The Tyr Phenomenon: A Hypocalcemic Response in High-Volume Treatment Responders to 177 Lu-Prostate-Specific Membrane Antigen Therapy

• Published in: Journal of Nuclear Medicine Vol. 64; no. 9; pp. 1412 - 1416
• Main Authors: Kumar, Shejil, Crumbaker, Megan, Harvey, Christopher, Pathmanandavel, Sarennya, John, Nikieth, Swiha, Mina M, McDonald, Michelle M, Clifton-Bligh, Roderick, Lee, Adrian, Bastick, Patricia, Counter, William, Nguyen, Andrew, Emmett, Louise
• Format: Journal Article
• Language: English
• Published: United States 01.09.2023
• Subjects: hypocalcemia; 177Lu-PSMA; metastatic prostate cancer
• ISSN: 0161-5505; 1535-5667; 2159-662X
• DOI: 10.2967/jnumed.123.265759

Lu-prostate-specific membrane antigen (PSMA) is an effective treatment for metastatic castration-resistant prostate cancer. Rarer treatment-related adverse events have not yet been described. We present case reviews of 2 men with a marked hypocalcemic osteosclerotic response to Lu-PSMA-I&T therapy. A clinical dataset of Lu-PSMA-I&T therapy was evaluated to estimate the incidence and clinical association with hypocalcemia. Forty-one of the 127 men (32%) had a serum calcium drop, and 6 (5%) developed clinical hypocalcemia during Lu-PSMA therapy. The baseline total tumor volume was significantly higher in those who developed hypocalcemia (median, 3,249 cm [interquartile range, 1,856-3,852] vs. 465 [interquartile range 135-1,172]; = 0.002). The mean prostate-specific antigen response in those with hypocalcemia was 78% (SD, 24%). Hypocalcemia may occur in response to Lu-PSMA-I&T, particularly with both high-volume bone metastases and a significant prostate-specific antigen response, and may be severe, requiring corticosteroids. Further evaluation of Lu-PSMA-induced hypocalcemia is required to better understand mechanisms, optimal treatments, and repercussions from any subsequent osteosclerotic response.