In prostate cancer, Lutetium-177 (177LuLu )-Prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) shows benefit even in earlier stages of the treatment course, potentially leading to broader application also in younger patients. However, evidence regarding its efficacy and safety in this population remains limited. Based on Gleason score, baseline prostate specific antigen (PSA) and prior chemotherapy status, 51 patients ≤ 65 years of age were matched to 51 patients ≥ 70 years. All patients were scheduled for 177LuLu-PSMA RLT. Efficacy was evaluated using relative PSA changes after two cycles, along with progression-free survival (PFS, defined as time from 1st RLT to ≥ 25% PSA increase from nadir) and overall survival (OS). Safety was assessed by changes in estimated glomerular filtration rate (eGFR), hemoglobin (Hb), white blood cells (WBC) and platelets from baseline to nadir, alongside Common Terminology Criteria of Adverse Events (CTCAE 5.0) grading for chronic kidney disease (CKD), anemia, leukocytopenia and thrombocytopenia. RLT showed similar efficacy in both age groups with comparable PSA changes after two cycles (younger patients: -8%; Interquartile range IQR, -55 to 46% versus older subjects: -20%, IQR, -71 to 46%; P = 0.766). No significant differences were observed for PFS (P = 0.882) and OS (P = 0.17). RLT was safe in both age groups, although eGFR, Hb, WBC and platelets declined significantly in both cohorts (P ≤ 0.001 each). Younger patients showed slightly better tolerance, with smaller decreases in Hb (P = 0.021) and platelets (P = 0.013), along with fewer grade 3 events (young vs. old: anemia, 2 vs. 7 and thrombocytopenia, 0 vs. 2). 177LuLu-PSMA RLT is a safe and effective treatment option in patients ≤ 65 years old, demonstrating comparable efficacy and a slightly more favorable safety profile relative to older patients. These findings support the use of 177LuLu-PSMA RLT regardless of age, which may be of importance given recent expansion of the indication spectrum.
Hornfeck et al. (Mon,) studied this question.