The Department of Nuclear Medicine at Inkosi Albert Luthuli Central Hospital (IALCH) treated the first 11 patients with metastatic castrate-resistant prostate cancer in January 2023 with Actininum-225 PSMA and Actininum-225 DOTATATE under the leadership of UKZN’s Head of Nuclear Medicine, Professor Mariza Vorster.
The IALCH became the second site in the country, the first in the province, and one of a handful globally to label 225 Actinium-PSMA and Actininum-225 DOTATATE in-house and provide targeted alpha therapy to prostate cancer patients and patients with metastatic neuroendocrine tumours.
Actinium-225 PSMA is a targeted radionuclide therapy that is administered as an outpatient, with a total average of four doses usually needed and administered at two-month intervals. There is a growing body of evidence that it produces remarkable responses with improved survival and quality of life in heavily pre-treated castrate-resistant prostate cancer patients who have no other treatment options.
According to Vorster, ‘Prostate-specific membrane antigen (PSMA) is overexpressed in metastatic prostate cancer and has been found to be a suitable target for imaging and therapy. The 225Ac labelled derivative, 225Ac-PSMA-617, has shown remarkable therapeutic efficacy in mCRPC patients and has fewer and less severe side effects than chemotherapy. Patients initially undergo 68Ga-PSMA-11 positron-emission tomography/computed tomography (PET/CT) before 225Ac-PSMA-617 treatment to determine whether there is a sufficient expression of the PSMA target.
‘This therapy will likely have a huge impact on the lives of patients with prostate cancer who are not responsive to other therapies, and should provide some much-needed hope for these patients. It will also save costs for the health department as targeted therapies have fewer side effects than systemic therapies,’ said Vorster. Vorster brings several years’ of expertise from the Steve Biko Academic Hospital’s Nuclear Medicine department which pioneered targeted alpha therapy (TAT) with 225Ac-PSMA on the African continent under the leadership of Professor Mike Sathekge and has clearly demonstrated its remarkable impact.
‘Until now, our patients have been travelling all the way to Steve Biko Academic Hospital via ambulance for treatment with 225Ac-PSMA. IALCH had secured only two slots every two months due to the high demand for 225Ac-PSMA with the increasing global incidence of prostate cancer. Having local access to this form of therapy allows us to reach and help more patients. I express my heartfelt gratitude to medical management at IALCH and the entire team at the hospital’s Department of Nuclear Medicine for their integral roles in realising this dream,’ added Vorster.
Words: MaryAnn Francis