FAPi-based targeted theranostics for treating radioiodine-refractory differentiated thyroid cancer
The study of FAPi-based lutetium-177 therapy in the All India Institute Of Medical Sciences in New Delhi was meant to investigate the therapeutic efficacy and safety of 177Lu-DOTAGA.(SA.FAPi)2 in RR-DTC patients. 15 heavily pre-treated (min 2 lines of prior treatment with lenvatinib and/or sorafenib) patients with the disease progression were selected based on FAPi PET/CT. An average of 3 sessions of 2 GBq each was administered in an 8-week interval.
Trial comparing radioligand treatment with 177Lu-PSMA-617 to the chemotherapy using cabazitaxel in treating mCRPC
TheraP, a phase II trial comparing radioligand treatment with 177Lu-PSMA-617 to the chemotherapy using cabazitaxel was finalized with 177Lu-PSMA demonstrating a clear advantage over the chemotherapy.
EAU updates its Prostate Cancer Guidelines
After the conclusion of the Vision trials the urological associations start gradually adjusting their Prostate Cancer guidelines, both in diagnostics and treatment. EAU now strongly recommends:
- PSMA PET/CT (with gallium-68 or fluorine-18) as a more accurate diagnostic method than CT and bone scan for the staging of high-risk prostate cancer (PSA > 20 ng/mL, or GS > 7, or clinically palpable tumour in both lobes (cT2c)), and
- 177Lu-PSMA as a therapy of choice for pre-treated (ADT) mCRPC patients with one or more metastatic lesions, highly expressing PSMA on the diagnostic radiolabelled PSMA PET/CT scan.
Both are available in our institution. Make your appointment now.
Nuclear theranostics: what’s next?
While theranostics has immensely improved overall survival and quality of life of NET and prostate cancer patients and is increasingly becoming mainstream, the science is tirelessly working on the next big thing – pan-cancer theranostics based on fibroblast activation protein (FAP) found in the cancer-associated fibroblasts (CAF). With many widespread cancers in question, this would be truly revolutionary. First-in-human PET/CT studies of 68Ga-FAPI have demonstrated excellent results. A tracer derivative better suited for the therapeutical ends is within reach.
Bone metastases, prostate cancer and theranostics
Bone metastases are a common secondary cancer of many cancer types, such as breast (70%), prostate (85%), lung and kidney cancer (40%), due to the unique bone microenvironment. Tumors mostly metastasize to axial skeleton (i.e. bones of the trunk and pelvis) rather than to appendicular skeleton (limbs and girdles) along the distribution of the red bone marrow.
Gallium-68 has demonstrated superiority to Fluorine-18 in digital PSMA-PET/CT scans for staging prostate cancer
Fluorine-18 is a commonly used isotope utilized for conducting PSMA-PET/CT to stage prostate cancer, due to its longer half-life and higher production capacity as compared to Gallium-68. The latest study, however, has demonstrated superiority of Ga-68, because of the focal unspecific uptake of F-18 in the bones of ribs and pelvis. Without additional follow-up exams or any morphological correlates, this may be misinterpreted as bone metastasis. While nonspecific uptake in other tissues and physiologic uptake in the ganglia can be filtered out, unspecific bone uptake tends to lead to false interpretation and misdiagnosis. Bone metastases do occur in 10% of patients with the newly diagnosed prostate cancer, and 80-90% of patients in the advanced stage. Over-staging the patient may result in inadequate therapy decisions, especially in case of early biochemical recurrence. Read more.
PSMA therapy under more restrictive regimen of 4-week intervals
How oft is the Lu-PSMA treatment conducted? The usual cycle consists of 3 sessions with 6 to 8 weeks interval in-between. Our more restrictive treatment regimen of 3 initial cycles with an interval of only 4 weeks in-between demonstrated >80% response rates even in heavily pre-treated patients. This treatment does not care, “where” the metastases are: lymph nodes, bone, lungs, liver or even tumor in the prostate region itself. The usual “victims” of PSMA ligands, the salivary glands and kidneys, are not significantly affected under this regimen. Read more here.
Check other scientific investigations of our team on the topic.
177Lu-PSMA therapy improves health-related quality of life in patients with mCRPC
On Friday, 17 September 2021, Novartis announced further positive findings from the VISION trial: 177Lu-PSMA-617 therapy delays worsening of physical functioning and the onset of pain symptoms in patients with mCRPC. Hence, beyond extending overall survival and progress-free period, this Breakthrough Therapy also improves health-related quality of life. Read more
National Comprehensive Cancer Network, an alliance of cancer centers in the US, whose guidelines in oncology are applied to treating cancers, has added 68Ga-PSMA-PET imaging to its clinical practice guidelines for prostate cancer. Moreover, it recognized the high precision of this diagnostic tool as a primary stand-alone method and scrapped conventional imaging as a necessary prerequisite for PSMA-PET. Read more in the Urology Times.