An exceptional response to 177LuPSMA undermined by neuroendocrine transformation

Abstract

Approximately 25% of patients who have undergone extensive systemic therapy for advanced metastatic castration-resistant prostate cancer (mCRPC) develop treatment associated neuroendocrine prostate cancer (NEPC). 177Lu-prostate specific membrane antigen (-PSMA) is an emerging alternative therapy for mCRPC patients who have exhausted other systemic therapy options; however, cells with neuroendocrine differentiation do not express PSMA and are not affected by this treatment. This case highlights an exceptional response of skeletal metastases to 177LuPSMA that is undermined by neuroendocrine transformation in the liver.