BACKGROUND Actinium-225 (Ac-225) labelled PSMA RLT has been tested recently in metastatic castration-resistant prostate cancer (mCRPC), with encouraging results. Ac-225, being an alpha emitter, is expected to have higher efficacy and fewer side effects compared to the beta-emitters such as Lutetium-177. We have performed a meta-analysis to assess the therapeutic responses, survival effects, and significant side effects of Ac-225 PSMA RLT in patients with mCRPC. METHODOLOGY Systematic literature search was carried out from five electronic databases PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science, and Cochrane Library until March 2021. Eight studies were found to be eligible for this metanalysis. RESULTS Eight studies with 226 patients were analyzed in this metanalysis. 81% (95% CI 73-89) patients had a decline in PSA levels. 60% of the patients showed more than 50% PSA decline. Two studies assessed survival effects of radioligand naïve patients compared to patients who had received Lu-PSMA therapy previously and the pooled HR for radioligand naïve patients is 0.22. The most common toxicity reported was xerostomia in 167 patients out of 226 patients (73.9%, 95% CI 67.6-79.5%); however, most of them were confined to grade I and II levels. Other reported side effects include hematologic toxicity and nephrotoxicity. CONCLUSION Ac-PSMA RLT is a safe and potentially effective treatment option for patients with mCRPC.

中文翻译：

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Actinium-225 前列腺特异性膜抗原放射性配体治疗转移性前列腺癌的功效和安全性：系统评价和荟萃分析。

背景 Actinium-225 (Ac-225) 标记的 PSMA RLT 最近在转移性去势抵抗性前列腺癌 (mCRPC) 中进行了测试，取得了令人鼓舞的结果。Ac-225 是一种 α 发射体，与 Lutium-177 等 β 发射体相比，预计具有更高的功效和更少的副作用。我们进行了一项荟萃分析，以评估 Ac-225 PSMA RLT 对 mCRPC 患者的治疗反应、生存效果和显着副作用。方法学 截至 2021 年 3 月，我们对五个电子数据库 PubMed/MEDLINE、SCOPUS、EMBASE、Web of Science 和 Cochrane Library 进行了系统文献检索。发现有 8 项研究符合本荟萃分析的条件。结果 本次荟萃分析分析了 8 项涉及 226 名患者的研究。81% (95% CI 73-89) 患者的 PSA 水平下降。60%的患者PSA下降超过50%。两项研究评估了未接受过放射配体治疗的患者与之前接受过 Lu-PSMA 治疗的患者相比的生存影响，未接受过放射配体治疗的患者的汇总 HR 为 0.22。最常见的毒性是 226 名患者中的 167 名出现口干症（73.9%，95% CI 67.6-79.5%）；然而，其中大多数仅限于一级和二级水平。其他报道的副作用包括血液毒性和肾毒性。结论 Ac-PSMA RLT 对于 mCRPC 患者来说是一种安全且可能有效的治疗选择。