Efficacy and Side Effects of Lutetium-177 PSMA-617 in Patients with Castration Resistant Metastatic Prostate Cancer: A Systematic Review and Meta- analysis

Omar Fahmy, Mohd Razaleigh Yusof, Mohd Ghani Khairul Asri

1) Department of Urology, Faculty of Medicine and Science Health Universiti Putra Malaysia 2) Department of Urology, Hospital Sultan Abdul Aziz Shah Universiti Putra Malaysia

Background. Progression of metastatic prostate cancer after castration resistance is one of the main challenges in prostate cancer therapy. 177Lu-PSMA-617 has been recently investigated in castration resistant metastatic prostate cancer.
Objectives. To systematically evaluate the efficacy and safety profile of 177Lu-PSMA- 617.
Patients and methods. A systematic review and meta-analysis was conducted according PRISMA principles. From initial 261 results, 3 randomized controlled trials met our inclusion criteria. The primary outcome of this study was oncological response and side effects. RevMan 5,4 software was applied in this systematic review and meta- analysis.
Results. A total of 1071 patients were included in the pooled analysis. 670 (62,6%) patients received 177Lu-PSMA-617. Progression-free survival was significantly better with a hazard ratio of 0,72 (p= 0,00001). 50%>PSA reduction reported in 75 (63%) vs. 45/121 patients (37,2%) (p=0,0001). Total adverse events recorded in 572 / 627 (91,2%) developed AEs, vs. 204 / 290 (70,3%) (p = 0,00001). Fatigue was reported in 306/647 (47,3%) patients vs 88/310 (28,4%) (p=0,00001). And constipation in 110/549 (20%) vs 24/225 (10,7%) (p=0,003). Both thrombocytopenia and leucopoenia were marginally significantly higher in 114 / 647 (17,6%) vs 19 / 310 (6,1%) (p=0,08) and 81 / 647 (12,5%) vs 13 / 310 (4,2%) (p=0,10), respectively.
Conclusion. 177Lu-PSMA-617 results in significant reduction in PSA and improves the progression-free survival. It can cause tolerable side effects, mainly fatigue, constipation, thrombocytopenia and leucopoenia.

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About the Authors

Corresponding author: Omar Fahmy – MBBS, MRCS (England), Masters Urology (Zagazig), FRCS Urology (Glasgow).; Associate Professor and Consultant Urologist of Department of Urology, Faculty of Medical Science and Health Universiti Putra Malaysia, 43400 Serdang, Malaysia; email: omarfahmy.ahmed@upm.edu.my

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