Lu-PSMA-617 Therapy For Metastatic Prostate Cancer: All You Need to Know
Sarah Mokrusch - Medical Content Writer
Posted Apr 7, 2022
Lutetium-177 (Lu-177) PSMA (Prostate-Specific Membrane Antigen) therapy is the latest advancement in the treatment of prostate cancer. This therapy is extremely precise, as Lu-177 particles get attached directly to the PSMA receptor which is present only at the prostate cancer cells, causing direct damage to their DNA by emitting a small amount of Beta-radiation. By targeting the cancer cells directly with radiation, damage to surrounding tissues and related side effects are reduced. Lu-177 PSMA therapy entails administering the drug 177Lu-PSMA-617.
In a clinical study, people who underwent PSMA therapy alongside standard treatment lived longer than those who received only standard treatment. The trial also showed an improvement in disease progression in people who received 177Lu-PSMA-617.
Currently, Lu-177 PSMA therapy for advanced prostate cancer is unavailable in the United States.
Why is Lutetium 177 used for PSMA therapy in prostate cancer?
PSMA is a protein found on prostate gland cells. However, when an individual has prostate cancer, the amount of PSMA on the surface of prostate cancer cells increases substantially. Lutetium-177 is the name of the radioactive medicine used in PSMA therapy, to specifically target the PSMA proteins in the body.
177Lu-PSMA-617 complex consists of 2 main components, i.e. a PSMA targeting ligand and a therapeutic radioactive atom, i.e. Lutetium-177. The Lu-177 is attached to the ligand and once the complex enters the bloodstream it gets attached to the PSMA receptor protein at the cancer cell, where Lu-177 directly damages the DNA of the cell by emitting small amounts of Beta-radiation.
This type of radiation therapy is known as radionuclide therapy, radioligand therapy, and molecular radiotherapy.
Lu-177 is the most commonly used radioactive material in targeted radiation therapy. It is preferred because it emits a lower energy of beta waves (β radiation) and has a shorter emission range of 1.6mm, compared to other radionuclides like Y-90. This means it can cause much less damage to the healthy tissues surrounding the cancer cells.
Am I eligible for Lu-177 (lutathera) therapy?
Treatment with Lu-177 is approved for patients with advanced metastatic prostate cancer or metastatic prostate cancer that is castration-resistant (mCRPC). Males with metastatic prostate cancer who already underwent hormone therapy and chemotherapy (chemical castration) may be eligible for this treatment.
It is important to note that not every person with advanced prostate cancer is a candidate for this therapy. Blood tests will be performed, and individuals will be scanned using a PSMA-PET scan to confirm that their cancer cells carry enough PSMA proteins required to conduct the therapy.
To learn more about the right treatment for you, please reach out to one of our specialists for guidance.
mCRPR and 177lu PSMA 617 therapy: a new hope?
Prostate cancer is the most commonly diagnosed cancer among men in the United States, apart from skin cancer. 60% of cases are diagnosed in men aged 65 years or older.
Metastatic Castration-Resistant Prostate Cancer (mCRPC) is an advanced form of prostate cancer. Standard methods to treat prostate cancer include hormone therapy that lowers testosterone levels, known as androgen deprivation therapy (ADT).
The cancer in individuals with mCRPC does not respond to these standard therapies and continues to grow even under low testosterone conditions. The cancer then metastasizes, which means it spreads to other parts of the body, including neighbouring lymph nodes, bones, the bladder, liver, lungs, and more. For these individuals, Lu-177 may be an option.
What are the success rates of a Lutetium treatment?
PSMA therapy for prostate cancer is designed to help individuals with metastatic prostate cancer to live longer by slowing the growth of cancer cells. It is not a cure, but can help prolong the life of people with advanced prostate cancer.
The therapy showed promise in the VISION clinical trial - a large, international phase 3 study of 831 PSMA-positive patients. The results of this trial were published in the New England Journal of Medicine in September 2021. According to Dr. Michael Morris from the Memorial Sloan Kettering Cancer Center and one of the principal investigators in the trial, patients who received Lu 177 together with standard treatment had an improved survival of 38%. The men undergoing the therapy also experienced a 60% reduction in the risk of disease progression (rFPS) compared to the standard of care1.
This type of targeted radioligand therapy is considered an improvement over standard treatment methods. In conventional radiotherapy, doctors manually focus radiation onto regions of the body where cancer cells are located. However, in Lu 177-type targeted radiotherapy, the drug can impact the prostate cancer cells in the body, with less damage to healthy tissues. This type of treatment can also result in fewer side effects.
Are there any Lu 177 side effects?
In the VISION trial, side effects of PSMA therapy for people with mCRPR included:
Dry mouth (Xerostomia)
Bone marrow effects
What to expect during Lu-177 PSMA therapy
PSMA therapy involves radioactive medicine, also known as radiopharmaceuticals. Because of this, the therapy is administered in a hospital’s nuclear medicine department.
A medical professional will inject the medicine into your arm. You will have to wait about 30 minutes for the drug to spread through your bloodstream. Your doctor may also prescribe anti-nausea (antiemetic) medication and a diuretic to help eliminate the Lu-177 from your body. You will be monitored at regular intervals and leave when your radiation levels come down.
In a few days, your doctor will schedule an imaging scan to see if the drug has targeted the right locations.
Is Lutetium 177 PSMA FDA approved?
177Lu-PSMA-617 is currently under review by the US FDA. In September 2021, the FDA accepted this new drug under priority review. The decision for approval is estimated to be made in the first half of 2022.
In June 2021, the FDA granted 177Lu-PSMA-617 a Breakthrough Therapy Designation (BTD). The BTD process is designed to expedite the review of drugs intended for serious conditions where early clinical results indicate improvement over already available therapies.
Note: This BTD status for 177Lu-PSMA-617 is not to be confused with the FDA’s approval of another lutetium therapy: 177Lu-Dotatate, for the treatment of pancreatic and gastrointestinal cancers. While this therapy uses Lutetium-177 to treat cancers, it does not target the PSMA proteins found on prostate cancer cells.
Why should I travel to Germany for Lutetium-177 PSMA therapy?
The nuclear medicine community in Germany is extremely strong. Germany was home to the first study evaluating the use of 177Lu-PSMA-617 radioligand therapy for advanced prostate cancer patients.
At the time, the multi-center study by Rahbar et al. had the largest number of patients participating (145) at 12 centers around Germany. The study, initiated by the German Society of Nuclear Medicine, was available online in October 2016 and published in the Journal of Nuclear Medicine in January 2017,.
How do I know if PSMA therapy is right for me?
If you have been diagnosed with mCRPR, you may be eligible for 177Lu-PSMA-617 therapy. While the treatment is under review in the United States, it is available in countries like Germany. Find out if PSMA is suitable for you. Please reach out to our specialists at Qunomedical to discuss your unique case.
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