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.

Lutetium Therapy in Metastatic Prostate Adenocarcinoma

PATIENT ONCOLOGY HISTORY

Age: 60-Year-Old Male
Diagnosis: Metastatic Castrate Resistance Prostate Cancer to the bone, hilar and paratracheal lymphadenopathy.
Previous Treatments: Cycles of palliative docetaxel, Provenge, Zytiga, Olaparib Cabazitaxel, with an ATR inhibitor, and palliative RT to Thoracic spine.

Clinical Assessment before the treatment begins: Radiating chest & pelvic pain, breathlessness on walking upstairs, decrease in appetite, and weight loss.

TREATMENT PROCEDURES

The patient was counselled regarding his extensive metastatic disease, including possible bone marrow involvement with the risk of relatively poorer outcomes in view of the disease’s extent.

The treatment options, potential benefits of 177Lu PSMA therapy tumor control and pain relief, complications and side effects including possible bone marrow suppression potentially requiring multiple Packed RBC or platelet transfusions, GCSF injections, and hospital or ICU admissions and in rare cases. The potential adverse effects of a dry mouth were also discussed.

Infusion: Lutetium PSMA Therapy

The patient received 1st dose of 177Lu DKFZ-PSMA-617 by slow intravenous infusion using renal protection protocol (Hydration with intravenous normal saline). And after 3 months, he received the 2nd dose of 177Lu DKFZ-PSMA-617. He is also on Enzalutamide daily under the guidance of the medical oncologist.

Clinical Assessment: The patient claimed a significant improvement in his general condition following the 177 Lu PSMA therapy. There is an improvement in his appetite and overall energy levels. He is not in pain and does not have to take any regular painkillers. He does not complain of any dry mouth. On examination, the patient was fairly nourished with some muscle wasting in the arms and legs. He was conscious, cooperative, and well oriented. Vitals were stable. There was no cyanosis, clubbing, or edema. Bilateral chests clear. CVS examination showed heart sounds. The abdomen was soft and non-tender. There was no peripheral palpable lymphadenopathy.

After 2 months, the patient received the 3rd dose of 177Lu DKFZPSMA-617 by slow intravenous infusion using renal protection protocol (Hydration with intravenous normal saline). And after 3 months, the patient received the 4th dose of 177Lu DKFZ-PSMA-617. He continued taking Enzalutamide daily under the guidance of the medical oncologist.

Clinical Assessment: He did not have any post infusion immediate complications. The patient claimed a significant improvement in his general condition following the 177 Lu PSMA therapy.

Consult Dr Ishita B Sen

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Patient Case Study - Results of Lutetium 177 PSMA Therapy ( Pluvicto ) in Metastatic Prostate Adenocarcinoma

PATIENT ONCOLOGY HISTORY

TREATMENT PROCEDURES

Infusion: Lutetium PSMA Therapy

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Consult Dr Ishita B Sen