Lutetium-177 PSMA Therapy: Everything You Need to Know
Lutetium-177 PSMA is the latest treatment method for metastatic or non-treatable cancer. With the help of modern technologies, it has become possible to attack cancer with a weapon of point destruction. That reduces the tumor and relieves symptoms without affecting neighboring healthy cells.
Below we will talk about two types of radionuclide therapy: peptide-receptor radionuclide therapy (PRRT) and prostate cancer therapy with Lu177 PSMA. So, let's look at how it works when prescribed and how safe it is.
What is Lutetium-177 PSMA therapy?
Lutetium 177 Dotatate is a treatment option for people with cancerous tumors at their advanced stages. It's a type of medicine that contains a radioactive substance (Lutetium-177) and a unique molecule (DOTATATE). The unique properties of this substance allow it to move freely through the circulatory system and fight cancer cells.
When the medicine is given to the patient through a vein, the Lutetium-177 sends high-energy particles called beta particles to the cancer cells. Malignant cells absorb energy. The drug uses this quality to recognize and distinguish them from healthy ones. These particles get inside tumor cells and attack them.
The DOTATATE part of the medicine helps to target only the cancer cells, as it sticks specifically to a protein (prostate-specific membrane antigen) found on the surface of the cancer cells. It means the treatment is more precise, reducing the risk of harm to healthy cells.
Getting this treatment is usually a quick and painless process. Most people don't experience any discomfort, and the side effects are typically mild. Lutetium 177 Dotatate is a safe and effective option for cancer treatment.
How does Lu-177 Therapy Work?
The patient is injected with a drug containing a radioactive molecule (lutetium-177). It recognizes the tumor's focus and destroys it from the inside. That is a kind of spot irradiation that the patient receives intravenously.
The drug molecule consists of two parts:
- Transport part. It is a protein molecule that recognizes a specific protein receptor on the surface of a cancer cell and interacts with it.
- Radioactive substance.
The PSMA molecule purposefully finds malignant cells and joins them, including primary prostate cancer and distant metastases. Scientists used this ability to develop a new technique – targeted alpha therapy with radium-223 and actinium-225.
In cancer, the protein content increases, distinguishing these cells from the rest. In addition, the isotope of lutetium (Lu-177) has a small radius of action — the radiation spreads by 1-2 mm. Thus, cancer cells are directly exposed to radiation, while neighboring healthy tissues are not.
In nuclear medicine, only therapeutic radionuclides that are safe for humans are used. Actinium-225 is a unique source of alpha radiation. After its exposure, cancer cells are unable to live or multiply. At the same time, there is no harmful effect on neighboring healthy cells due to radiation spreading by 0.04 mm.
PSMA therapy with Actinium-225 is effective even when all other possibilities have already been exhausted. It helps patients with metastatic cancer resistant to chemotherapy and hormonal drugs. And even in the case of the ineffectiveness of PSMA therapy with Lutetium-177, replacing radionuclide with Actinium-225 improves therapy results and forecasts for the future.
In what cases is Lu-177 PSMA used?
Lutetium 177 Dotatate is often used in medicine to treat prostate cancer in the late stages, with metastases to soft tissues and bones. The primary condition is the presence of a molecular target. However, due to the large amount of protein on the surface of cancer cells, the drug molecules can only be absorbed by cancer-mutated cells.
That can be checked using scintigraphy or computed tomography. First, a substance is injected into the body that "highlights" the tumor cells in the images. If the tumor is "glowing," then the therapy will be effective.
Another area is radionuclide therapy of peptide receptors, abbreviated PRRT. It is used to treat neuroendocrine tumors, particularly neoplasms of the stomach and pancreas.
Radionuclide therapy is usually performed in cases where:
- the neoplasm gives metastases;
- other treatments are ineffective, and cancer continues to progress despite ongoing treatment;
- surgery is not possible;
- all "traditional" methods of treatment have been exhausted.
PRRT often becomes the last hope for cancer patients with progressive metastatic inoperable tumors. Lutetium 177 PSMA effectively destroys both the tumor and metastases. In addition, treatment relieves pain and eliminates other clinical cancer symptoms. Thanks to targeted therapy, patients already feel a significant improvement in their well-being and general condition in a short time.
What is the Success Rate of Lutetium-177?
Clinical studies have shown a 12-month overall survival in 75% of patients and an 18-month overall survival in 64%.
On average, 80% of prostate cancer cases had a positive response to radionuclide therapy. However, some patients may require additional therapy courses to eradicate malignant neoplasms. Thus, PSMA therapy has a good response and success in patients with metastatic prostate cancer.
About 62% of patients with malignant tumors of the middle part of the gastrointestinal tract of stage 4 lived for three years, thanks to Lu-177. This medicine achieves such a result in at most 10% of cases.
According to a study published by The Journal of Nuclear Medicine, survival significantly increased in stage 4 prostate cancer patients. More than 64% of patients show long-term results after Lutetium-177 therapy. The life expectancy of patients has increased by 50%.
How safe is Lutetium-177 therapy?
Damage to healthy tissues when using lutetium-177-PSMA is minimal. Radiation is concentrated mainly on tumor cells. In addition, PSMA therapy has low toxicity. Blood tests are performed during treatment, and kidney and liver functions are monitored.
