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Lutetium-177-PSMA-Radioligandentherapie

Konsensus im Rahmen der GKV-finanzierten Versorgung zwischen den Hochschulkliniken in Aachen, Bonn, Düsseldorf, Essen und Köln und dem MDK Nordrhein

Lutetium-177-PSMA radioligand therapy

Consensus within the framework of GKV-funded care between the university hospitals in Aachen, Bonn, Düsseldorf, Essen, and Cologne and the MDK Nordrhein

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Zusammenfassung

In den letzten 3 Jahren hat in der Nuklearmedizin die Lutetium-177-Prostataspezifisches Membranantigen(PSMA)-Radioligandentherapie (177Lu-PSMA-RLT) als eine neue Therapieform zur Behandlung des kastrationsresistenten metastasierten Prostatakarzinoms zunehmende Beachtung gefunden. Diese Therapie kombiniert das in der Nuklearmedizin bereits seit vielen Jahren in der therapeutischen Anwendung befindliche Radionuklid Lutetium-177 mit einem molekularen Target des transmembranösen prostataspezifischen Membranantigens, welches durch Prostatakarzinomzellen exprimiert wird. Da es bisher keine prospektiven randomisierten Studien zur 177Lu-PSMA-RLT gibt und angesichts steigender Therapiezahlen die Frage nach der Vergütung immer wieder Gegenstand der Prüfung durch den MDK Nordrhein war, bestand der Wunsch nach Klärung, unter welchen Bedingungen die 177Lu-PSMA-RLT als GKV-Leistung erbracht werden kann. Dieser Beitrag soll die behandelnden Ärzte unterstützen, die Funktionsweise dieser neuen Therapieoption zu verstehen, in ein Gesamttherapiekonzept beim kastrationsresistenten metastasierten Prostatakarzinom einzuordnen und v. a. auch die 177Lu-PSMA – basierend auf den vorliegenden Daten – an die richtige Stelle der Sequenz der Therapie des kastrationsresistenten metastasierten Prostatakarzinoms einzuordnen.

Abstract

In the last 3 years, Lutetium-177 prostate-specific membrane antigen radioligand therapy (Lu-177-PSMA-RLT) has received increasing attention in nuclear medicine as a new form of treatment for castration-resistant metastatic prostate cancer. This therapy combines the radionuclide Lutetium-177, which has been therapeutically used in nuclear medicine for many years, with a molecular target of the transmembrane prostate-specific membrane antigen expressed by prostate cancer cells. Since there are no prospective randomized studies on Lu-177-PSMA-RLT and the question of reimbursement has repeatedly been the subject of review by the MDK Nordrhein (Medischenische Dienst der Krankenversicherung), there was a desire because of the increasing number of patients being treated to clarify under which circumstances Lu-177-PSMA-RLT can be reimbursed by German statutory health insurance. The goals of this article are to help treating physicians understand how this new therapy option works, to integrate it in the overall therapy concept for castration-resistant metastatic prostate cancer, and, above all, to use Lu-177-PSMA-RLT—based on the current data—at the right place in the therapy sequence of castration-resistant metastatic prostate cancer.

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Authors and Affiliations

  1. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland

    H. Ahmadzadehfar M.Sc., C. Schlenkhoff & M. Essler

  2. Klinik für Urologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    P. Albers

  3. Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Deutschland

    A. Bockisch & K. Herrmann

  4. Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Deutschland

    M. Boegemann

  5. Abteilung für Medizin-Controlling, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    C. Böhme & C. Wildenhain

  6. Herz- und Diabeteszentrum Bad Oeynhausen, Klinik für Nuklearmedizin, Bad Oeynhausen, Deutschland

    W. Burchert

  7. Klinik für Nuklearmedizin, Universitätsklinikum Köln, Köln, Deutschland

    M. Dietlein, A. Drzezga & M. Schmidt

  8. Abteilung für Medizin-Controlling, Universitätsklinikum Aachen, Aachen, Deutschland

    U. Fabry

  9. Medizinische Klinik und Poliklinik III, Universitätsklinikum Bonn, Bonn, Deutschland

    G. Feldmann

  10. Klinik für Urologie, Universitätsklinikum Köln, Köln, Deutschland

    A. Heidenreich

  11. Klinik für Nuklearmedizin, Uniklinikum Aachen, Aachen, Deutschland

    A. Heinzel & F. M. Mottaghy

  12. KC Onkologie des GKV-SV und der MDK-Gemeinschaft, Düsseldorf, Deutschland

    A. Heyll, E. Ost & B. Zimmer

  13. AOK Rheinland/Hamburg, Düsseldorf, Deutschland

    C. Höhling

  14. MFB Stationäre Versorgung, MDK Nordrhein, Düsseldorf, Deutschland

    C. Kreuzer & R. Mengel

  15. Abteilung für Medizin-Controlling, Universitätsklinikum Bonn, Bonn, Deutschland

    D. Laufer

  16. Klinik für Nuklearmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    H-W. Müller

  17. Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Bonn, Deutschland

    S. C. Müller

  18. Klinik für Nuklearmedizin, Universitätsklinikum Münster, Münster, Deutschland

    K. Rahbar & M. Schäfers

  19. Abteilung für Medizin-Controlling, Universitätsklinikum Köln, Köln, Deutschland

    W. Reifenhäuser

  20. Abteilung für Integrierte Onkologie – CIO Bonn, Universitätsklinikum Bonn, Bonn, Deutschland

    I. Schmidt-Wolf

Authors
  1. H. Ahmadzadehfar M.Sc.
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  2. P. Albers
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  3. A. Bockisch
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  4. M. Boegemann
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  5. C. Böhme
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  6. W. Burchert
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  7. M. Dietlein
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  8. A. Drzezga
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  9. U. Fabry
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  10. G. Feldmann
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  11. A. Heidenreich
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  12. A. Heinzel
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  13. K. Herrmann
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  14. A. Heyll
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  15. C. Höhling
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  16. C. Kreuzer
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  17. D. Laufer
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  18. R. Mengel
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  19. F. M. Mottaghy
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  20. H-W. Müller
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  21. S. C. Müller
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  22. E. Ost
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  23. K. Rahbar
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  25. M. Schäfers
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  26. C. Schlenkhoff
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  27. M. Schmidt
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  28. I. Schmidt-Wolf
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  29. C. Wildenhain
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  30. B. Zimmer
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  31. M. Essler
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Corresponding author

Correspondence to H. Ahmadzadehfar M.Sc..

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Interessenkonflikt

H. Ahmadzadehfar, P. Albers, A. Bockisch, M. Boegemann, C. Böhme, W. Burchert, M. Dietlein, A. Drzezga, U. Fabry, G. Feldmann, A. Heidenreich, A. Heinzel, K. Herrmann, A. Heyll, C. Höhling, C. Kreuzer, D. Laufer, R. Mengel, F.M. Mottaghy, H.‑W. Müller, S.C. Müller, E. Ost, K. Rahbar, W. Reifenhäuser, M. Schäfers, C. Schlenkhoff, M. Schmidt, I. Schmidt-Wolf, C. Wildenhain, B. Zimmer und M. Essler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ahmadzadehfar, H., Albers, P., Bockisch, A. et al. Lutetium-177-PSMA-Radioligandentherapie. Urologe 57, 709–713 (2018). https://doi.org/10.1007/s00120-018-0642-2

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  • DOI: https://doi.org/10.1007/s00120-018-0642-2

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