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Positive effect of Actinium 225-PSMA treatment on ECOG performance status: A case report on a patient with castration resistant stage IV prostate carcinoma
Efecto positivo del tratamiento con Actinio 225-PSMA sobre el estado funcional ECOG: Informe del caso de un paciente con cáncer de próstata en estadio IV resistente a la castración
Fuad Novruzova, Jamil A. Aliyevb, Zeynəb Allahverdiyevac, Elnur Mehdia, Francesco Giammariled,
Corresponding author
a Department of Nuclear Medicine, National Centre of Oncology, Baku, Azerbaijan
b Department of General Surgery, National Centre of Oncology, Baku, Azerbaijan
c Department of Medical Oncology, Central Clinic Hospital, Baku, Azerbaijan
d International Atomic Energy Agency, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
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"apellidos" => "Aliyev" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Zeynəb" "apellidos" => "Allahverdiyeva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Elnur" "apellidos" => "Mehdi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:4 [ "nombre" => "Francesco" "apellidos" => "Giammarile" "email" => array:1 [ 0 => "F.Giammarile@iaea.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Nuclear Medicine, National Centre of Oncology, Baku, Azerbaijan" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of General Surgery, National Centre of Oncology, Baku, Azerbaijan" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Medical Oncology, Central Clinic Hospital, Baku, Azerbaijan" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "International Atomic Energy Agency, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto positivo del tratamiento con Actinio 225-PSMA sobre el estado funcional ECOG: Informe del caso de un paciente con cáncer de próstata en estadio IV resistente a la castración" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1163 "Ancho" => 3167 "Tamanyo" => 438819 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Due to progressive disease, the patient received 2 cycles of targeted treatment with <span class="elsevierStyleSup">177</span>Lu-PSMA, for a total of about 15<span class="elsevierStyleHsp" style=""></span>GBq. The figure shows <span class="elsevierStyleSup">68</span>Ga PSMA-11 PET/CT scan prior to treatment, MIP (A), axial PET (B), axial CT (C), and axial fusion (D) images indicate multiple intense pathologic uptakes in lymph nodes (simple arrow), liver (dashed arrow) and bone (arrowhead).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Prostate cancer is the third highest cause of cancer deaths and the most commonly found malignancy in males within economically developed countries.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Prostate-specific membrane antigen (PSMA) is a unique target in metastatic castration resistant prostate carcinoma patients (mCRPC). PSMA is a good example of theranostic agent. Promising results obtained with Gallium-68 labelled PSMA Positron Emission Tomography/Computed Tomography (PET/CT) have been extensively studied for prostate cancer, particularly restaging in patients with biochemical relapse following treatment with curative intent.</p><p id="par0015" class="elsevierStylePara elsevierViewall">PSMA can also be used with therapy purposes. In particular, alpha-emitting radioisotope Actinium-225 is more effective than beta-emitting Lutetium-177, due to higher rates of double-strand DNA breaks in prostate cancer cells. It has less tissue penetration and minimal surrounded effects in PSMA-negative cells.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">However, limited data are available on the clinical efficacy and side effects of <span class="elsevierStyleSup">225</span>Ac-PSMA targeted radionuclide treatment in mCRPC patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In our case, <span class="elsevierStyleSup">225</span>Ac-PSMA resulted in remarkable clinical and biochemical responses. It may be considered as a promising therapy and could improve the ECOG performance status of end-stage mCRPC patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">However, the results obtained do not allow to reach any conclusion since, unfortunately, due to the short follow up of the patient, the increase in the ECOG level could not be confirmed in a long period of time (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Source of foundation</span><p id="par0035" class="elsevierStylePara elsevierViewall">Science Development Foundation under the President of the Republic of Azerbaijan (Grant No. EIF-2014-9(24)-KETPL-14/13/3).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Source of foundation" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Novruzov F, Aliyev JA, Allahverdiyeva Z, Mehdi E, Giammarile F. Efecto positivo del tratamiento con Actinio 225-PSMA sobre el estado funcional ECOG: Informe del caso de un paciente con cáncer de próstata en estadio IV resistente a la castración. Rev Esp Med Nucl Imagen Mol. 2019;38:260–261.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2292 "Ancho" => 1500 "Tamanyo" => 290954 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">74 y patient with metastatic prostate carcinoma, diagnosed 4 years before and treated with Docetaxel and hormonal therapy. The figure shows bone scan prior to treatment.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1163 "Ancho" => 3167 "Tamanyo" => 438819 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Due to progressive disease, the patient received 2 cycles of targeted treatment with <span class="elsevierStyleSup">177</span>Lu-PSMA, for a total of about 15<span class="elsevierStyleHsp" style=""></span>GBq. The figure shows <span class="elsevierStyleSup">68</span>Ga PSMA-11 PET/CT scan prior to treatment, MIP (A), axial PET (B), axial CT (C), and axial fusion (D) images indicate multiple intense pathologic uptakes in lymph nodes (simple arrow), liver (dashed arrow) and bone (arrowhead).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1163 "Ancho" => 3167 "Tamanyo" => 401710 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After the second cycle of <span class="elsevierStyleSup">177</span>Lu-PSMA, <span class="elsevierStyleSup">68</span>Ga-PSMA PET/CT control scan showed no response in lymph node lesions. Only one liver lesion disappeared, while the bone lesion increased. The patient was considered in stable disease after the treatment. MIP (A), axial PET (B), axial CT (C), and axial fusion (D) images indicate multiple intense pathologic uptakes in lymph nodes (simple arrow), liver (dashed arrow) and bone (arrowhead). In comparison with pre-treatment images only the liver lesion disappeared (dashed arrow), while the bone lesion increased (arrowhead). When <span class="elsevierStyleSup">225</span>Ac-PSMA treatment (8<span class="elsevierStyleHsp" style=""></span>MBq) was administered (about one month after the decision to treat), the patient was in ECOG stage IV, with a PSA level of 623.8<span class="elsevierStyleHsp" style=""></span>ng/mL. The thrombocyte count was 64,000 one day before treatment, after 5 days of the treatment the thrombocyte count has increased to 88,000. Fifteen days after the treatment, the PSA level got down to 476.3<span class="elsevierStyleHsp" style=""></span>ng/mL and ECOG performance status rise to more favourable stage III. No treatment-related toxicity occurred, but the patient passed away 45 days after treatment because of heart failure (that was diagnosed 2 years before).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended approaches and details of specific care options" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.G. Sanda" 1 => "J.A. Cadeddu" 2 => "E. Kirkby" 3 => "R.C. Chen" 4 => "T. Crispino" 5 => "J. 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| 2022 March | 1 | 2 | 3 |
