n.45 – THERAPY OF REFRACTORY METASTATIC PROSTATE (PC) CANCER PATIENT WITH 64CUCL2: A PRELIMINARY CASE REPORT OF CLINICAL EFFICACY



Abstract

BACKGROUND-AIM
Peng et al. demonstrated human prostate cancer xenografts could be visualized in vivo by positron emission tomography (PET) after intravenously injection of 64CuCl2 as a radio-tracer. Copper-64 (t1/2 = 12.7 h; ß+=17,4%; ß-= 39%; EC= 43,6% ) has a potential for use in diagnostic imaging and radiotherapy. Our aim is to evaluate 64CuCl2 therapeutic clinical efficacy in a case report of PC patient.
METHODS
A 67 years old male patient affected by a mixed prostate adenocarcinoma infiltrating the bladder and with nodal and skeletal metastasis was evaluated. The patient couldn’t urinate and underwent to a permanently bilateral uretero-cutaneous stomy. He was treated with docetaxel (6 cycles) and adrenal deprivation therapy (ADT) between 2009-2013; neverthless the patient was in desease progression. So the patient underwent to a diagnostic PET/CT scan after intravenously administration of 446 MBq (12,05 mCi) of 64CuCl2 to prove the radio-tracer uptake. Then the patient underwent to the therapeutic administration of 64CuCl2 (934, 1919 and 2984 MBq – 25,24, 51,86 and 80,65 mCi – for three cycles respectively within 90 days) between August and November 2014.
The patient subjected to serial PET/CT scans at 1 hour, 18 h and 42 h after the second therapeutic administration of 64CuCl2 for dosimetric calculation.
The patient also took blood sample at T0, 30 days, 42d, 48d, 50d, 58d and 92d after the first administration of 64CuCl2, for haematological parameters evaluation with renal and hepatic function panel and the tPSA and fPSA serum levels measures.
Quantitative PET analysis was performed to determine biodistribution of 64Cu radioactivity and 64Cu radiation dosimetry estimated for target and no target organs.
RESULTS
Lesions discovered on the fused PET/CT had to be a clearly detectable in particular prostate-bladder tumor lesion, addominal and pelvic lymph-nodes and skeletal metastasis for each therapeutic administration.
Dosimetric calculation suggested liver and kidneys are the critical organs (liver 0,301 mSv/MBq, kidneys 0,0426 mSv/MBq, bone marrow 0,026 mSv/MBq and tumor lesions 0,037 mSv/MBq) in line with the literature.
Despite these results biochemical evaluation demonstrated that no hematological, hepatic or renal alterations occurred. tPSA levels passed from basal values of 3350 ng/ml before the copper administration to 344,5 ng/ml after the second cycle of radionuclide therapy. This important tPSA decrease suggests a significant 64CuCl2 effectiveness. After the third cycle of therapy the patient resumed to urinate and felt good.
CONCLUSION
The patient is on follow up and will repeat morphological examination to estimate the degree of pelvic organs disease. Whereby exciting results we will plan a fourth administration of 64CuCl2 in December 2014.

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