Evidence map›Paper›PMID 40705094›Full record

SynthesisEuropean journal of nuclear medicine and molecular imaging2025

Efficacy and safety of rechallenge therapy with [177Lu]Lu-PSMA in metastatic castration-resistant prostate cancer: a systematic review and meta-analysis.

Zineddine Belabaci, Leonie Schmidt, Mouhammed Sleiay, Felipe Couñago, Fernando López Campos, Marwan Tolba, Thomas Zilli, Ali Afshar-Oromieh, Mohamed Shelan

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European journal of nuclear medicine and molecular imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Beyond [BMC cancer · 2026
    Pooled it
  2. Efficacy and safety of [Frontiers in medicine · 2026
    Pooled it
  3. Article
  4. Efficacy, safety, and quality of life outcomes of [International urology and nephrology · 2026
    Review
  5. Article
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Zineddine BelabaciFaculty of Medicine, Djillali Liabes University, Sidi Bel Abbes, Algeria.
Leonie SchmidtDepartment of Radiation Oncology, Inselspital Bern, University of Bern, Bern, Switzerland.
Mouhammed SleiayFaculty of Medicine, Hama University, Hama, Syria.
Felipe CouñagoDepartment of Radiation Oncology, University Hospital Quironsalud, Universidad Europea de Madrid, Madrid, Spain.
Fernando López CamposDepartment of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Marwan TolbaDepartment of Radiation Oncology, Dalhousie University, Halifax, Canada.
Thomas ZilliDepartment of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.
Ali Afshar-OromiehDepartment of Nuclear Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
Mohamed ShelanDepartment of Radiation Oncology, Inselspital Bern, University of Bern, Bern, Switzerland. Mohamed.Shelan@insel.ch.ORCID 0000-0002-6477-6655

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLutetium-177 PSMA radioligand therapy ([¹⁷⁷Lu]Lu-PSMA-RLT) is an effective treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). Prospective studies reported favourable efficacy and safety outcomes of up to 6 cycles of [¹⁷⁷Lu]Lu-PSMA. This study aimed to evaluate the efficacy and safety of [¹⁷⁷Lu]Lu-PSMA rechallenge therapy in patients with mCRPC who progressed after an initial course of [¹⁷⁷Lu]Lu-PSMA-RLT.

methodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was performed using relevant keywords in PubMed, EMBASE, and Scopus from establishment to March 2025. Primary endpoints included biochemical responses with a decline in prostate-specific antigen (PSA) of more than 50% and any PSA decline. Secondary outcomes included survival outcomes and treatment-related toxicity following rechallenge therapy with [¹⁷⁷Lu]Lu-PSMA. A random-effects model was used to generate pooled proportions through meta-analysis.

resultsEleven studies with 307 patients were included in the final analysis. Of these, 196 received 177Lu-PSMA RLT alone, and 111 received tandem 177Lu/225Ac-PSMA RLT. The pooled proportions of patients with more than a 50% PSA decline and any PSA decline were 0.45 (95% CI: 0.36–0.54) and 0.71 (95% CI: 0.61–0.80), respectively. In a total of 102 patients, 44 (43%) showed low-grade 1–2 xerostomia; however, no cases of serious xerostomia (grade ≥ 3) were reported. Moreover, the pooled proportion of patients experiencing grade ≥ 3 toxicity was 0.14 (95% CI: 0.09–0.19).

conclusionRechallenge therapy with [¹⁷⁷Lu]Lu-PSMA is a feasible and safe treatment option for late/end mCRPC patients. Tandem approaches with [225Ac]Ac-PSMA may help expand understanding of how to optimize outcomes after [¹⁷⁷Lu]Lu-PSMA progression. However, these findings require confirmation in prospective, randomized studies comparing different rechallenge strategies to define optimal sequencing and patient selection criteria in advanced prostate cancer.

Indexed as

DipeptidesHeterocyclic Compounds, 1-RingLutetiumProstatic Neoplasms, Castration-ResistantRadioisotopesSafetyHumansMaleNeoplasm MetastasisProstate-Specific AntigenTreatment OutcomeDipeptidesHeterocyclic Compounds, 1-RingLutetiumLutetium-177lutetium (177Lu) vipivotide tetraxetanProstate-Specific AntigenRadioisotopes[¹⁷⁷Lu]Lu-PSMA[²²⁵Ac]Ac-PSMAProstate cancerProstate-specific membrane antigenRadioligand therapyRechallenge

Identifiers

PMID40705094
PMCPMC12660338

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.