Targeted alpha-therapy using astatine (At-211)-labeled PSMA1, 5, and 6: a preclinical evaluation as a novel compound

Purpose Targeted alpha-therapy (TAT) for prostate-specific membrane antigen (PSMA) is a promising treatment for metastatic castration-resistant prostate cancer (CRPC). Astatine is an alpha-emitter (half-life=7.2 h) that can be produced by a 30-MeV cyclotron. This study evaluated the treatment effect of At-211-labeled PSMA compounds in mouse xenograft models. Methods Tumor xenograft models were established by subcutaneous transplantation of human prostate cancer cells (LNCaP) in NOD/SCID mouse. [At-211]PSMA1, [At-211]PSMA5, or [At-211]PSMA6 was administered to LNCaP xenograft mice to evaluate biodistribution at 3 and 24 h. The treatment effect was evaluated by administering [At-211]PSMA1 (0.40 +/- 0.07 MBq), [At-211]PSMA5 (0.39 +/- 0.03 MBq), or saline. Histopathological evaluation was performed for the at-risk organs at 3 and 6 weeks after administration. Results [At-211]PSMA5 resulted in higher tumor retention compared to [At-211]PSMA1 and [At-211]PSMA6 (30.6 +/- 17.8, 12.4 +/- 4.8, and 19.1 +/- 4.5 %ID/g at 3 h versus 40.7 +/- 2.6, 8.7 +/- 3.5, and 18.1 +/- 2.2%ID/g at 24 h, respectively), whereas kidney excretion was superior in [At-211]PSMA1 compared to [At-211]PSMA5 and [At-211]PSMA6. An excellent treatment effect on tumor growth was observed after [At-211]PSMA5 administration. [At-211]PSMA1 also showed a substantial treatment effect; however, the tumor size was relatively larger compared to that with [At-211]PSMA5. In the histopathological evaluation, regenerated tubules were detected in the kidneys at 3 and 6 weeks after the administration of [At-211]PSMA5. Conclusion TAT using [At-211]PSMA5 resulted in excellent tumor growth suppression with minimal side effects in the normal organs. [At-211]PSMA5 should be considered a new possible TAT for metastatic CRPC, and translational prospective trials are warranted.