Long-Term Nephrotoxicity of 177Lu-PSMA Radioligand Therapy

• Published in: The Journal of nuclear medicine (1978) Vol. 65; no. 1; p. 79
• Main Authors: Steinhelfer, Lisa, Lunger, Lukas, Cala, Lisena, Pfob, Christian H, Lapa, Constantin, Hartrampf, Philipp E, Buck, Andreas K, Schäfer, Hannah, Schmaderer, Christoph, Tauber, Robert, Brosch-Lenz, Julia, Haller, Bernhard, Meissner, Valentin H, Knorr, Karina, Weber, Wolfgang A, Eiber, Matthias
• Format: Journal Article
• Language: English
• Published: New York Society of Nuclear Medicine 01.01.2024
• Subjects: Castration; Clinical trials; Epidemiology; Epidermal growth factor receptors; Glomerular filtration rate; Kidney diseases; Lutetium isotopes; Metastases; Metastasis; Prostate cancer; Renal function; Risk factors
• ISSN: 0161-5505; 1535-5667; 1535-5667
• DOI: 10.2967/jnumed.123.265986

β-emitting 177Lu targeting prostate-specific membrane antigen (PSMA) is an approved treatment option for metastatic castration-resistant prostate cancer. Data on its long-term nephrotoxicity are sparse. This study aimed to retrospectively evaluate post–177Lu-PSMA estimated glomerular filtration rate (eGFR) dynamics for at least 12 mo in a cohort of metastatic castration-resistant prostate cancer patients. Methods: The institutional databases of 3 German tertiary referral centers identified 106 patients who underwent at least 4 cycles of 177Lu-PSMA and had at least 12 mo of eGFR follow-up data. eGFR (by the Chronic Kidney Disease Epidemiology Collaboration formula) at 3, 6, and 12 mo after 177Lu-PSMA radioligand therapy was estimated using monoexponentially fitted curves through available eGFR data. eGFR changes were grouped (≥15%–<30%, moderate; ≥30%–<40%, severe; and ≥40%, very severe). Associations between eGFR changes (%) and nephrotoxic risk factors, prior treatment lines, and number of 177Lu-PSMA cycles were analyzed using multivariable linear regression. Results: At least moderate eGFR decreases were present in 45% (48/106) of patients; of those, nearly half (23/48) had a severe or very severe eGFR decrease. A higher number of risk factors at baseline (−4.51, P = 0.03) was associated with a greater eGFR decrease. Limitations of the study were the retrospective design, lack of a control group, and limited number of patients with a follow-up longer than 1 y. Conclusion: A considerable proportion of patients may experience moderate or severe decreases in eGFR 1 y from initiation of 177Lu-PSMA. A higher number of risk factors at baseline seems to aggravate loss of renal function. Further prospective trials are warranted to estimate the nephrotoxic potential of 177Lu-PSMA.