Efficacy and side effects of Lutetium-177 PSMA-617 in patients with castration resistant metastatic prostate cancer: a systematic review and meta-analysis

Background. Progression of metastatic prostate cancer after castration resistance is one of the main chal-lenges in prostate cancer therapy.177Lu-PSMA-617 has been recently investigated in castration resistant metastatic prostate cancer. Objectives. To systematically evaluate the efficacy and safety profile of177Lu-PSMA-617. Patients and methods. A systematic review and meta-analysis was conducted according PRISMA principles. From initial 261 results, 3 randomized controlled trials met our inclusion criteria. The primary outcome of this study was oncological response and side effects. RevMan 5,4 software was applied in this systematic review and meta-analysis. Results. A total of 1071 patients were included in the pooled analysis. 670 (62,6%) patients received177Lu-PSMA-617. Progression-free survival was significantly better with a hazard ratio of 0,72 (p= 0,00001). 50%>PSA reduction reported in 75 (63%) vs. 45/121 patients (37,2%) (p=0,0001). Total adverse events recorded in 572 /627 (91,2%) developed AEs, vs. 204 /290 (70,3%) (p = 0,00001). Fatigue was reported in 306/647 (47,3%) patients vs 88/310 (28,4%) (p=0,00001). And constipation in 110/549 (20%) vs 24/225 (10,7%) (p=0,003). Both thrombocytopenia and leucopoenia were marginally significantly higher in 114 /647 (17,6%) vs 19 /310 (6,1%) (p=0,08) and 81 /647 (12,5%) vs 13 /310 (4,2%) (p=0,10), respectively. Conclusion.177Lu-PSMA-617 results in significant reduction in PSA and improves the progression-free survival. It can cause tolerable side effects, mainly fatigue, constipation, thrombocytopenia and leucopoenia.

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