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HIGHLIGHTS FROM THE 2024 SNMMI ANNUAL MEETING |
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| Novel Approaches and Combination Therapies; Pre-Targeting Approaches
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| Combination Treatment of Prostate Cancer Using Pembrolizumab with PSMA-Based Radioligands
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| Thomas Hope, MD
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| Thomas Hope presents on the combination of pembrolizumab, an immune checkpoint inhibitor, with PSMA-based radioligand therapy for prostate cancer. His presentation highlighted the potential of this treatment to enhance immune response by increasing the tumor mutational burden and priming the immune system. Initial trials, including the PRINCE and UCSF studies, showed promising results, with ongoing trials like the EVOLUTION study expected to further elucidate the efficacy and optimal dosing of this combination therapy.
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| Non-PSMA Targets for Prostate Cancer Radiopharmaceutical Therapies
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| Hossein Jadvar, MD, PhD, MPH, MBA, MSL, FACNM, FSNMMI
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| Hossein Jadvar's presentation at the SNMMI 2024 highlighted several promising non-PSMA targets for prostate cancer therapy, including GRPR, FAP, PSCA, and CD46. These targets are being explored for their potential in enhancing diagnostic imaging and therapeutic efficacy, with advancements in radiopharmaceuticals like GRP analogues, FAPI-based tracers, and antibody-drug conjugates showing significant promise.
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| Novel Approaches of Combination PSMA-Based Radiopharmaceutical Treatments for Prostate Cancer
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| James Buteau, MD, FRACP, FRCPC
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| James Buteau presents on innovative PSMA-based radiopharmaceutical treatments for prostate cancer, focusing on three ongoing trials: VIOLET, AlphaBet, and LuCAB. The VIOLET trial examines the use of Terbium-161-PSMA-I&T to target micrometastases in mCRPC, while AlphaBet explores combining Radium-223 and Lutetium-177 PSMA-I&T to enhance treatment for bone metastases. |
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| Prostate Cancer - Focus on Therapy
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| Phase 3 Trial of [177Lu]Lu-PSMA-617 in Taxane-Naive Patients with Metastatic Castration-Resistant Prostate Cancer (PSMAfore)
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| Oliver Sartor, MD
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| Oliver Sartor presents updated results from the PSMAfore phase III trial of [177Lu]Lu-PSMA-617 in taxane-naive mCRPC patients. The trial showed significant improvement in radiographic progression-free survival with [177Lu]Lu-PSMA-617 compared to androgen receptor pathway inhibitors, though no overall survival benefit was observed, likely due to a high crossover rate. The treatment was well-tolerated with fewer severe adverse events.
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| 225Ac-PSMA / 177Lu-PSMA Tandem Therapy for Metastatic Castration-Resistant Prostate Cancer – A Prospective Phase 3 Randomized Study from Azerbaijan
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| Fuad Novruzov, MD, Ph.D.
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| Fuad Novruzov presents results from a phase 3 trial in Azerbaijan evaluating 225Ac-PSMA + 177Lu-PSMA tandem therapy for mCRPC. The study showed that tandem therapy significantly improved progression-free survival and PSA50 responses compared to standard docetaxel treatment, with no severe hematologic or nephrotoxicity. Though overall survival was similar between arms, tandem therapy patients had better outcomes, suggesting combined alpha and beta radionuclide therapy can reduce adverse effects while maintaining efficacy.
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| Efficacy and Toxicity of 177Lu-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer in a Real-World Setting: Results from the U.S. Expanded Access Program and Comparison with Phase 3 VISION Data
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| Vishnu Murthy
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| Vishnu Murthy presents results from a US expanded access program assessing the efficacy and toxicity of 177Lu-PSMA-617 for metastatic castration-resistant prostate cancer in a real-world setting. Compared to the phase 3 VISION trial, expanded access patients had more prior ARPI use and worse ECOG status but showed similar median overall survival (15.1 vs. 15.3 months) and PSA response rates.
