Page 54 - ARNM-3-3

Advances in Radiotherapy
& Nuclear Medicine LuPSMA response patterns on PSMA PET

(increased, reduced, resolved, and stable) and time point criteria. Conventional post-treatment imaging (CT and
(baseline and post-treatment). Ninety-five percent CI for bone scintigraphy) was available for 92% (34/37), of whom
the repeatability statistics were derived by bootstrapping. 18% (6/37) demonstrated radiographic progression.
Analyses were performed using R, version 4.0.5. 16
3.2. Analysis of PSMA PET using the TLW
3. Results We have previously reported the results of whole-body

3.1. Patient characteristics quantitative analysis of pre- and post-treatment PSMA and
FDG PET in the LuPIN study. 17
Baseline characteristics are presented in Table 1. Thirty-
seven participants were evaluable (with scans pre- and Figure 2 shows the distribution of resolved, reducing,
post-treatment): 68% (25/37) completed six cycles of stable, increasing, and new lesions identified by the TLW
177 Lu-PSMA-617 in combination with NOX66, and 32% for each participant.
(12/37) completed 2–5 cycles. The median PSA decline Classification of the overall TLW response pattern
was 77% (interquartile range, IQR: 34–92%), and 70% showed that 24% (9/37) of participants were categorized as
(26/37) attained a PSA50 response. The median PSA-PFS “responders,” none had stable disease, 41% (15/37) as “low-
was 8.6 months (95%CI, 5.6–11.6), and the median OS volume progressors,” and 35% (13/37) as “high-volume
was 22 months (95%CI, 18.6–25.6). The median follow-up progressors.”
duration was 26.0 months.
Radiographic progression was observed in 18%
At the time of post-treatment imaging, 54% (20/37) had (6/34). The TLW correctly classified all six participants
experienced disease progression by PSA and/or clinical with radiographic disease progression and additionally
identified 19 of 34 participants with radiographically stable
Table 1. Baseline of patient characteristics. Numbers are disease on conventional imaging as “progressors” using the
presented as absolute counts (percentages) or as medians TLW (Table 2).
(interquartile ranges)
Of the 28 patients identified as “progressors” using the
Characteristic n=37 TLW, 32% (9/28) had no evidence of PSA progression,
Age (years) 68 (65–74) while 68% (19/28) had both PSA progression and
ECOG
0 or 1 32 (86) Table 2. Comparison of baseline and post‑treatment PSMA
2 5 (14) PET/CT, PSA and radiographic characteristics between TLW
“responders” and “progressors.” Numbers are presented as
PSA at C1 (ug/L) 91 (41.3–380)
absolute counts (percentages) or as medians (interquartile
Haemoglobin (NR: 130–180 g/L) 122 (112–131) range)
Alkaline Phosphatase (NR: 30–100 U/L) 124 (83–359)
Characteristic TLW responders TLW progressors
Albumin (NR: 36–52 g/L) 40 (36–42) (n=9) (n=28)
De novo metastatic disease 19 (51) Baseline PSMA PET/CT
Gleason score TTV 125 (0.6–567) 48.7 (0.9–1002.7)
≤7 7 (19)
SUVmax 37.8 (5–122) 20.4 (5.6–122.3)
8–10 21 (57)
SUVmean 8.5 (3.9–12) 6.6 (3.7–22.6)
Unknown/Not available* 9 (24) Post-treatment PSMA PET/CT
Prior systemic treatments TTV 39 (0.6–116) 103 (2.4–2308)
LHRH agonist/antagonist 37 (100)
SUVmax 7.8 (1.6–12.5) 16 (6.2–73.1)
Chemotherapy 37 (100)
SUVmean 3.7 (0.9–5.4) 4.8 (3.6–10.4)
Docetaxel 37 (100) PSA progression* 1/9 (11) 19/28 (68)
Cabazitaxel 34 (92) Radiographic 0/9 (0) 6/28 (21)
ASI 37 (100) progression*
Note: * Indicates these participants had the diagnosis confirmed Note: * Indicates at time of post-treatment imaging.
by biopsy of a metastatic deposit or disease confirmation using Abbreviations: PSA: Prostate-specific antigen; PSMA PET/CT: Prostate-specific
biochemical (PSA) and imaging findings. membrane antigen-positron emission tomography/computed
Abbreviations: ASI: Androgen-signaling inhibitor; ECOG: Eastern tomography; SUV max: Maximum standardized uptake value; SUV mean: Mean
cooperative oncology group; LHRH: Luteinising hormone releasing standardized uptake value; TLW: Traffic light workflow; TTV: Total tumor
hormone; NR: Normal range; PSA: Prostate-specific antigen. volume.

Volume 3 Issue 3 (2025) 46 doi: 10.36922/ARNM025110011