Modern medicine is gradually abandoning traditional therapy in favor of new, more effective, and safe nuclear methods. One of these is the treatment with radioisotopes of lutetium 177.
Lu 177 psma and drugs based on it are used to treat metastatic prostate cancer and neuroendocrine tumors in late stages. Lutetium 177 emits soft beta radiation, which acts pointwise on cancer-affected cells.
If, say without complicated medical terms, the essence of Lu-177 PSMA therapy boils down to targeting drugs at cancer cells, which causes their death. A radioactive, biological molecule is injected into the patient, which recognizes the tumor focus and destroys it from the inside. That is point irradiation that the patient receives intravenously. Lutetium 177 treatment does not affect the body's healthy cells (it does not expose them to radiation).
Only cancer cells have a considerable amount of specific protein on their surface, which is a target for exposure to lutetium 177. Due to this, the drug molecules can only be absorbed by cells mutated from cancer. As a result, lu 177 psma accumulated in the tumor. The radiation is very short, no more than 2 mm, so nearby tissues practically do not suffer from radiation.
The effectiveness of lutetium 177 treatment is most objectively reflected in the results of clinical studies. Studies include hundreds and thousands of patients with the same diagnoses. They help to collect large amounts of reliable information about the effectiveness of individual drugs, the frequency of side effects, and the possibility of combining different types of lu 177 psma therapy.
With the help of lutetium 177 treatment of prostate cancer, it is possible to achieve the following:
- reducing the number of metastases;
- decrease in PSA (a primary marker of prostate cancer);
- improving well-being by eliminating the symptoms of the disease;
- increase in life expectancy.
Clinical studies have shown a 12-month overall survival rate in 75% of patients and an 18-month overall survival rate in 64%. In 30% of patients, PSA levels decreased by more than 50%. The well-being of patients is much improved. They have less pain. They can again take a more active part in life.
On average, 80% of prostate cancer cases had a positive response to lu 177 psma therapy. Nevertheless, some patients may need additional curatorial courses to eradicate malignant neoplasms.
When using the drug for the lutetium 177 treatment of neuroendocrine tumors of the last stage, an increase in cancer patients' duration and quality of life is observed. About 62% of patients with malignant tumors of the middle part of the gastrointestinal tract of stage 4 lived for three years thanks to lu 177 psma therapy. This medicine achieves such a result in at most 10% of cases.
The introduction of lu 177 psma strains the kidneys and liver. Therefore, the function of these organs is checked before starting lutetium 177 treatment. In addition, the patient passes a biochemical blood test and undergoes other general clinical studies. For example, suppose tumor foci are present in the liver. In that case, before lu 177 psma therapy, doctors can perform stenting of the bile ducts to avoid mechanical jaundice.
Lutetium 177 treatment, like any other method, can cause several undesirable side effects, including:
- Dry mouth, occasionally loss or violation of taste. Due to increased dryness, the risk of developing caries increases;
- Increased fatigue;
- Nausea and vomiting;
- Violation of the outflow of bile (if the tumor has metastasized to the liver);
- Allergic reactions.
Currently, lutetium 177 PSMA is successfully used in medical practice to treat metastatic castration-resistant prostate cancer. Lutetium 177 DOTATATE or DOTATOC (trade name Lutathera) – for treating neuroendocrine tumors, meningiomas, etc.
Most of the published trials concerning PSMA are based on a treatment that uses lutetium-177-psma-617.
One of the leading pharmaceutical manufacturers, the Swiss company Novartis continues to research new concepts further to improve the targeted treatment of metastatic prostate cancer. One of Novartis' recent developments — Pluvicto (lutetium 177 vipivotide tetraxetan) — has demonstrated a significant improvement in survival in quality of life. Based on the results of VISION studies, the drug was approved by the FDA in March 2022 and, after that, by regulators in the UK and Canada.
The planning of lutetium 177 treatment, the production of radioactive nuclides, and the provision of high radiation protection is a technically complex process. That is why patients often cannot undergo lu 177 psma therapy for prostate cancer in their country and are looking for appropriate opportunities in foreign clinics. To date, lutetium 177 treatment is available only in clinics of advanced developed countries in Europe, Israel, and Turkey.
|1||University Hospital Carl Gustav Carus||Dresden, Germany|
|2||University Hospital Ludwig-Maximilians||Munich, Germany|
|3||University Hospital rechts der Isar||Munich, Germany|
|4||Helios Hospital Berlin-Buch||Berlin, Germany|
|5||Teknon Medical Centre||Barcelona, Spain|
|6||Ichilov Sourasky Medical Centre||Tel Aviv, Israel|
|7||SHEBA Medical Centre||Ramat Gan, Israel|
|8||University Hospital Motol||Prague, Czech Republic|
|9||University Hospital||Krakow, Poland|
|10||Anadolu Medical Centre||Gebze, Turkey|
The advantages of lutetium 177 treatment include the following:
- the ability to destroy metastases in any part of the body;
- the absence of irreversible side effects
- low risk of complications;
- healthy tissues are not damaged during irradiation.
When choosing a clinic for lu 177 psma therapy, it is worth considering the treatment protocol, on which the effectiveness directly depends. Therefore, one of the evaluation criteria is the percentage of association of PSMA with lutetium 177. If it exceeds 50%, the changes in the course of therapy will be insignificant.
Lu-177 PSMA treatment cost depends on various factors, such as preliminary examination, follow-up examinations, hospitalization, the level of the medical center, the number of prescribed procedures, etc. In various clinics, the average price for the procedure varies from 10.000 euros to 30.000 euros.
- ScienceDirect: Lutetium 177
- Taylor & Francis Online: Lutetium-177-PSMA-617: A Vision of the Future
- AiroMedical: Prostate Cancer Treatment with Lutetium 177
- Gov.UK: Lutetium (177Lu) vipivotide tetraxetan: Treatment protocol: Information for patients
- OncologyPro: Lutetium-177-prostate-specific membrane antigen therapy