Adverse Events, ER Visits, and Hospitalizations After Lu-PSMA for mCRPC

A poster presented at the Society of Urologic Oncology Annual Meeting reported on adverse events (AEs) occurring during or shortly after treatment with Lutetium-177-PSMA (Lu-PSMA), as well as on independent variables associated with emergency room (ER) visits and hospital admissions.

Lu-PSMA is considered an effective treatment for patients with metastatic castration-resistant prostate cancer (mCRPC), though the side effects that occur during or immediately after administration are not well understood.

To investigate Lu-PSMA associations with AEs, ER visits, and hospitalizations, Mohamed E. Ahmed, MD, and colleagues retrospectively reviewed the medial records of 185 patients with mCRPC who received radioligand therapy at the Mayo Clinic from April to November 2022. Their primary goal was to outline the early side effects reported in the clinical notes. ER visits and hospitalizations within 30 days of administration were defined as secondary goals.

Researchers sought to determine independent variables associated with ER visits and hospital admissions through univariable and multivariable logistic regression analyses.

Among the patient sample, the median age at the time of first Lu-PSMA cycle was 70 years, with a median prostate-specific antigen level of 11.8 ng/ml.

The most observed side effects attributed to Lu-PSMA during or shortly after administration were gastrointestinal in origin, including nausea (19.5%), vomiting (19.5%), abdominal pain (9.2%), and constipation (8.6%). Other side effects included fatigue (29.2%) and dry mouth (4.9%).

A total of 16 patients visited the ER after receiving Lu-PSMA. Two of those patients experienced anemia and thrombocytopenia, 2 had pneumonia and acute respiratory failure, 2 had abdominal pain and vomiting, 2 presented with sepsis and septic shock, and 1 had intestinal obstruction and perforated appendicitis. Additionally, 2 patients were hospitalized due to severe anemia.

Importantly, researchers noted that a high Eastern Cooperative Oncology Group performance score was associated with increased ER visits and hospital admissions (P=.017 and P=.007, respectively).

“Mild to moderate short-term side effects secondary to treatment with Lu-PSMA are not uncommon, but most patients can be managed in an outpatient setting,” study authors concluded, adding that “larger studies are warranted to further characterize the real-world intensification of care following treatment with Lu-PSMA.”