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18 August 2021 | Story André Damons | Photo André Damons
Dr Osayande Evbuomwan is a Senior Lecturer and medical specialist in nuclear medicine in the Department of Nuclear Medicine, Faculty of Health Sciences, at the University of the Free State (UFS).

The University of the Free State (UFS) Department of Nuclear Medicine has, for the first time, started using Lutetium 177 PSMA (Lu-177 PSMA) therapy for the treatment of metastatic castrate-resistant prostate cancer (MCRPC) – an advanced stage of prostate cancer.

The UFS and the Free State province are now joining other South African universities, such as the University of Pretoria, the University of the Witwatersrand, and other provinces in using this method to treat MCRPC patients. 

Dr Osayande Evbuomwan, a Senior Lecturer and medical specialist in the Department of Nuclear Medicine, Faculty of Health Sciences, says they have started treating their first MCRP patient (first cycle) with peptide receptor radionuclide therapy (PRRT) on 15 July. It is the first time that Lutetium 177 PSMA – a type of PRRT used for treating patients with MCRPC – has been used in the Free State. This method is used on MCRPC patients who are not eligible for chemotherapy or 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 registrar training in nuclear medicine. When he joined the UFS in 2019, he – with the always available help of the Head of Department, Dr Gerrit Engelbrecht – pushed for the therapy to be used in the department. 

“We in the Department of Nuclear Medicine are happy that expertise is now available and that some funds have been released for this treatment to commence. The index patient is very sick with MCRPC and was too sick to qualify for first-line chemotherapy. Each patient will need about four-six cycles for complete treatment. The patient is being treated in the Department of Nuclear Medicine at the Universitas Academic Hospital and Annex.” 

“We are hoping that he will be able to complete at least four cycles and respond well to the treatment. We believe that the ability to administer this treatment now is good news for the Free State, as the people of the Free State also deserve to be exposed to this level of treatment. We are hoping that the government will continue to provide more funds for more of these patients to be treated in our facility,” says Dr Evbuomwan.

It was budgeted to treat five patients (20 cycles), with each cycle (just the Lu-177 PSMA) costing more than R50 000. 

A googled image from the internet of a case before, during, and after completing the full course of therapy. The first image is before
treatment and the last image is after completing treatment, while the images in between are during treatment.
(Source: Google) 

Prostate cancer one of the leading causes of morbidity and mortality

Dr Evbuomwan says prostate cancer is one of the leading causes of morbidity and mortality in the world, including South Africa. When it progresses to the advanced stage of MCRPC, the prognosis becomes bad. 

Dr Evbuomwan explains that there are various conventional systemic therapies, including first- and second-line chemotherapy that could be used to treat patients at this bad stage. However, not all patients are fit for chemotherapy. The few who are fit, according to Dr Evbuomwan, usually end up failing the first-line chemotherapy, which has a lot of undesirable side effects and require long-stay hospital admissions. 

Only a few centres are able to offer second-line chemotherapy. So many of these patients end up suffering from prolonged bone pains before eventually dying from the disease.

PRRT is a targeted nuclear medicine therapy that offers the opportunity 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 providing lower doses of radiation and damage to normal organs and tissues, a characteristic that conventional therapies do not offer, explains Dr Evbuomwan.  

According to him, Lutetium 177 PSMA (Lu-177 PSMA) is a type of PRRT used for treating patients with MCRPC, who are not eligible for chemotherapy or have failed first-line chemotherapy. Numerous research studies around the world have proven that this treatment improves quality of life, slows down disease progression, and improves overall survival, with little or very tolerable side effects in most patients. 

The University of Pretoria is one of the pioneers of this treatment in the world, having done a lot of research with it since 2017. Other provinces such as the Western Cape and KwaZulu-Natal have also recently become involved with the therapy. This therapy is expensive and requires a lot of expertise. It also involves the input of a multidisciplinary team (MDT), which must at least include a nuclear medicine physician, a radiation oncologist, and a urologist. The Departments of Urology and Radiation Oncology at the UFS were also instrumental in the initiation of the therapy and form part of the MDT team at the UFS in the management of these patients.

Treatment puts department, university, and hospital on the map

Dr Evbuomwan says the ability to administer this treatment puts the department, the UFS, and the hospital on the map, alongside other top universities within and outside the country. “It also creates an avenue for us to gather data for research purposes and for publications. We are now able to offer a promising, safe, and highly efficacious therapy for patients with MCRPC in the Free State. Some of these patients no longer need to travel to other provinces to get the treatment.”

There are plans to expand the treatment to more patients – and hospital management, who were present at the first treatment, are excited and looking forward to the outcome of this current treatment.

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News Archive

UFS hones focus to nurture world-class research - Business Day
2006-02-10

 

Sue Blaine
THE University of the Free State plans to concentrate academic study in five areas to strengthen its status as a research institution, the university said yesterday.

The Bloemfontein-based university will focus on areas it classes as development (economics, health, literacy and other human activities) and social transformation — an analysis of how South African society is changing from a philosophical and political viewpoint.

The other three research areas are new technologies, water resources and security, and food production and security.

“It makes sense to concentrate the university’s human resources, infrastructure, financial resources and intellectual expertise,” said university rector and vice-chancellor Prof Frederick Fourie.

The move introduces a style of research that matches international trends.

Universities in Canada, Britain and Australia are setting up their research departments in this way.

In SA, the universities of Stellenbosch, the Witwatersrand, Cape Town and KwaZulu-Natal have embarked on similar strategies.

Fourie gave the example of his alma mater, the US’s Harvard University, whose Nanoscale Science and Engineering Centre is an example of “clustering” on a larger scale.

The centre is a collaboration with Harvard, the Massachusetts Institute of Technology, the University of California, Santa Barbara, the Museum of Science, Boston, and universities in the Netherlands, Switzerland and Japan.

Fourie said the modern research world was so diverse and complex that no university could cover all bases so it was better to establish areas of expertise that made it different from its peer institutions.

Having scientists and researchers work in teams meant certain issues could be researched and developed in a multidisciplinary manner. “I think it’s the only way in which any university can excel. This will help SA become world class in selected areas,” Fourie said.

It is in chemistry that the cluster model has already had its most visible results, with a slice of the university’s on-campus pharmacological testing company Farmovs, established in the 1980s, sold to the US’s Parexel International.

The company is one of the largest biopharmaceutical outsourcing organisations in the world, providing knowledge-based contract research, medical marketing and consulting services to the global pharmaceutical, biotechnology and medical device industries, according to Biospace, an internet-based company providing resources and information to the life science industry.

President Thabo Mbeki, in his state of the nation address last Friday, committed government to allocating more resources to research, development and innovation, and increasing the pool of young researchers in SA.

He said government would “continue to engage the leadership of our tertiary institutions focused on working with them to meet the nation’s expectations with regard to teaching and research”.

The university used to be home to several A-rated scientists, who are considered by a peer review, conducted by the National Research Foundation, to be world leaders in their fields, but had lost them to other institutions. Fourie hopes to lure them back, and with them postgraduate students and funding for their work.

“At universities where you get a star researcher they tend to attract people and funding; if they leave they take that with them,” he said.

Fourie said R50m would be spent on the project, with some already spent last year and the last disbursements to be made next year.

There is R10m in seed money to gather experts and improve equipment and infrastructure, and R17m has been invested in chemistry equipment and staff.

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