After the treatment, a visual examination is performed to ensure that the radiation accumulations are only in the tumor.
Radionuclide treatment is indicated for weakened patients with advanced stages of cancer. Therefore, scientists and practitioners pay special attention to the effectiveness of therapy and its tolerability.
Are There Any Lu 177 Side Effects?
Radionuclide treatment causes fewer side effects than other types. In general, the risks are minimal – because drugs for PRRT act precisely the same as snipers.
Sometimes the number of leukocytes and platelets in the blood decreases but usually not significantly. In some cases, the drugs have a toxic effect on the kidneys.
The most typical side effects of radionuclide therapy include the following:
- Dry mouth and eyes – 68% of patients;
- Nausea – 48% of patients;
- Fatigue – 36% of patients;
- Anemia – 10% of patients.
Other adverse effects can be pain or discomfort at the injection site, increased risk of infection, irregular heartbeat, and increased risk of blood clots. It is essential to add that not all patients will experience these side effects, and the severity can vary.
Most side effects are temporary and pass within a few days/weeks after the treatment course.
Before, during, and after the procedure
In most cases, no special preparation for the procedure is required. But before starting Lu-177 therapy, patients are advised to avoid smoking and alcohol consumption and not to take anticoagulants and aspirin. Since Lu-177 accumulates in the salivary glands, patients are given cooling compresses 30 minutes before and a few hours after therapy. It helps to slow down blood flow and minimize the accumulation of radiation. In addition, to protect the kidneys, the patient is recommended to drink more water.
Medications for PRRT are available in solutions and are administered intravenously through a dropper for 10-20 minutes. After that, the doctor monitors the patient's condition for at least 48 hours.
Usually, patients return home within two days after therapy if there are no side effects. Then within a few days after therapy, examinations are carried out to monitor the accumulation of Lu-177 in tumor cells. The drug's effectiveness is checked using scintigraphy and PSMA PET CT scanning with computed tomography. In total, 2 to 4 cycles of treatment are needed at intervals of 6-8 weeks.
Where to get Lutetium 177 therapy?
Is Lutetium 177 PSMA FDA approved?
Since 2018, the U.S. The Food and Drug Administration (FDA) has approved lutetium-177 for treating terminal tumors. At the same time, cancer patients had to have healthy kidneys and bone marrow.
According to the results of VISION clinical trials, in 2021, lutetium-177-PSMA-617 received FDA approval and the status of a "breakthrough in therapy" for metastatic hormone-resistant prostate cancer. That means that even early clinical data indicate the possibility of significant improvement compared to other types of therapy. With one or more courses of Lu-177 treatment, the 5-year survival rate of patients increased to 30%. In 30-40% of patients, remission persisted for two years.
In spring 2022, the FDA approved Pluvicto (the active ingredient Lutetium-177 vipivotide tetraxetan) for the treatment of metastatic prostate cancer.
The same day, the FDA approved Locametz (active ingredient gallium Ga 68 gosetotide), the first radioactive diagnostic tool for positron emission tomography.
Today, clinical studies of the use of drugs in the early stages of cancer are continuing.
Alternative names for Lu-177
Currently, in medical practice, cancer doctors use lutetium-177-PSMA to treat metastatic prostate cancer. Lutetium-177-DOTATATE or DOTATOC (trade name Lutathera) – for treating neuroendocrine tumors, meningiomas, etc.
The drug Lutathera of the Swiss pharmaceutical company Novartis has demonstrated effectiveness in the treatment of neuroendocrine tumors of the midgut during phase III clinical trials. An article with the results was published in the Journal of Clinical Oncology.
Lutetium-177 treatment abroad
Treatment of prostate cancer with lutetium is carried out in the best clinics in Germany, Turkey, and Israel. On the AiroMedical portal, you can find highly qualified medical care, specify the cost of treatment in various nuclear medicine clinics, compare prices, and book a medical program. Our benefits:
- lu-177 therapy in one of the best clinics;
- affordable cost of treatment;
- communication with doctors and clinic administration both before and after prostate cancer treatment;
- preparation of a treatment program;
- appointment at a time convenient for the patient;
- the second opinion of the best Lutetium doctor;
- solution of all organizational issues (documents for entry into the country, airport transfer, hotel, translator, etc.)
Our team interviewed leading doctors to get answers to the most frequent question regarding the therapy. Read more about Lu 177 FAQ and how to prepare for the treatment.
With AiroMedical, you can receive world-class treatment in modern clinics with the latest equipment, innovative methods, and round-the-clock consultant support. For more information about the Lutetium-177 PSMA treatment, please, contact us. Our managers will organize a medical trip in the shortest possible time.
References:
- U.S. The Food and Drug Administration: FDA approval of Pluvicto (lutetium Lu 177 vipivotide tetraxetan)
- Novartis: Positive survival data for therapy 177Lu-PSMA-617
- WebMD: Lutetium Lu 177 Dotatate Intravenous Side Effects
- Drugs.com: Lutetium Lu 177 dotatate
- National LIbrary of Medicine: Safety and Survival Outcomes of Lutetium-177
