Dr Osayande Evbuomwan is Senior Lecturer and Medical Specialist in Nuclear Medicine in the Department of Nuclear Medicine, Faculty of Health Sciences, Free State University (UFS).
UFS and Free State Province are now joining other South African universities, such as University of Pretoria, University of the Witwatersrand and other provinces to use this method to treat patients with the disease. by MCRPC.
Dr Osayande Evbuomwan, lecturer and specialist doctor in the nuclear medicine department, Faculty of Health Sciences, says they began treating their first MCRP patient (cycle one) with radionuclide peptide receptor therapy (PRRT) on July 15. This is the first time that Lutetium 177 PSMA – a type of PRRT used to treat patients with CPRM – has been used in the Free State. This method is used in MCRPC patients who are not eligible for chemotherapy or who have failed first or second line chemotherapy.
Expertise and funds are now available for this treatment
Dr Evbuomwan was trained and exposed to this therapy at the University of the Witwatersrand during his training as a nuclear medicine registrar. When he joined UFS in 2019, he – with the always available help from the head of the department, Dr Gerrit Engelbrecht – pushed for the therapy to be used in the department.
âWe at the Department of Nuclear Medicine are pleased that the expertise is now available and that funds have been made available for the start of this treatment. The index patient is very ill with CPRM and was too ill to qualify for first line chemotherapy. Each patient will need approximately four to six cycles for a complete treatment. The patient is treated in the nuclear medicine department of the Universitas University Hospital and its annex.
âWe hope he will be able to complete at least four cycles and respond well to treatment. We believe that being able to administer this treatment now is good news for the Free State, as the people of the Free State deserve to be exposed to this level of treatment as well. We hope that the government will continue to provide more funds for more of these patients to be treated at our facility, âsaid Dr Evbuomwan.
It was budgeted to treat five patients (20 cycles), each cycle (only the Lu-177 PSMA) costing over R50,000.
Prostate cancer, one of the main causes of morbidity and mortality
Dr Evbuomwan says Prostate cancer is one of the leading causes of morbidity and mortality worldwide, including South Africa. When it progresses to the very advanced stage of MCRPC, the prognosis becomes very poor.
Dr Evbuomwan explains that there are various conventional systemic therapies, including first-line and second-line chemotherapy, which could be used to treat patients at this very bad stage. However, not all patients are suitable for chemotherapy. The rare fit people, Dr. Evbuomwan said, usually end up failing first-line chemotherapy, which has many unwanted side effects and requires long-term hospital stays.
Only a few centers are able to offer second-line chemotherapy. So many of these patients end up suffering from prolonged bone pain before they die from the disease.
PRRT is a targeted nuclear medicine therapy that offers the potential to deliver very high levels of radiation specifically to cancer cells because these cancer cells express specific receptors to which certain peptides can bind. This specificity to cancer cells offers the advantage of delivering lower doses of radiation and damage to normal organs and tissues, a feature that conventional therapies do not provide, says Dr. Evbuomwan.
According to him, Lutetium 177 PSMA (Lu-177 PSMA) is a type of PRRT used to treat patients with CPRM, who are not eligible for chemotherapy or who have failed first-line chemotherapy. Numerous research studies around the world have proven that this treatment improves quality of life, slows disease progression and improves overall survival, with low or very tolerable side effects in most patients.
The University of Pretoria is one of the pioneers of this treatment in the world, having carried out extensive research with it since 2017. Other provinces such as the Western Cape and KwaZulu-Natal have also recently become involved in the therapy. . This therapy is expensive and requires a lot of expertise. It also involves the contribution of a multidisciplinary team (EMD) which must at least include a nuclear medicine doctor, a radiation oncologist and a urologist. The UFS urology and radiation oncology departments were also instrumental in initiating therapy and are part of the UFS MDT team in the management of these patients.
Treatment puts department, university and hospital on the map
Dr Evbuomwan says the ability to deliver this treatment puts the department, UFS and hospital on the map, alongside other leading universities inside and outside the country. âIt also allows us to collect data for research and publication purposes. We are now able to offer a promising, safe and highly effective therapy for patients with CRPS in the Free State. Some of these patients no longer need to travel to other provinces for treatment.
There are plans to expand the treatment to more patients – and the hospital management, who were present during the first treatment, are enthusiastic and eagerly awaiting the results of this current treatment.