177Lu-PSMA and 177Lu-DOTATATE Therapy in a Patient With Metastatic Castration-Resistant Prostate Cancer and Neuroendocrine Differentiation

Assadi, Majid; Pirayesh, Elahe; Rekabpour, Seyed Javad; Zohrabi, Farshad; Jafari, Esmail; Nabipour, Iraj; Esmaili, Abdolhamid; Amini, Abdullatif; Ahmadzadehfar, Hojjat

doi:10.1097/rlu.0000000000002824

Cited by 20 publications

(11 citation statements)

References 6 publications

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“…Benign conditions such as benign prostate hyperplasia have similarly been shown to have upregulated somatostatin and are [ 68 Ga]Ga-DOTATATE PET positive [ 27 , 28 ]. Patients with mCRPC and NePC and intense [ 68 Ga]Ga-DOTATATE uptake may be amenable to treatment with PRRT ([ 177 Lu]Lu-DOTATATE; Lutathera) [ 29 , 30 ]. [ 11 C]C-choline and [ 68 Ga]Ga-DOTATATE have been shown to have comparable detection rates for mCRPC [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Evaluation of Metastatic Castration Resistant Prostate Cancer and Neuroendocrine Prostate Cancer with [68Ga]Ga DOTATATE PET-CT

Bilen

Akintayo

Liu

et al. 2022

Cancers

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Objectives: Prostate cancer is well known to express high levels of somatostatin receptors and preliminary data suggests that PET imaging with the somatostatin analog, [68Ga]Ga-DOTATATE, may allow for whole body staging of patients with metastatic castration resistant prostate cancer (mCRPC) and neuroendocrine prostate cancer (NePC). This study explores the utility of [68Ga]Ga-DOTATATE PET-CT to identify metastatic deposits in men with mCRPC and NePC and prognosticate disease progression. Methods: [68Ga]Ga-DOTATATE PET-CT was performed in 17 patients with mCRPC and of those, 2/17 had NePC. A semiquantitative analysis with standardized uptake values (SUV) (e.g., SUVmax, SUVmean) was performed for each metastatic lesion and reference background tissues. [68Ga]Ga-DOTATATE uptake in metastatic deposits was further classified as: mild (less than liver), moderate (up to liver average), or marked (greater than liver). Serial prostate-specific antigen measurements and patient survival were followed up to 3 years after PET imaging to assess response to standard of care treatment. Results: All patients had at least one metastatic lesion with identifiable [68Ga]Ga-DOTATATE uptake. Marked [68Ga]Ga-DOTATATE uptake was found in 7/17 patients, including both NePC patients, and all were non-responders to systemic therapy and died within the follow up period, with a mean time to death of 8.1 months. Three patients had mild [68Ga]Ga-DOTATATE uptake, and all were responders to systemic therapy and were alive 36 months after [68Ga]Ga-DOTATATE imaging. Conclusions: [68Ga]Ga-DOTATATE is able to identify mCRPC and NePC metastatic deposits, and lesions with [68Ga]Ga-DOTATATE uptake > liver may portend poor outcomes in patients with mCRPC.

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Section: Discussionmentioning

confidence: 99%

Prognostic Evaluation of Metastatic Castration Resistant Prostate Cancer and Neuroendocrine Prostate Cancer with [68Ga]Ga DOTATATE PET-CT

Bilen

Akintayo

Liu

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…Benign conditions such as benign prostate hyperplasia have similarly been shown to have upregulated somatostatin and are 68 Ga DOTATATE PET positive [27,28]. Patient with mCRPC and NePC and intense 68 Ga DOTATATE uptake may be amenable to treatment with PRRT ( 177 Lu-DOTATATE; Lutathera) [29,30]. 11 C-choline and 68 Ga DOTATATE have been shown to have comparable detection rates for MCRPC [31].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Evaluation of Metastatic Castration Resistant Prostate Cancer and Neuroendocrine Prostate Cancer with 68Ga DOTATATE PET-CT

