/full/10.1148/rg.2021210014).
• Research in The Oncologist found that “TARE requires fewer sessions compared to TACE, resulting in fewer hospital visits and lower financial burden on patients (https://academic.oup.com/oncolo/article/29/2/117/7490834).

Given the high costs associated with liver transplantation, the ability of TARE to improve outcomes while reducing expenses makes it an attractive option for both patients and healthcare providers.

Conclusion: A Critical Tool for Liver Transplant Candidates

TARE with Y-90 is a transformative therapy for liver transplant candidates, offering multiple advantages:
• Effective downstaging, enabling patients to qualify for transplantation.
• Bridging therapy benefits, preventing tumor progression during long waitlist periods.
• Superior post-transplant outcomes, with increased survival rates and lower recurrence risks.
• Better tolerance and fewer side effects compared to other locoregional therapies.
• Cost-effectiveness, reducing hospitalizations and financial burdens.

Given these benefits, TARE should be a primary treatment consideration for HCC patients seeking liver transplantation. Its ability to prolong survival, improve transplant eligibility, and enhance post-transplant outcomes makes it a critical component in modern liver cancer management.

Sources:

https://nuclearmedicinetherapy.in/post/tare-for-liver-cancer-3-reasons-tare-is-beneficial-for-liver-cancer-patients-waiting-for-a-liver-transplant
https://pmc.ncbi.nlm.nih.gov/articles/PMC4882351/
https://pmc.ncbi.nlm.nih.gov/articles/PMC5497664/

https://academic.oup.com/oncolo/article/29/2/117/7490834
https://www.e-jlc.org/journal/view.php?number=489
https://pubs.rsna.org/doi/full/10.1148/rg.2021210014

Consult Dr Ishita B Sen

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