Work

Could we reduce renal toxicity of [177Lu]Lu-PSMA radioligand therapy with furosemide?

Year: 2026

Type: article

Abstract: Purpose Impaired renal function after [ 177 Lu]Lu-PSMA radioligand therapy (RLT) is a growing concern as the field moves toward earlier applications. Little is known how renal function could be protected. This study evaluates the impact of furosemide administered shortly after [ 177 Lu]Lu-PSMA RLT, based on long-term follow-up of renal function and quantitative assessment of renal uptake. Methods Retrospective analysis of patients treated with a least 4 cycles of [ 177 Lu]Lu-PSMA at two Swiss RLT centers with 40 mg furosemide 30 min after injection (CenA) and without (CenB). CenA used [ 177 Lu]Lu-PSMA-I&T and [ 177 Lu]Lu-PSMA-617, while CenB used only [ 177 Lu]Lu-PSMA-I&T. A mixed-effects model was used to evaluate eGFR and PSA change per cycle in the first cohort. To increase the number for renal uptake of [ 177 Lu]Lu-PSMA-I&T in CenA, supplementary patients with less than 4 cycles were included for quantitative SPECT assessment. Results In CenA, 24 patients with 5.4±0.8 doses (17 [ 177 Lu]Lu-PSMA-617 / 7 [ 177 Lu]Lu-PSMA-I&T) were followed over 202.0±58 days. In center CenB 20 patients with 5.4±0.9 doses were followed over 210.6±48 days. CenB showed a significant drop in eGFR per cycle of -2 ml/min/1.73m 2 (CI − 2.8/−1.1), p < 0.001, while CenA showed no significant decrease per cycle, with 0.3 ml/min/1.73m 2 (CI − 0.6/1.1), p = 0.587. For quantitative analysis 20 patients with [ 177 Lu]Lu-PSMA-I&T in CenB had a mean SUV peak of 7.7±3.1, while 16 patients in CenA with [ 177 Lu]Lu-PSMA-I&T had a mean SUV peak of 7.1±3.0 and 17 patients with [ 177 Lu]Lu-PSMA-617 had a mean of 6.2±1.8. Conclusion Furosemide may reduce tracer accumulation in the kidneys after [ 177 Lu]Lu-PSMA RLT. This might explain the mostly stable eGFR values observed in CenA, while there was a significant drop in CenB, without furosemide. If diuretics could reduce renal toxicity without impairing efficacy warrants further prospective evaluation.

Source: European Journal of Nuclear Medicine and Molecular Imaging

DOI: 10.1007/s00259-026-07865-8