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177Lu-PSMA-Therapie

Aktuelle Evidenzlage beim Einsatz in der Behandlung von Patienten mit metastasiertem Prostatakarzinom

177Lu-PSMA therapy

Current evidence for use in the treatment of patients with metastatic prostate cancer

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Zusammenfassung

Hintergrund

In der Therapie des metastasierten kastrationsresistenten Prostatakarzinoms (mCRPC) wurden in den letzten Jahren große Fortschritte erzielt. Zum Einsatz kommen heute Substanzen, welche immer effektiver die Androgenrezeptorachse blockieren, verschiedene Chemotherapeutika und das Radiopharmakon Radium-223 (223Ra). Trotzdem ist nach wie vor eine Heilung im metastasierten kastrationsresistenten Stadium nicht möglich, und neue alternative Therapieformen werden dringend benötigt. Insbesondere in Deutschland wird daher die Lutetium-177(177Lu)-dotierte PSMA- (prostataspezifisches Membranantigen) Radioligandentherapie (177Lu-PSMA-RLT) als weitere Therapieform in individuellen Heilversuchen mit vielversprechenden Erfolgen eingesetzt.

Fragestellung

Es wird eine Standortbestimmung der 177Lu-PSMA-RLT beim mCRPC 2017 beschrieben.

Material und Methode

Darstellung der Therapielandschaft und der sich ergebenden Herausforderungen sowie Sichtung der bisherigen Datenlage zur 177Lu-PSMA-RLT nach pubmed-Recherche.

Ergebnisse

In verschiedenen, teils umfangreichen retrospektiven Arbeiten zeigt sich die 177Lu-PSMA-RLT als vielversprechender Ansatz im Sinne einer potentiell lebensverlängernden Therapie mit günstigem Toxizitätsprofil in der Behandlung des mCRPC.

Schlussfolgerung

Trotz der hoffnungsvollen Ansätze müssen die vielversprechenden Ergebnisse der 177Lu-PSMA-RLT nun dringend durch prospektive Studien bestätigt werden.

Abstract

Background

Despite significant progress in the treatment of metastatic castration-resistant prostate cancer (mCRPC) in recent years (including agents targeting androgen receptor signaling, chemotherapy, and 223Ra), most of these patients still succumb to prostate cancer. Recently, 177lutetium prostate-specific membrane antigen radioligand therapy (177Lu-PSMA-RLT) has been increasingly used within compassionate use provisions in these patients in Germany and showed promising efficacy.

Objectives

Establishment of the current position of 177Lu-PSMA-RLT in mCRPC in 2017.

Materials and methods

Presentation of the therapy landscape in mCRPC and the current challenges within treatment and survey of the available data on 177Lu-PSMA-RLT after PubMed-based research.

Results

In several larger retrospective studies, 177Lu-PSMA-RLT seems to be an encouraging new option with the potential to extend overall survival while displaying a favorable toxicity profile.

Conclusions

Prospective trials are urgently needed to confirm these encouraging results found in retrospective analyses with 177Lu-PSMA-RLT in the treatment of mCRPC.

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Abbreviations

177Lu-PSMA-RLT:

Lutetium-177-dotierte PSMA-Radioligandentherapie

PSMA:

prostataspezifisches Membranantigen

mCRPC:

metastasiertes kastrationsresistentes Prostatakarzinom

LHRH:

luteinisierendes Hormon-Releasing-Hormon

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 GB A1, 48149, Münster, Deutschland

    M. Boegemann & A. J. Schrader

  2. Klinik für Nuklearmedizin, Universitätsklinikum Münster, Münster, Deutschland

    K. Rahbar

Authors
  1. M. Boegemann
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  2. A. J. Schrader
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  3. K. Rahbar
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Correspondence to M. Boegemann.

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Interessenkonflikt

M. Boegemann, A. J. Schrader und K. Rahbar geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Boegemann, M., Schrader, A.J. & Rahbar, K. 177Lu-PSMA-Therapie. Urologe 56, 1440–1444 (2017). https://doi.org/10.1007/s00120-017-0510-5

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  • DOI: https://doi.org/10.1007/s00120-017-0510-5

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