Widjaja L, Derlin T, Ross TL, et al. - In patients who received PSMA(prostate-specific membrane antigen)-targeted radioligand therapy (RLT), there was not a frequent occurrence of serious adverse renal events after this treatment. However, renal impairment during follow-up of patients who developed moderate chronic kidney disease (CKD) post-RLT was shown to be independently predicted by pretherapeutic estimated glomerular filtration rate (eGFR).

• PSMA-targeted RLT may be related to renal toxicity.

• This study involved 46 metastatic castration resistant prostate cancer patients scheduled for Lu-177-PSMA-RLT.

• A reduction in average eGFR from 76 ± 17 to 72 ± 20 ml/min/1.73 m ² was evident following 4 ± 3 cycles of RLT.

• Development of CKD grade 2 (no grade 3 or higher) in 16/46 (30.4%) was revealed during follow-up.

• A high accuracy of pretherapeutic eGFR in detecting occurrence of CKD vs no CKD was evident, with an area under the curve (AUC) of 0.945 (best threshold, 77 ml/min/1.73 m ² ), followed by that of Tc-99m-MAG3-derived tubular extraction rate (TER; AUC, 0.831; best threshold, 200 ml/min/1.73 m ² ).

• In Kaplan–Meier analyses, adverse renal outcome was observed for those having lower eGFR and lower scintigraphy-derived TER, with pretherapeutic eGFR unveiled as the only predictive parameter in multivariate analysis.