177Lu-PSMA-617 in Metastatic Castration Resistant Prostate Cancer (mCRPC) With Bone Marrow Involvement and Cytopenia

Launched by M.D. ANDERSON CANCER CENTER · Jun 9, 2025

Keywords

ClinConnect Summary

This clinical trial is studying a new treatment called 177Lu-PSMA-617 for men with advanced prostate cancer that no longer responds to hormone therapy and has spread to the bone marrow, causing low blood counts (a condition called cytopenia). The goal is to see if this treatment can help control the cancer and to understand how safe it is for patients with this condition.

Men who may be eligible are adults with prostate cancer that has spread and is resistant to hormone treatments, who have already tried at least one other approved therapy. Their cancer must be confirmed to have affected the bone marrow, and they need to have certain blood count levels within a specific range. Participants must be willing to undergo blood tests and bone marrow samples during the study, continue hormone therapy during the trial, and follow safety measures like using condoms during and for six months after treatment to avoid passing on the drug. The study is not yet recruiting, and it is only open to men aged 65 to 74 with good overall health aside from their cancer. This trial offers a chance to try a promising new therapy while carefully monitoring its effects and safety in this specific group of prostate cancer patients.

Gender

MALE

Eligibility criteria

• • Eligibility Criteria
• • 1. Signed informed consent must be obtained before participation in the study. Participant subjects must be willing and able to provide consent.
• • 2. Participants must be adults ≥18 years of age.
• • 3. Histologically or cytologically confirmed adenocarcinoma of the prostate
• • 4. Metastatic, castration-resistant prostate cancer (mCRPC) with a rise in PSA over a previous reference value measure 1 week prior. Minimal start value is 2.0 ng/mL
• • 5. Has received ≥1 line prior systemic therapy approved in the metastatic and/or castrationresistant setting (in addition to androgen deprivation therapy \[ADT\])
• 6. Cytopenia due to prostate cancer involvement of bone marrow as documented by the presence of cancer cells in the BM sample and at least one of the below:
• • 1. Hemoglobin ≥7 g/dl and \< 9 g/dl
• • 2. Pretransfusion Hemoglobin \< 8 g/dl within 28 days for enrollment
• • 3. Platelet count ≥50 X 109 /L and ≤100 X 109 /L
• • 7. Participants must agree to blood, bone marrow aspiration and biopsy collections at the specified time points.
• • 8. Have had either orchiectomy OR be on luteinizing hormone-releasing hormone (LHRH) agonist or antagonist therapy with serum testosterone \<50 ng/dL AND agree to stay on LHRH agonist or antagonist therapy during the study.
• • 9. Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2
• • 10. Serum creatinine ≤1.5 x ULN or estimated glomerular filtration rate \>50 mL/min.
• 11. Adequate hepatic function:
• • 1. Total bilirubin ≤1.5 x ULN (≤3 x ULN if tumor liver involvement)
• • 2. AST ≤2.5 x ULN (≤5 x ULN if tumor liver involvement)
• • 3. ALT ≤2.5 x ULN (≤5 x ULN if tumor liver involvement)
• • 12. Participants must have a positive 68Ga-PSMA-11 PET/CT scan, defined by at least 1 PSMA positive lesion with uptake \> liver parenchyma in one or more metastatic lesions of any size in any organ system.
• • 13. To avoid the risk of drug exposure through the ejaculate (even men with vasectomies), subjects must use a condom during sexual activity while on the study drug and for 6 months following the last dose of the study drug. If the subject is engaged in sexual activity with a woman of childbearing potential, a condom is required along with another effective contraceptive method consistent with local regulations regarding the use of birth control methods for subjects participating in clinical studies and their partners. Donation of sperm is not allowed while on the study drug and for 6 months following the last dose of the study drug.
• • Exclusion Criteria
• • 1. Has primary bone marrow disorder (e.g. leukemia, myeloproliferative or myelodysplastic disorder)
• • 2. Presence of iron deficiency or other hematological disorders that may cause anemia and cytopenia
• • 3. Has participated in a study of an investigational agent or an investigational device within 4 weeks of the first dose of study therapy
• • 4. Has received treatment with an approved systemic therapy within 2 weeks of dosing or has not yet recovered (i.e., grade ≤1 or baseline) from any acute toxicities attributed to the systemic therapy.
• • 5. Has received radiation therapy or major surgery within 14 days of first administration of study drug.
• • 6. Has received radiopharmaceutical agents in the past (e.g., Strontium-89, PSMA-targeted radioligand therapy)
• • 7. Has received prior PSMA-targeting therapy
• • 8. Another malignancy that is progressing or requires active treatment with the exception of non-melanoma skin cancer that has undergone potentially curative therapy
• • 9. Untreated or active primary brain tumor, CNS metastases, leptomeningeal disease, or spinal cord compression
• • 10. Uncontrolled infection with human immunodeficiency virus (HIV), hepatitis B, or hepatitis C infection; or diagnosis of immunodeficiency
• • 11. Has known allergy or hypersensitivity to study drugs
• • 12. Concurrent cytotoxic chemotherapy, immunotherapy, radioligand therapy, Poly Adenosine Diphosphate-Ribose Polymerase (PARP) inhibitor, biological therapy, or investigational or anti-cancer therapy
• • 13. Concurrent serious (as determined by the Principal Investigator) medical conditions, including, but not limited to, uncontrolled infection, known active hepatitis B or C, or other significant co-morbid conditions that, in the opinion of the investigator, would impair studyparticipation or cooperation
• 14. No active clinically significant cardiac disease is defined as any of the following:
• • a. History or current diagnosis of ECG abnormalities indicating a significant risk of safety for participants in the study, such as i. Concomitant clinically significant cardiac arrhythmias, e.g., sustained ventricular tachycardia, complete left bundle branch block, high-grade atrioventricular (AV) block (e.g., bi-fascicular block, Mobitz type II and third-degree AV block) ii. History of familial long QT syndrome or known family history of Torsades de Pointes
• • 15. History of somatic or psychiatric disease/condition that may interfere with the objectives and assessments of the study
• • 16. Symptomatic cord compression, unstable vertebral metastasis or clinical or radiologic findings indicative of impending cord compression