177Lu-PSMA-617 Outcomes in Octogenarians With mCRPC

Key Takeaways

• More than half of patients had a PSA50 response, and progression-free and overall survival were reported in the same treated cohort.
• Hospitalization during therapy was common, and serious hematologic toxicities included anemia and thrombocytopenia.
• The authors wrote that outcomes were comparable to registrational trials and that the findings supported feasibility in well-selected older men, with closer monitoring suggested.

Men aged 80 years and older with metastatic castration-resistant prostate cancer had a 57% PSA50 rate after 177Lu-PSMA-617 in a multicenter retrospective cohort. All had disease treated after chemotherapy and received at least one cycle of the radioligand therapy. Investigators focused on outcomes in octogenarians, a group often less represented in trial populations for this targeted radioligand treatment. The analysis reflected standard-of-care use outside a prospective treatment protocol and focused on real-world feasibility and tolerability in selected older adults.

Clinical and demographic data were abstracted from electronic medical records in a multicenter retrospective cohort of 95 men, with treatment spanning August 2022 to December 2024. Patients had metastatic castration-resistant disease after chemotherapy, and the median age at treatment initiation was 83 years. Median follow-up was 24.1 months, with an IQR of 6.7 to 28.1 months, and patients received a median of five treatment cycles. At baseline, 38% had documented cardiac disease and 22% had chronic kidney disease. Kaplan-Meier methods were used to estimate progression-free and overall survival in this cohort receiving standard-of-care therapy.

Investigators also reported deeper declines, with 21 patients achieving a PSA90 response, or 23% of the cohort. Median progression-free survival was 7.3 months, with a 95% CI of 6.4 to 8.7 months, and median overall survival was 13.5 months, with a 95% CI of 9.7 to 18.8 months. These results showed biochemical response alongside progression and survival outcomes in octogenarians treated in routine practice.

Grade 3 or higher hematologic toxicity included severe anemia in 20% (19 patients) and thrombocytopenia in 4% (4 patients), and one patient developed grade 3 or higher acute kidney injury. Dose delays occurred in 15% (14 patients), dose reductions in 7% (seven patients), and toxicity led 11% (10 patients) to discontinue treatment. Hospitalization during therapy was reported for 39% (37 patients), including two who required ICU-level care, and one treatment-related death occurred. The authors wrote that outcomes were comparable to registrational trials and supported feasibility and efficacy in well-selected older men, with closer monitoring suggested. Overall, the cohort showed that treatment was deliverable in selected octogenarians, although hospitalization during therapy was frequent.