177-lutetium-PSMA and 225-actinium-PSMA or Peptide Receptor Treatments

177-lutetium-PSMA and 225-actinium-PSMA in the treatment of metastatic prostate cancer

In January 2017, we were the first health care provider in Finland to use 177-lutetium-PSMA* drug therapy in the treatment of  advanced prostate cancer, which enables destroying metastases outside the bones efficiently without any severe adverse effects. 225-actinium-PSMA drug was used in 2021 for the first time.

Before the treatment, we carry out a diagnostic PET scan using F-PSMA tracers to ensure that 177-lutetium-PSMA or 225-actinium-PSMA uptake occurs in the metastases.

177-lutetium-PSMA and 225-actinium-PSMA therapies are administered intravenously, and its their most common side effect is a dry mouth. Depending on the individual, the treatment is typically performed 2–6 times approximately every 4–6 weeks (177-lutetium-PSMA) or approximately every 8 week (225-actinium-PSMA).

The multidisciplinary team in charge of peptide-receptor therapies at Docrates Cancer Center is led by Chief Physician in Nuclear Medicine Jukka Kemppainen.

*177-lutetium-PSMA och 225-actinium-PSMA are still experimental treatments, and have a special permission for compassionate use by the Finnish Medicines Agency (Fimea). The international randomised controlled trials are also in their third phase, after which official and more detailed Current Care Guidelines can probably be issued for the cancer cases selected for treatment. However, some results were already presented in October’s ESMO2018 conference, according to which the dose escalation study had shown that even a dose three times larger than that proved effective at Docrates was found safe and well tolerated without the appearance of the toxicity that restricts the dosage.
The VISION study results** were presented in ESMO2021 conference: the results showed that treatment with 177-lutetium-PSMA significantly improved overall survival (OS) in patients with PSMA-positive metastatic castration-resistant prostate cancer.

**Publiced in NEJM September 2021

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