ASCO GU 2021: Lu-177 radiotherapy illuminates the path of radiation therapy for prostate cancer

Dr. Sathekge gave a presentation on the role of ute in prostate cancer in a plenary speech at the Advanced Prostate Cancer Personalized Treatment Progress and Commitment Conference at the American Society of Clinical Oncology's Urogenespheric System Cancer Symposium (ASCO GU) in 2021.
Throughout the field of prostate cancer, Dr. Sathekge emphasized that the Lu-177 PSMA-based approach plays an important role in the initial stages of local, lymph node and long-range diseases;
Sathekge highlighted the molecular structure of PSMA trans-membrane glycoproteins.
the protein is expressed at a basic level, it is elevated in cancer, leading to its use in all of these adaptations.
Lu-177 PSMA is a radioactive polymer in which the radioactive moleculeemits a radiation called b-wave and binds to prostate cancer cells that express PSMA.
A previous study in The Lancet found that PSMA PET-CT was able to detect cancer metastasis more accurately than usual scans for prostate cancer imaging and to guide clinical treatment of patients with high-risk prostate cancer to help doctors better develop medical plans.
Lutetium-177 PSMA therapy combines treatment with diagnosis, also known as therapeutic diagnostics.
Sheba Medical Center is one of the few medical centers in the world that offers this treatment to patients with advanced and metastatic prostate cancer.
in phases, he provided data that demonstrated the usefulness of PSMA-PET/CT in primary tumors, lymph nodes, and distant metastasis in patients with high-risk diseases.
he highlights the data from the proPSMA trial to this.
addition, it is possible to detect relapsed diseases at much lower PSA levels than in conventional imaging.
Sathekge later stressed the importance of FDG imaging - a treatment that is unlikely to be successful with FDG and PSMA.
use of these methods is necessary for molecularly targeted therapy.
in therapy, Dr. Sathekge emphasized the "simple" way of targeting radiotherapy.
dose of local radiotherapy causes the DNA chain to break, leading to cell death.
As already mentioned, Dr. Sathekge stressed the importance of multidisciplinary participation in patient selection, including appropriate imaging findings, positive treatment for tumor progression, appropriate blood, kidney and liver function, and appropriate disease adaptation (mCRPC).
177-Lu-PSMA can be used to reduce PSA and improve pain and quality of life by properly controlling the disease.
, 30-35% of patients did not respond.
important, he stressed that PSMA expression is closely related to the response to treatment.
in Pretoria, they identified patients with advanced diseases and invasive tumor biology.
this and access to treatment, appropriate sequencing will be carried out in a multidisciplinary manner.
he used data from the WARMTH study to highlight ECOG status, liver metastasis and bone metastasis as critical prognosis for patients receiving 177-Lu-PSMA.
Phase 2 clinical trial in TheraP randomized mCRPC patients treated with dorsets into two groups, using the radioactive drug Luttium 177 labeled PSMA-617, and kabathal (yew alkane).
177-Lu-PSMA had a better PSA response and lower toxicity than mCRPC men treated with dopparta.
preliminary results of the trial showed that the Lu-PSMA group (n-98) nearly doubled to the main endpoint of prostate-specific antigen (PSA) response rate (PSA was nearly twice as high as the baseline ≥50%) compared to the kabatha group (n-85), at 66% and 37%, respectively.
looking ahead, Dr. Sathekge discussed the order of treatment, highlighting the results of the data that showed a good response to 225-Ac-PSMA in patient groups that had not been treated with chemotherapy.
, he highlighted the potential for retrerapy with 17-Lu-PSMA, which is more responsive than many other systemic therapies.
toxicity, Dr. Sathekge stressed the possibility of dry mouth, given the presence of PSMA in the salivary glands.
to reduce toxicity include dose reduction, combination therapy, and new albumin-binding PSMA radioactive mating.
addition, Dr. Sathekge emphasized the potential for combination therapy with therapeutic therapies and androgen axis targets.
, advanced imaging methods can be used to identify PARP expressions to allow targeted use of PARP inhibitors in patients most likely to benefit.
Sathekge concluded by stressing that L offers the potential for targeted therapy that can improve survival outcomes and quality of life.
: Mike Machaba Sathekge, M.D., is a professor at the University of Pretoria and head of the Department of Nuclear Medicine.
is the President of the South African Medical Research Council.
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