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The impact of repeated cycles of radioligand therapy using [177Lu]Lu-PSMA-617 on renal function in patients with hormone refractory metastatic prostate cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Background

[177Lu]Lu-PSMA-617 is a well-tolerated therapy for the treatment of metastatic prostate cancer. However, because of the mainly renal excretion of the tracer, the kidneys are one of the most limiting organs. The purpose of this study was to examine the post-therapeutic changes in renal function over time and to identify risk factors for developing renal toxicity. We also tested the reliability of markers for renal function monitoring.

Methods

Fifty-five patients with castrate-resistant metastatic prostate cancer treated with at least three cycles of [177Lu]Lu-PSMA-617 were investigated. Renal function was assessed through laboratory tests (creatinine, GFR, cystatin C) and Tc-99 m-MAG3 measurements. Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. To identify risk factors for renal toxicity, we used Pearson’s correlation coefficient and the corresponding p values.

Results

None of the 55 patients experienced severe nephrotoxicity (grade 3/4). In 14 patients (25%), we observed increased creatinine levels of CTC 1° or 2°. There were 16 cases of increased GFR (grade 1/2). At the baseline, only 14 patients had elevated cystatin C. However, post-therapeutic cystatin C was elevated in 32 patients (58%). A significant effect on renal function was found for age (p = 0.049), hypertension (p = 0.001) and pre-existing kidney disease (p = 0.001). The most reliable predictive markers of nephrotoxicity were TER-MAG3 and cystatin C.

Conclusion

Renal toxicity in patients treated with [177Lu]Lu-PSMA-617 was low. There was no (sub)acute grade 3 or 4 nephrotoxicity.

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    Authors and Affiliations

    1. Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

      Anna Yordanova, Anja Becker, Elisabeth Eppard, Stefan Kürpig, Markus Essler & Hojjat Ahmadzadehfar

    2. Department of Urology, University Hospital Bonn, Bonn, Germany

      Christian Fisang

    3. Department of Internal Medicine, MED3, University Hospital Bonn, Bonn, Germany

      Georg Feldmann

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    1. Anna Yordanova
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    2. Anja Becker
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    Correspondence to Hojjat Ahmadzadehfar.

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    The authors declare that they have no financial or non-financial competing interests.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

    This article does not contain any studies with animals performed by any of the authors.

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    Informed consent was obtained from all individual participants included in the study.

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    Anna Yordanova and Anja Becker contributed equally to this work

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    Yordanova, A., Becker, A., Eppard, E. et al. The impact of repeated cycles of radioligand therapy using [177Lu]Lu-PSMA-617 on renal function in patients with hormone refractory metastatic prostate cancer. Eur J Nucl Med Mol Imaging 44, 1473–1479 (2017). https://doi.org/10.1007/s00259-017-3681-9

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    • DOI: https://doi.org/10.1007/s00259-017-3681-9

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