Lutetium-177 PSMA Therapy: Everything You Need to Know
How Does Lu-177 Therapy Work?
What are Lutetium-177 and PSMA therapy? Lu-177 is a short-lived radioisotope with various medical applications, but it is mainly used for oncology treatment. Nevertheless, it is an innovative application for treating advanced prostate cancer, especially when the metastases are spreading.
What is the difference between classic radiation therapy? Traditional radiotherapy provides the external radiation of the body when beams are delivered from outside the body. But radionuclide therapy acts oppositely.
The radionuclide Lu-177 is combined with the pharmaceutical agent (molecule), which links to prostate-specific membrane antigen (PSMA). PSMA is a protein actively produced in prostate cancer cells. The production of this substance can be confirmed with the particular imaging procedure called PSMA-PET scanning.
During the treatment, the radiopharmaceutical drug is injected into the bloodstream and delivers radio particles to the needed area. Lutetium targets tumorous tissue to release beta-radiation and destroy the cancerous cells by pairing with the molecule which binds with the membrane receptor.
The other type of therapy, which also engages radioisotope, is called peptide receptor radionuclide therapy (PRRT). It is the first-line treatment for advanced neuroendocrine tumours and uses cell-targeting protein similar to natural hormones. For example, the protein in a complex with 177 Lutetium binds neuroendocrine cancer cells and kills them.
Why is Lutetium 177 Used for PSMA Therapy in Prostate Cancer?
Beta radiation, used in therapy, has a significant impact on malignancy development. This is because the high-energy electrons are delivered to the right areas, and the targeted cells are killed. What is essential is that healthy tissues are not affected by radiation because of the extra-precise impact of the Lu-177 treatment.
Furthermore, if comparing results of PSMA and other kinds of prostate cancer therapies (chemo- or hormone therapy), radiopharmaceuticals show much more significant results. The tumour size is reduced, and the cancerous cells stop spreading to other body regions.
The other reason doctors prefer this type of curation is the resistance of tumours to different curation types. And even in such cases, radioligand therapy has an excellent chance to be successful.
Moreover, with the help of PSMA therapy, many side effects can be avoided. It is a significant benefit compared to traditional prostate cancer treatment like chemo-, hormone or conventional radiotherapy.
What Are Success Rate for Lutetium-177?
As the Lu-177 therapy is a modern innovation in medicine, numerous trials are conducted in this field.
In clinical studies, doctors compare the results of other therapies to radioligand treatment outcomes. For example, recent trials show that patients' lives with last-stage prostate cancer were extended four months after treatment with Lutetium. Other clinical investigations presented 12-month overall survival in 75% of patients and 18-month overall survival in 64%.
On average, 80% of prostate cancer cases had a positive answer on radionuclide therapy. Nevertheless, some patients may require additional curation courses to eradicate malignance entirely. So, the PSMA therapy has a good response and success rate in patients with metastatic prostate cancer.
Before, during and after the procedure
Before the procedure, the doctor will ask about possible allergies, current medications, family medical history, etc. Then, the physical examination will be provided, and the PET scan will be carried out to determine tissues which produce high quantities of prostate-specific membrane protein. The specialist also will prescribe blood tests to evaluate liver and kidney function.
In most cases, no special preparation for the Lu-177 procedure is needed. But before the therapy starts, patients are recommended to drink a significant amount of liquid, avoid smoking and alcohol consumption and not take anticoagulants and aspirin.
During the procedure, the patient will lay, and the doctor or nurse injects a radiopharmaceutical agent through the needle into the vein on the arm. Since the drug will enter the body, it will travel throughout the organism and be delivered to the cancerous gland cells. The molecule will bind to the membrane receptor, and the radio particle will destroy cells. The procedure will last 60-90 minutes, and the patient will stay at the clinic under observation.
After the procedure, a follow-up imaging scan will be done to evaluate the results of the performed intervention. Usually, patients return to their homes within two days after therapy when there are no side effects. During the next visit, the doctor will check new scans and evaluate the result of the treatment. For some prostate cancers, one treatment is enough, but other cases may require repeating the procedure in 6-8 weeks. Doctors advise avoiding exhausting physical work.
Are There Any Lu 177 Side Effects?
PSMA therapy has low toxicity because of its possibility to affect only cancerous cells without destroying healthy tissues. Possible side effects go away within a few days after the procedure and may include:
- dry eyes;
- dry mouth;
Sometimes, the dryness of mucous membranes can stay for a prolonged time. In that case, a patient needs a consultation with a specialist.
One more dangerous symptom is decreased blood count because of Lutetium's impact on bone marrow. According to recent studies, haemoglobin and erythrocyte levels are not significantly impaired. At the same time, thrombocytes and leukocytes can be considerably decreased, but never under critical level.
Although severe side effects usually don't happen, the person undergoing 177 Lu therapy must be under doctors' observation and control.
Benefits of Lutetium 177 PSMA Therapy in Germany
Germany is the country of choice when a patient is diagnosed with metastatic prostate cancer and needs PSMA treatment. The 177 Lu therapy was initially developed at the University of Heidelberg in Germany. Since then, Germany has remained the top country in radioligand curation of gland tumours.
German hospitals have numerous advantages, such as state-of-art equipment and high-quality radiopharmaceuticals. In addition, the drug industry is steadily developing, and all radioisotopes (including 177 Lu) receive certification due to the latest standards.
Furthermore, the German specialists in nuclear medicine are world-known doctors and have a lot of experience in that field. Moreover, the German Society for Radiation Oncology (DEGRO) is actively researching PSMA therapy for advanced prostate cancer. That's why new approaches are consistently implemented in German medicine.
The clinic is one of the most modern in Germany and has several certifications, including the certificate of the German Cancer Society. The department of nuclear medicine is the largest in the world. It has more than 60 years of experience using radio particles such as Lu 177. The head physician of the nuclear medicine department is an author of over 100 scientific publications. Moreover, the medical institution cooperates with the prostate centre to provide a modern approach to PSMA therapy for gland cancer.
The hospital is the second largest in the Bavaria region. The principle of the hospital is an interdisciplinary approach. That's why the medical institution cooperates with the Comprehensive Cancer Centre in order to organise high-quality medical care in oncology treatment, including malignant prostate tumours. The nuclear medicine department has state-of-art equipment for precise cancer diagnostics (PET/CT and SPECT/CT of the last generations) at its disposal. Furthermore, the department is a part of ENETS (European Neuroendocrine Tumour Society). The chief doctor is an author of over 450 articles and a member of scientific journal editorial boards.
The clinic is the third-largest medical institution in Germany and treats over 340,000 inpatients and 90,000 outpatients annually. The medical staff consists of numerous experienced and qualified specialists. In addition, the hospital has the Centre for Ion Beam Therapy which offers proton and ion carbon radiation treatment. By the way, there are only two such centres in Germany. In addition, doctors are recognised as the most qualified according to Forbes magazine.
As the clinic is the European leader, over 500,000 patients are treated here annually. The specialists of the medical institution participate in modern research. Moreover, the nuclear medicine unit is one of the best in Germany in its field. Furthermore, the clinic is known because of using the latest technologies in radiotherapy. The chief of the department is the owner of numerous awards and prizes.
The medical institution carries out world-renowned research, forming the theoretical and practical basis of German principles in diagnosing and treating diseases. The medical focus of the clinic lies in anti-tumour treatment, including prostate cancer therapy. The PSMA Lutetium 177 curation is a particular focal point of the hospital. The medical institution has the most advanced equipment for providing Lu 177 therapy.