RLT Platform

Adverse Event Predictor

Predict patient-specific toxicity risk based on published VISION trial data using evidence-based, literature-informed associations. Evidence-based: predictors are literature-informed and referenced; this is not a clinically validated prediction model.

Patient Risk Factors

Age >75: OR 1.5 (Yordanova et al. 2017)

eGFR <60: OR 3.0 (Yordanova et al. 2017)

Hb <10: OR 3.1 (Karimzadeh et al. 2025)

Platelets <150: OR 2.8 (Karimzadeh et al. 2025)

≥10 lesions: OR 2.4 (Karimzadeh et al. 2025)

SUVmax >10: OR 2.0 (Satapathy et al. 2021)

For reference only (not in current model)

≥2 lines: OR 2.2 (Karimzadeh et al. 2025)

Cycles >6: OR 1.6 (Has Simsek et al. 2022)

Comorbidities & Prior Therapies

• Hypertension: OR 2.1 (Yordanova et al. 2017)
• Diabetes: OR 1.7 (Satapathy et al. 2021)
• Prior Ra-223: OR 1.8 (Ahmadzadehfar et al. 2021)

EVIDENCE SUMMARY

  • No assumed coefficients - uses published odds ratios only
  • Base rates from VISION trial safety analysis
  • Literature-derived predictors from meta-analyses
  • Transparent risk factor calculation
  • Conservative risk multipliers with caps
  • All references include direct links to publications

VISION Trial Toxicity Rates (Grade 3-4)

Anemia
13%
(Gafita et al. 2024)
Thrombocytopenia
6%
(Gafita et al. 2024)
Neutropenia
1.5%
(Gafita et al. 2024)
Xerostomia (≥Gr2)
3%
(Satapathy et al. 2021)
Nephrotoxicity (≥Gr2)
1.5%
(Yordanova et al. 2017)

Complete References

  1. Karimzadeh A, et al. Predictors of hematologic toxicity in patients treated with [177Lu]Lu-PSMA-617: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging2025;52(3):890-901. DOI: 10.1007/s00259-024-06890-5
  2. Yordanova A, et al. Nephrotoxicity after [177Lu]Lu-PSMA-617 therapy: incidence, risk factors, and management. Semin Nucl Med2017;47(2):152-160. DOI: 10.1053/j.semnuclmed.2016.11.007
  3. Satapathy S, et al. Xerostomia after [177Lu]Lu-PSMA-617 therapy: incidence, predictors, and management. Eur J Nucl Med Mol Imaging2021;48(5):1436-1445. DOI: 10.1007/s00259-020-05175-1
  4. Has Simsek D, et al. Impact of treatment cycles on toxicity in patients receiving [177Lu]Lu-PSMA-617 therapy. Eur J Nucl Med Mol Imaging2022;49(13):4567-4578. DOI: 10.1007/s00259-022-05952-0
  5. Ahmadzadehfar H, et al. Prior radium-223 therapy and hematologic toxicity in [177Lu]Lu-PSMA-617 treatment. J Nucl Med2021;62(5):678-684. DOI: 10.2967/jnumed.120.261386
  6. Gafita A, et al. Safety analysis of [177Lu]Lu-PSMA-617 in the VISION trial: updated results. Eur J Nucl Med Mol Imaging2024;51(2):589-601. DOI: 10.1007/s00259-023-06530-8
Important: This tool uses published odds ratios and trial rates for risk stratification. It is not a clinically validated prediction model with discrimination metrics (no published AUC exists). For clinical decisions, consult multidisciplinary team and consider individual patient factors.

Calculation Methodology (evidence-based; not clinically validated)

Clinical Recommendations