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| Lu-177-PSMA-I&T Treatment in Metastatic Castration-Resistant Prostate Cancer: First Experience in Thailand
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| Benjapa Khiewvan, MD
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| Benjapa Khiewvan presents Thailand's initial experience with Lu-177-PSMA-I&T treatment for mCRPC. The study evaluated outcomes in 40 mCRPC patients who had progressed after chemotherapy and ADT. The findings revealed that 25% of patients achieved a PSA response (≥50% decline) after the first cycle, increasing to 22.5% after all treatment cycles. Patients with a PSA response showed significantly longer overall survival compared to non-responders.
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| Analysis of the Prospective ProsTIC Registry
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| David Chen, Ph.D.
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| David Chen presents findings from the ProsTIC registry, which evaluated outcomes for mCRPC patients with stable or rising PSA after the first cycle of [177Lu]Lu-PSMA-617 therapy. The study found that 44% of these patients achieved a PSA50 response with additional cycles, and significant quality-of-life improvements were observed in 71% of the cohort.
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| Effect of Bone Marrow Disease on Hematologic Toxicity and PSA Response to 177Lu-PSMA-617 Therapy
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| Meryam Losee, BS
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| Meryam Losee presents a study on the impact of bone marrow disease on hematologic toxicity and PSA response to 177Lu-PSMA-617 therapy in mCRPC patients. The study found that a higher percentage of PSMA-avid bone disease was linked to increased hematologic adverse events and treatment discontinuation due to toxicity. Additionally, patients with lower SUV in bone disease had lower PSA50 response rates compared to those with higher SUV, highlighting the prognostic value of total tumor SUVmean and the extent of PSMA-avid bone disease in predicting treatment outcomes.
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| Influence of Androgen Receptor Signaling Inhibitors on Absorbed Doses in mCRPC Patients Undergoing 177Lu-PSMA-617 Therapy: First Dosimetry Results
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| Josef Zahner, MD, Ph.D.
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| Josef Zahner presents a study assessing the influence of androgen receptor pathway inhibitors (ARPIs) on absorbed doses in mCRPC patients undergoing 177Lu-PSMA-617 therapy. The study found no significant difference in the mean tumor lesion absorbed doses between patients receiving combination radioligand + ARPI therapy and those receiving radioligand therapy alone, suggesting that the combination likely has an additive effect rather than a synergistic one.
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| Eight Years of Reimbursable PSMA-Based Imaging and Therapy of Prostate Cancer in Israel – Gained Knowledge and Insights
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| PSMA PET in Patients with Prostate Cancer – Gained Insights from Eight Years of Reimbursable Imaging |
| Dan Cohen, Ph.D. |
| Dan Cohen presents insights from eight years of PSMA PET imaging in Israel, highlighting its significant impact on prostate cancer management. The adoption of PSMA PET/CT has improved lesion identification, patient stratification, and treatment guidance, though it has limitations in predicting extracapsular extension. The technology also provides molecular insights that inform disease progression and modify traditional clinical workflows. |
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| PSMA Radioligand Therapy in Patients with Prostate Cancer: Technical Considerations for Diagnostic, Quantitative, and Dosimetric Imaging
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| John A. Kennedy, Ph.D.
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| John Kennedy discusses the technical aspects of diagnostic, quantitative, and dosimetric imaging for PSMA radioligand therapy in prostate cancer. He highlights advancements in SPECT and PET imaging, including the development of solid-state cameras like CZT and the integration of triple modality imaging systems, which enhance spatial resolution and image quantification.
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| Saul Hertz’s Theranostic Dream is Shaping the Future of Cancer Care: Bridging Evidence-Based Medicine and Precision Oncology |
| Michael Hofman, MBBS (Hons), FRACP, FAANMS, FICIS |
| Michael Hofman highlights advancements in theranostics, building on Saul Hertz's pioneering work with radioactive iodine. Dr. Hofman emphasizes the critical role of evidence-based medicine and precision oncology in the development and acceptance of theranostic approaches, particularly with PSMA and DOTATE ligands for prostate and neuroendocrine cancers. |
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