Efficacy and Safety of Actinium-225 Prostate-Specific Membrane Antigen Radioligand Therapy in Metastatic Prostate Cancer: A Systematic Review and Metanalysis

• Published in: Medical principles and practice Vol. 32; no. 3; pp. 178 - 191
• Main Authors: Parida, Girish Kumar, Panda, Raj Abhisek, Bishnoi, Komal, Agrawal, Kanhaiyalal
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.10.2023
• Subjects: Actinium - therapeutic use; Antigens; Cancer therapies; Dipeptides - adverse effects; Humans; Ligands; Male; Medical prognosis; Meta-analysis; Metastasis; Patients; Prostate; Prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms, Castration-Resistant - drug therapy; Prostatic Neoplasms, Castration-Resistant - radiotherapy; Retrospective Studies; Software; Statistical analysis; Systematic Review; Toxicity; Treatment Outcome; Metastatic castration-resistant prostate cancer; Metanalysis; Actinium-225 prostate-specific membrane antigen radioligand therapy
• DOI: 10.1159/000531246
• ISSN: 1011-7571; 1423-0151

Background: Actinium-225 (Ac-225) labelled PSMA RLT has been tested recently in metastatic castration-resistant prostate cancer (mCRPC), with encouraging results. Ac-225, being an alpha emitter, is expected to have higher efficacy and fewer side effects compared to the beta-emitters such as Lutetium-177. We have performed a meta-analysis to assess the therapeutic responses, survival effects, and significant side effects of Ac-225 PSMA RLT in patients with mCRPC. Methodology: Systematic literature search was carried out from five electronic databases PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science, and Cochrane Library until March 2021. Eight studies were found to be eligible for this metanalysis. Results: Eight studies with 226 patients were analyzed in this metanalysis. 81% (95% CI 73–89) patients had a decline in PSA levels. 60% of the patients showed more than 50% PSA decline. Two studies assessed survival effects of radioligand naïve patients compared to patients who had received Lu-PSMA therapy previously and the pooled HR for radioligand naïve patients is 0.22. The most common toxicity reported was xerostomia in 167 patients out of 226 patients (73.9%, 95% CI 67.6–79.5%); however, most of them were confined to grade I and II levels. Other reported side effects include hematologic toxicity and nephrotoxicity. Conclusion: Ac-PSMA RLT is a safe and potentially effective treatment option for patients with mCRPC.