SNMMI: Botox May Facilitate Relief from Dry Mouth Side Effect of PSMA-Targeted Radiopharmaceuticals
For patients being treated with radiopharmaceutical agents for metastatic prostate cancer, the combination of botulinum toxin and an anti-nausea patch led to a 30 percent reduction in PSMA uptake in the salivary glands, according to preliminary research findings presented at the SNMMI conference.
Adjunctive use of botulinum toxin (Botox) may have a significant impact in mitigating a common dry mouth side effect that can occur with the use of PSMA-targeted radiopharmaceutical agents for treating metastatic prostate cancer, according to preliminary findings presented at the Society for Nuclear Medicine and Molecular Imaging (SNMMI) conference.
For the study, researchers assessed the adjunctive combination of botulinum toxin IncoA (Xeomin/Merz Pharmaceuticals) and transdermal scopolamine patches in a small cohort of 14 patients (mean age of 68) with metastatic castration-resistant prostate cancer (mCRPC), who received a combination of the PSMA-targeted radioligand agents actinium (225Ac) and lutetium (177Lu-PSMA).
The study authors noted the botulinum toxin IncoA injections into one parotid gland and contralateral submandibular glands occurred three to four weeks before the use of radioligand treatment, and the scopolamine patches were applied behind the ears from three days prior to radioligand treatment and maintained up to two hours after treatment.
The above imaging demonstrates the reduced PSMA uptake after the combined adjunctive use of botulinum toxin and scopolamine to facilitate salivary gland protection during radioligand therapy to address metastatic prostate cancer. (Images courtesy of SNMMI.)
The researchers found that botulinum toxin IncoA treated parotid glands exhibited a mean 30 percent reduction in PSMA uptake in contrast to untreated parotid glands. There was also a 17 percent mean reduction in PSMA uptake in treated submandibular glands, according to the study authors.
“This study demonstrates that BTX, administered at recommended doses in combination with transdermal scopolamine, offers a promising therapeutic strategy for reducing radiation-induced salivary gland toxicity without compromising PSMA tumor uptake,” noted lead study author Tianzhi Zhao, a research assistant affiliated with the Theranostics Centre of Excellence in the Yong Loo Lin School of Medicine at the National University of Singapore, and colleagues.
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While there was mild injection pain reported by patients, researchers noted no grade 3 or 4 toxicities. The use of transdermal scopolamine led to moderate dry mouth for three days after application, but the researchers pointed out that no patients discontinued the radioligand treatment due to xerostomia.
By mitigating this side effect, the study authors suggested the combination of botulinum toxin and scopolamine patches may bolster adherence and help improve access to radioligand therapies for mCRPC.
“The significance of this work lies in its direct patient benefit and its potential to expand the therapeutic utility of PSMA radiopharmaceutical therapy, particularly withalpha-emitting radionuclides like 225Ac,” suggested Zhao.
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