Differences and Common Ground in 177Lu-PSMA Radioligand Therapy Practice Patterns: International Survey of 95 Theranostic Centers
- Author(s)
- Farolfi, A; Armstrong, WR; Djaileb, L; Gafita, A; Hotta, M; Allen-Auerbach, M; Unterrainer, LM; Fendler, WP; Rettig, M; Eiber, M; Hofman, MS; Hadaschik, B; Herrmann, K; Czernin, J; Calais, J; Benz, MR;
- Details
- Publication Year 2024-03-01,Volume 65,Issue #3,Page 438-445
- Journal Title
- Journal of Nuclear Medicine
- Publication Type
- Research article
- Abstract
- (177)Lu-labeled prostate-specific membrane antigen (PSMA) radioligand therapy effectively treats metastatic castration-resistant prostate cancer. Patients requiring treatment, and consequently the number of theranostic centers, are expected to increase significantly after Food and Drug Administration and European Medicines Agency approval. This requires standardization or harmonization among theranostic centers. The aim of this study was to assess operational differences and similarities among (177)Lu-PSMA treatment centers. Methods: A questionnaire comprising 62 items, designed by a core team of 5 physicians and externally reviewed by international experts, was developed. Study participants were asked to provide answers about their center, patient selection, radiopharmaceuticals, clinical assessment before and after (177)Lu-PSMA treatments, laboratory values, treatment discontinuation, posttreatment imaging, and general information. An invitation e-mail to participate in the study was sent in June 2022. Duplicates were removed to allow for only one valid response per center. Results: Ninety-five of 211 (45%) contacted centers completed the questionnaire. Most participating centers were in Europe (51%), followed by America (22%) and Asia (22%). During the 12 mo before this study, a total of 5,906 patients received (177)Lu-PSMA therapy at the 95 participating centers. Most of these patients were treated in Europe (2,840/5,906; 48%), followed by Asia (1,313/5,906; 22%) and Oceania (1,225/5,906; 21%). PSMA PET eligibility for (177)Lu-PSMA was determined most frequently using (68)Ga-PSMA-11 (77%). Additional pretherapy imaging included (18)F-FDG PET/CT, CT, renal scintigraphy, and bone scintigraphy at 41 (49%), 27 (32%), 25 (30%), and 13 (15%), respectively, of the 84 centers for clinical standard of care, compassionate care, or local research protocols and 11 (26%), 25 (60%), 9 (21%), and 28 (67%), respectively, of the 42 centers for industry-sponsored trials. PSMA PET eligibility criteria included subjective qualitative assessment of PSMA positivity at 33% of centers, VISION criteria at 23%, and TheraP criteria at 13%. The mean standard injected activity per cycle was 7.3 GBq (range, 5.5-11.1 GBq). Sixty-two (65%) centers applied standardized response assessment criteria, and PSMA PET Progression Criteria were the most applied (37%). Conclusion: Results from this international survey revealed interinstitutional differences in several aspects of (177)Lu-PSMA radionuclide therapy, including patient selection, administered activity, and the response assessment strategy. Standardization or harmonization of protocols and dedicated training are desirable in anticipation of increasing numbers of patients and theranostic centers.
- Publisher
- Society of Nuclear Medicine and Molecular Imaging
- Keywords
- United States; Male; Humans; *Precision Medicine; *Positron Emission Tomography Computed Tomography; Europe; Gallium Radioisotopes; 177Lu-PSMA; Pet/ct; prostate cancer; radionuclide therapy; survey; theranostic
- Department(s)
- Cancer Imaging
- Publisher's Version
- https://doi.org/10.2967/jnumed.123.266391
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-04-02 04:13:38
Last Modified: 2024-04-02 04:13:52