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We analyzed real-world clinical outcomes of sequential α-/β-emitter therapy for metastatic castration-resistant prostate cancer (mCRPC). Methods: We assessed safety and overall survival in 26 patients who received 177 Lu-prostate-specific membrane antigen ligand ( 177 Lu-PSMA) after 223 Ra in the ongoing noninterventional REASSURE study ( 223 Ra α-Emitter Agent in Nonintervention Safety Study in mCRPC Population for Long-Term Evaluation; NCT02141438). Results: Patients received 223 Ra for a median of 6 injections and subsequent 177 Lu-PSMA for a median of 3.5 mo (≥ the fourth therapy in 69%). The median time between 223 Ra and 177 Lu-PSMA treatment was 8 mo (range, 1-31 mo). Grade 3 hematologic events occurred in 9 of 26 patients (during or after 177 Lu-PSMA treatment in 5/9 patients; 8/9 patients had also received docetaxel). Median overall survival was 28.0 mo from the 223 Ra start and 13.2 mo from the 177 Lu-PSMA start. Conclusion: Although the small sample size precludes definitive conclusions, these preliminary data, especially the 177 Lu-PSMA treatment duration, suggest that the use of 177 Lu-PSMA after 223 Ra is feasible in this real-world setting.

the journal of nuclear medicine

<sup>177</sup>Lu-Prostate-Specific Membrane Antigen Ligand After <sup>223</sup>Ra Treatment in Men with Bone-Metastatic Castration-Resistant Prostate Cancer: Real-World Clinical Experience

177Lu-Prostate-Specific Membrane Antigen Ligand After 223Ra Treatment in Men with Bone-Metastatic Castration-Resistant Prostate Cancer: Real-World Clinical Experience

¹⁷⁷Lu-Prostate-Specific Membrane Antigen Ligand After ²²³Ra Treatment in Men with Bone-Metastatic Castration-Resistant Prostate Cancer: Real-World Clinical Experience