KEY TAKEAWAYS
- The phase 3 VISION study aimed to utilize real-world data to determine the tolerability of Lutetium-177–PSMA-617 in prostate cancer men with baseline cytopenia.
- The results of the study revealed low toxicity-related treatment discontinuation in men with mCRPC and baseline cytopenias, indicating a poor prognosis overall.
The VISION trial (NCT03511664) findings resulted in the approval of lutetium-177 (177Lu)–PSMA-617 for treating metastatic castration-resistant prostate cancer (mCRPC). Excluding individuals with baseline cytopenias, the safety of this therapy in this common patient demographic remains uncertain.
For a study, researchers aimed to utilize real-world data to determine the tolerability of radioligand therapy in individuals with compromised bone marrow reserve. They retrospectively examined records of patients receiving their first 177Lu–PSMA-617 dose from April 26 to December 1, 2022.
Categorization based on pre-treatment hematologic parameters included an anemia cohort (Hg < 9 g/dL), thrombocytopenia cohort (Plt < 100 x 10^9/L), leukopenia cohort (WBC < 2.5 x 10^9/L), and multiple cytopenia cohort—criteria aligned with VISION trial exclusions. They utilized descriptive statistics to study the longitudinal data and clinical outcomes.
Researchers identified 273 patients as recipients of 177Lu, with 33 (12%) exhibiting baseline cytopenia before their initial treatment cycle. Among these, 25 (76%) had anemia, 4 (12%) had thrombocytopenia, 2 (6%) had leukopenia, and 2 (6%) had multiple cytopenias. The median number of treatment cycles was 4, with 21 (64%) patients currently undergoing therapy and 12 (36%) having permanently ceased treatment.
For the anemia cohort, median longitudinal changes in blood counts are detailed in Table 1. Discontinuation reasons included toxicity (n=5), disease progression (n=4), or death (n=8). Of the 9 patients ceasing treatment due to toxicity or disease progression, 5 subsequently succumbed. Dose reductions or treatment delays for worsening myelosuppression were applied in 8 (24%) and 8 (24%) patients, respectively.
Packed red blood cell or platelet transfusions were necessary for 26 (78%) patients, and 16 (48%) sought emergency department care or were hospitalized.
The study revealed low toxicity-related treatment discontinuation in men with mCRPC and baseline cytopenias, indicating a poor prognosis overall.
Source: https://suo-abstracts.secure-platform.com/a/gallery/rounds/18/details/3118
Clinical Trial: https://clinicaltrials.gov/study/NCT03511664
Ahmed ME, Mahmoud AM, Abdelrazek AS, et al. Tolerability of lutetium-177–PSMA-617 in men with prostate cancer and baseline cytopenia. Presented at: 2023 Society of Urologic Oncology Annual Meeting. November 28 – December 1, 2023; Washington, DC. Abstract 28.
