177Lu-PSMA-617: Trial shows it's more effective than changing ARPIs

[Maxone73]

"Patients who enrolled in the trial were assigned to either a change in ARPI, for example from abiraterone to enzalutamide or vice versa, or 177Lu-PSMA-617, a prostate-specific antigen (PSMA)-targeted radioligand therapy. This analysis found that treatment with 177Lu-PSMA-617 prolonged radiographic progression-free survival, improved PSA response rate, and increased objective response rate compared to a change in ARPI, regardless of whether patients had received prior abiraterone or enzalutamide."

eurekalert.org/news-release...

[DrawingSnowmen]

Here's an interesting tidbit:

>Those treated with 177Lu-PSMA-617 after abiraterone fared better than those previously treated with enzalutamide, though all results consistently favored 177Lu-PSMA-617 over a change to a different ARPI.

[Shams_Vjean]

Noting this was a taxane naive population. Wondering if there’s a comparable study for a post-taxane treated group?

[mrssnappy in reply to Shams_Vjean]

Significance: The approval of 177Lu-PSMA-617 for patients with mCRPC post-ARPI and post-taxane chemotherapy in March of 2022 based on the VISION clinical trial was a paradigm shift for the management of advanced prostate cancer. The PSMAfore clinical trial was designed to determine if 177Lu-PSMA-617 could also benefit a broader group of patients with mCRPC who have progressed on ARPI but have not received taxane chemotherapy. Check out the VISION trial - ncbi.nlm.nih.gov/pmc/articl...

[Shams_Vjean in reply to mrssnappy]

“The lack of standardization of the standard treatment regimens in both the arms and the heterogeneous patient treatment profiles can be considered additional limitations”

PSMAfore addressed some of the above noted limitations, but only in the taxane naive population. Vision didn’t use any ARSI control arms; and, sans other studies using that criteria with a taxane treated population, we can only speculate as to whether the PMSAfore results are transferable to taxane treated patients.

The yet wide variability in treatment responses for the entire population of patients treated with Pluvicto begs for a far better understanding the nuances related to the various subsets of patients who ‘qualify’ for the therapy. A better understanding, particularly when taxane treatment is a prerequisite for qualifying, could be helpful for better predicting response to the therapy in certain subsets of the overall patient population.

[Shorehousejam]

please, they should separate men with mutations and no mutations to really see any real world results…

[Shams_Vjean in reply to Shorehousejam]

That would certainly appear to be a very good place to begin narrowing down the populations more likely to see better results from the therapy. Hope there’s data in that regard already available for sorting and sifting out an observational conclusion.

[Maxone73 in reply to Shorehousejam]

Yes, they tend to do it in secondary analysis. I hate to wait! 😜