Despite the approval of 177Lu-PSMA-617 as standard treatment for patients with mCRPC, at least 50% of patients do not respond to the therapy, especially those with visceral disease. This study analyzes real-world outcomes of 177Lu-PSMA-I&T used in heavily pretreated patients in Brazil.
Retrospective analysis of patients with mCRPC previously treated with at least one androgen receptor pathway inhibitor (ARPI) who underwent 177Lu-PSMA-I&T between 2020 and 2025 in two large oncology centers. Our primary endpoint was prostate-specific antigen (PSA) response rate of 50% or more (PSA50). Secondary endpoints included overall survival (OS) and time to next sequential therapies (TNST). Statistical analyses were performed in JAMOVI and RStudio.
Forty-three patients were included, with median age 74 years and median baseline PSA 41 ng/mL. Prior to 177Lu-PSMA-I&T, 86% received more than one ARPI line and 23.3% underwent more than one taxane-based chemotherapy. Visceral disease was present in 41.9%. The overall PSA50 response for all patients was 44.2% and for patients with visceral disease was 33.3%. Median OS was 13.9 months [95% confidence interval (CI) 10.9-19.2] and 12-month survival was 55.5% [95% CI 42.1%-73.3%]. Out of the 24 patients who received subsequent therapies, median TNST was 2.9 months [95% CI 1.6-5.4].
Our results showed that 177Lu-PSMA-I&T achieved a PSA response comparable to those treated with 177Lu-PSMA-617 in randomized trials, despite our heavily treated patients' characteristics. A significant number of patients had visceral disease with expected lower PSA response, highlighting the need for more active combinations in this subgroup.
EJNMMI reports. 2026 Jun 09*** epublish ***
Helena F Bruzzi, Gabriela C K Lopes, Hannah B V Bekierman, Sergio Altino de Almeida, José Alexandre Pedrosa, Camila Mosci, Haonne S Abboud, Christiane Magalhães, Isabella Palazzio, Laura Fernandes, Vinicius Freire da Silva, Juliana Tarouquella da Silva Andrade, Daniel Herchenhorn
Instituto D'Or de Ensino e Pesquisa IDOR, Oncologia D'Or, Rio de Janeiro, Brazil., Postgraduate Program, Central Coordination of Continuing Education (CCEC), PUC-Rio, Rio de Janeiro, Brazil., Department of Urology, National Cancer Institute (INCA), Rio de Janeiro, Brazil., Department of Nuclear Medicine, Rede D'Or São Luiz, Rio de Janeiro, Brazil., Instituto D'Or de Ensino e Pesquisa IDOR, Oncologia D'Or, Rio de Janeiro, Brazil. .