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177Lu-PSMA Myelosuppression — SCE Medical Oncology MCQ

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ModerateUrological Cancers177Lu-PSMA MyelosuppressionSCE Medical Oncology

A 72-year-old man with mCRPC on 177Lu-PSMA-617 develops grade 2 thrombocytopenia and grade 1 anaemia after 3 cycles. What is the dose-limiting toxicity of radioligand therapy?

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Correct answer: B — Cumulative marrow suppression and thrombocytopenia

The dose-limiting toxicity of 177Lu-PSMA-617 is myelosuppression, particularly thrombocytopenia and anaemia. This results from: (1) radiation to haematopoietic marrow adjacent to bone metastases, (2) low-level PSMA expression on some bone marrow cells, (3) cumulative bone marrow reserve depletion with successive cycles. The VISION trial administered up to 6 cycles; dose modifications for cytopenias follow protocol-defined thresholds. Dry mouth (salivary gland PSMA expression) is the most common non-haematological toxicity. Renal toxicity is uncommon with 177Lu (unlike 225Ac-PSMA).

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer