Pluvicto

[NLondon43]

Hi, can anyone point me to an up to date, comprehensive paper/review on the efficacy of Pluvicto? We have reached the end of the treatment road and are having to consider using our savings to pay for the treatment. Thanks All

[Ian99]

Hi. I am not on this treatment yet but expect to do so further down the road if it’s suitable. The FDA approved PLUVICTO based on evidence from one clinical trial (NCT03511664) of 831 patients with PSMA-positive mCRPC. The safety population of this trial included 734 patients. The trial was conducted in Canada, Europe, and the United States.

Have a look. This may give you some insight while you await a more comprehensive reply. I would just add that UK is rather expensive if you’re going private (£20k a session from memory). You can find less expensive venues in Europe (Germany - Homburg near Saarbrücken- has been recommended), also India. Good luck.

[Skifanatic]

I found this study interesting…suggesting, if I read it correctly, that evidence of certain tumor/gene mutations might improve response to Pluvicto.

pubmed.ncbi.nlm.nih.gov/386...

[EdBar]

My MO, Dr. Sartor was one of the leading authors on the trial that got it approved by the FDA. As he explained to me, a third get a great response from it, a third get a bit of a response and a third get no response.

Ed.

[dhccpa in reply to EdBar]

One of the many "later" treatments that might work better if used sooner. Or in combo with other treatments.

[EdBar in reply to dhccpa]

Yes but not approved for earlier at least in the US

[dhccpa in reply to EdBar]

Understood. Maybe soon.

[spencoid2 in reply to dhccpa]

It was my thinking that it would have been great if Pluvicto was given right at diagnosis of high risk disease to get the little stray buggers floating around ready to become metastatic cancer. However it was explained to me that with the current methods, not enough isotope (attached to ligands)will coalesce to kill the cancer cells when attracted to too few cells. This sort of made sense to me but suggests that other nuclear medicine approaches being developed might be more suitable. There is experimentation with alpha emitters such as actinium 225 (not 227) which release higher energy but with shorter span. The idea is that this will kill only cells to which the ligand is attracted and that are close by. No need to stay away from family and friends during treatment and possibly less collateral damage as well as the ability to treat smaller targets.

[dhccpa in reply to spencoid2]

Hopefully the pipeline will get better and more efficient.

[louschu in reply to EdBar]

Dr Kwon at Mayo concurs. I had a great response

[Pwjpp55]

I had a fantastic response to Pluvicto and it kept the bastard in the box for a year! Unfortunately, however, it got out of the box and I started Neubeqa.

[j-o-h-n]

From Station A and Station i.

Pluvicto, also known as lutetium-177 vipivotide tetraxetan, is a radiopharmaceutical used in the treatment of prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC). Its efficacy has been evaluated in clinical trials, with promising results for patients who have limited treatment options. Here's an overview of the efficacy of Pluvicto based on available clinical data:

Clinical Trials and Efficacy

VISION Trial

The efficacy of Pluvicto was prominently evaluated in the VISION trial, a phase 3 clinical study that provided substantial evidence for its use in mCRPC. Key outcomes from the trial include:

Overall Survival (OS):

Patients treated with Pluvicto plus the best standard of care (SOC) showed a significant improvement in overall survival compared to those who received SOC alone.

The median overall survival was 15.3 months in the Pluvicto group versus 11.3 months in the control group, representing a 4-month improvement (Hazard Ratio [HR] = 0.62; 95% CI, 0.52-0.74; p < 0.001).

Progression-Free Survival (PFS):

Radiographic progression-free survival, which measures the time during and after treatment that a patient lives with the disease without it getting worse, also showed improvement.

The median PFS was 8.7 months for the Pluvicto group compared to 3.4 months for the control group (HR = 0.40; 99.2% CI, 0.29-0.57; p < 0.001).

Objective Response Rate (ORR):

The ORR, which is the proportion of patients with tumor size reduction of a predefined amount and for a minimum time period, was higher in the Pluvicto group.

ORR was 29.8% in the Pluvicto group versus 1.7% in the control group.

Other Benefits and Considerations

Quality of Life:

Patients receiving Pluvicto reported better quality of life outcomes, including improved pain control and delayed deterioration in health status.

Safety Profile:

Common side effects included fatigue, dry mouth, nausea, anemia, and thrombocytopenia. While some adverse effects were significant, they were generally manageable and did not outweigh the benefits for many patients.

Mechanism of Action

Pluvicto targets PSMA, a protein highly expressed on the surface of prostate cancer cells, delivering targeted radiation to destroy these cells while minimizing damage to surrounding healthy tissue. This targeted approach contributes to its efficacy in reducing tumor size and delaying disease progression.

Summary

Pluvicto has demonstrated significant efficacy in improving overall survival, progression-free survival, and response rates in patients with PSMA-positive mCRPC. The VISION trial results highlight its potential as a valuable treatment option for this patient population, especially those who have exhausted other treatment avenues. However, its use should be carefully considered in the context of its safety profile and in consultation with healthcare professionals specialized in oncology.

Good Luck, Good Health and Good Humor.

j-o-h-n

[chips1942]

Was the scan you had a PSMA pet/Ct? If so, You can expect only the PSMA avid spots to respond to the treatment. Lesions in the lung can be difficult to treat. I’ve had 7- cycles of Docetaxel with minimal response & have had 4- cycles of Pluvicto with only a partial response & only to lymph nodes & nodules that are positive for PSMA. Other areas in my lungs & mediastinum which show up on a FDG scan as cancerous have not been affected by Pluvicto.

[pe43]

I typed the question 'What is the efficacy of Pluvicto treatment for prostate cancer?' in the AI link perplexity.ai. You get a short answer to the question, 5 references for further information, and 5 suggested follow-up questions to submit.

[lgutman in reply to pe43]

I am on a paid version of perplexity using Claude 3.0 and I got a lot of details regarding Pluvicto in different age ranges, etc. I also uploaded all of my father's records to get more detailed information on his case. You want to make sure you are also searching on academic mode.

[pe43 in reply to lgutman]

Thanks for the suggestions! I'm using the free version of Perplexity but will check out the paid version.

[Seasid]

Pluvicto (lutetium Lu 177 vipivotide tetraxetan) is a radioligand therapy approved by the FDA for the treatment of metastatic castration-resistant prostate cancer (mCRPC). It is specifically designed for patients whose cancer has progressed despite androgen receptor pathway inhibition and other standard treatments.

### Efficacy of Pluvicto:

1. **VISION Trial Results**: The most pivotal data on Pluvicto comes from the VISION clinical trial, which led to its FDA approval.

- **Overall Survival (OS)**: Patients receiving Pluvicto had a median overall survival of approximately 15.3 months, compared to 11.3 months for those who received standard care alone.

- **Radiographic Progression-Free Survival (rPFS)**: The median rPFS was significantly longer at 8.7 months for Pluvicto compared to 3.4 months in the control group.

- **Response Rates**: The treatment led to significant reductions in PSA levels, tumor size, and the number of metastatic lesions. About 46% of patients had a greater than 50% reduction in PSA levels.

2. **Safety Profile**: Pluvicto is generally well-tolerated, but like all cancer treatments, it does have side effects. Common adverse effects include fatigue, dry mouth, nausea, and bone marrow suppression (which can lead to anemia, low platelet counts, and low white blood cell counts).

3. **Mechanism**: Pluvicto works by targeting prostate-specific membrane antigen (PSMA) on the surface of prostate cancer cells. It delivers a radioactive payload directly to these cells, minimizing damage to surrounding healthy tissue.

### Considerations:

- **Eligibility**: It is typically used in patients who have advanced prostate cancer that is PSMA-positive and has already been treated with androgen deprivation therapy (ADT) and chemotherapy.

- **Combination Therapy**: Research is ongoing to determine the effectiveness of Pluvicto when used in combination with other therapies, such as immunotherapy or additional androgen receptor pathway inhibitors.

Overall, Pluvicto represents a promising treatment option for patients with advanced prostate cancer, particularly those who have few other options available. The treatment's ability to improve survival and delay disease progression makes it a significant advance in the management of mCRPC.