¹⁷⁷ Lu-PSMA Radioligand Therapy in Metastatic Castration-resistant Prostate Cancer With Complex Renal Conditions : A Case Series.
Sharjeel Usmani, Anas Al Balushi, Sulaiman Al Saadi et al.
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Case in brief
A retrospective case series described six patients with metastatic castration-resistant prostate cancer and complex pre-existing renal conditions, including hemodialysis-dependent end-stage renal disease, renal transplant, chronic kidney disease, severely reduced glomerular filtration rate, obstructed kidneys, or a solitary kidney. Each received at least two cycles of ¹⁷⁷Lu-PSMA-617 radioligand therapy with individualized dosimetry, multidisciplinary management, and renal monitoring. PSA declined by at least 50% in 4/6 patients (67%); responses across the cohort ranged from 37% to 99.9%. Renal function was stable or improved in most cases, and no patient permanently stopped therapy because of acute renal toxicity.
What made this case unusual
The series included patients with markedly different and complex renal conditions, including hemodialysis and renal transplantation, who are typically excluded from clinical trials of this predominantly renally cleared therapy.
Diagnostic / clinical pearl
In selected patients with substantial renal comorbidity, individualized dosimetry, multidisciplinary input, and close renal monitoring supported administration of ¹⁷⁷Lu-PSMA-617 without permanent discontinuation for acute renal toxicity in this series.
Why it matters
These cases add clinical experience for a population often excluded from trials and underscore the need for prospective data and consensus guidance.