Bilen¹,

Akintayo²,

Liu³

et al. 2022

Preprint

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Objectives: Prostate cancer is well known to express high levels of somatostatin receptors and preliminary data suggests that PET imaging with the somatostatin analog, 68Ga-DOTATATE, may allow for whole body staging of patients with metastatic castration resistant prostate cancer (mCRPC) and neuroendocrine prostate cancer (NePC). This study explores the utility of 68Ga-DOTATATE PET-CT to identify metastatic deposits in men with mCRPC and NePC and prognosticate disease progression. Methods: 68Ga-DOTATATE PET-CT was performed in 17 patients with mCRPC and of those 2/17 had NePC. Semiquantitative analysis with standardized uptake values (SUV) (e.g. SUVmax, SUVmean) was performed for each metastatic lesion and reference background tissues. 68Ga-DOTATATE uptake in metastatic deposits was further classified as: mild (less than liver), moderate (up to liver average), or marked (greater than liver). Serial prostate-specific antigen measurements and patient survival were followed up to 3 years after PET imaging to assess response to standard of care treatment. Results: All patients had at least one metastic lesion with identifiable 68Ga-DOTATATE uptake. Marked 68Ga-DOTATATE uptake was found in 7/17 patients, including both NePC patients, and all were non-responders to systemic therapy and died within the follow up period, with a mean time to death of 8.1 months. 3 patients had mild 68Ga-DOTATATE uptake, and all were responders to systemic therapy and were alive 36 months after 68Ga-DOTATATE imaging. Conclusions: 68Ga-DOTATATE is able to identify mCRPC and NePC metastatic deposits, and lesions with 68Ga-DOTATATE uptake > liver may portend poor outcomes in patients with mCRPC.

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“…We expect to observe a 30% prevalence of intra‐patient inter‐metastatic heterogeneity based on 68 Ga‐PSMA‐617/ 18 F‐FDG imaging in our recruited population and a 10–20% prevalence of NED, as confirmed by 68 Ga‐DOTATATE imaging. However, the percentage of DOTATATE‐positive patients is difficult to determine because there are only a few reports looking specifically at such a prevalence in the literature with most patients being already diagnosed with neuroendocrine disease [5,28–30]. Based on our secondary analyses, we anticipate that intra‐patient inter‐metastatic heterogeneity and DOTATATE‐positive patients with PCa will be more prevalent among patients who received several lines of mCRPC therapies.…”

Section: Discussionmentioning

confidence: 99%

The Triple‐Tracer strategy against Metastatic PrOstate cancer (3TMPO) study protocol

et al. 2021

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ObjectiveTo determine the prevalence of intra‐patient inter‐metastatic heterogeneity based on positron emission tomography (PET)/computed tomography (CT) in patients with metastatic castration‐resistant prostate cancer (mCRPC) and to determine the prevalence of neuroendocrine disease in these patients and their eligibility for radioligand therapies (RLTs).Patients and MethodsThis multicentre observational prospective clinical study will include 100 patients with mCRPC from five Canadian academic centres. Patients with radiological or biochemical progression and harbouring at least three metastases by conventional imaging will be accrued. Intra‐patient inter‐metastatic heterogeneity will be determined with triple‐tracer imaging using fluorine‐18 fluorodeoxyglucose (18F‐FDG), gallium‐68‐(68Ga)‐prostate‐specific membrane antigen (PSMA)‐617 and 68Ga‐DOTATATE, which are a glucose analogue, a PSMA receptor ligand and a somatostatin receptor ligand, respectively. The 68Ga‐PSMA‐617 and 18F‐FDG PET/CT scans will be performed first. If at least one PSMA‐negative/FDG‐positive lesion is observed, an additional PET/CT scan with 68Ga‐DOTATATE will be performed. The tracer uptake of individual lesions will be assessed for each PET tracer and patients with lesions presenting discordant uptake profiles will be considered as having inter‐metastatic heterogeneous disease and may be offered a biopsy.Expected ResultsThe proposed triple‐tracer approach will allow whole‐body mCRPC characterisation, investigating the inter‐metastatic heterogeneity in order to better understand the phenotypic plasticity of prostate cancer, including the neuroendocrine transdifferentiation that occurs during mCRPC progression. Based on 68Ga‐PSMA‐617 or 68Ga‐DOTATATE PET positivity, the potential eligibility of patients for PSMA and DOTATATE‐based RLT will be assessed. Non‐invasive whole‐body determination of mCRPC heterogeneity and transdifferentiation is highly innovative and might establish the basis for new therapeutic strategies. Comparison of molecular imaging findings with biopsies will also link metastasis biology to radiomic features.ConclusionThis study will add novel, biologically relevant dimensions to molecular imaging: the non‐invasive detection of inter‐metastatic heterogeneity and transdifferentiation to neuroendocrine prostate cancer by using a multi‐tracer PET/CT strategy to further personalise the care of patients with mCRPC.

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177Lu-PSMA and 177Lu-DOTATATE Therapy in a Patient With Metastatic Castration-Resistant Prostate Cancer and Neuroendocrine Differentiation

Cited by 20 publications

References 6 publications

Prognostic Evaluation of Metastatic Castration Resistant Prostate Cancer and Neuroendocrine Prostate Cancer with [68Ga]Ga DOTATATE PET-CT

Prognostic Evaluation of Metastatic Castration Resistant Prostate Cancer and Neuroendocrine Prostate Cancer with [68Ga]Ga DOTATATE PET-CT

Prognostic Evaluation of Metastatic Castration Resistant Prostate Cancer and Neuroendocrine Prostate Cancer with 68Ga DOTATATE PET-CT

The Triple‐Tracer strategy against Metastatic PrOstate cancer (3TMPO) study protocol

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