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.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2023 Oct 19 [Epub ahead of print]
Lisa Steinhelfer, Lukas Lunger, Lisena Cala, Christian H Pfob, Constantin Lapa, Philipp E Hartrampf, Andreas K Buck, Hannah Schäfer, Christoph Schmaderer, Robert Tauber, Julia Brosch-Lenz, Bernhard Haller, Valentin H Meissner, Karina Knorr, Wolfgang A Weber, Matthias Eiber
Department of Nuclear Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Department of Urology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; ., Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany., Department of Nuclear Medicine, University Hospital Wurzburg, Wurzburg, Germany., Department of Nephrology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; and., Department of Urology, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Institute of AI and Informatics in Medicine, School of Medicine, and Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.