Lutetium-PSMA is used more and more frequently. Known as Pluvicto, It has demonstrated survival benefit for patients in later line therapy through the VISION study, as well as early line CRPC through PSMAfore. So it’s being used more and more in the clinic now. So for new drugs being developed that are being developed in the post-Pluvicto space, it’s important to understand what the comparator… how well they might do. So our real-world study interrogated the Flatiron database and we looked for patients who had been treated with Pluvicto and examined patients who had treatment following Pluvicto. What we found was the treatments ranged from cabazitaxel to combinations of taxanes and carboplatin and sometimes rechallenge with AR pathway inhibitors.
What we did find is that outcomes are poor in this patient population. Patients who develop disease progression after receiving Lutetium-PSMA do poorly, a median overall survival of only 8 months. Some patients receive Lutetium-PSMA prior to having had chemotherapy and those patients, as you’d expect, do do slightly better, a median overall survival around 12-14 months. Those who have had prior chemotherapy do more poorly, a median overall survival around 6 months.
So it’s important to understand this as we develop clinical trials to help these patients. Patients who have had Pluvicto, we now understand, do poorly and we need to find treatments that help them. By understanding how poorly they do do we can guide our clinical trials towards that.
Do findings suggest an optimal sequencing approach in metastatic castration-resistant prostate cancer?
Our real-world data study was unfortunately not designed to determine if patients should have chemotherapy before Pluvicto or Pluvicto before chemotherapy. We can’t really gain too much information from what we’ve conducted.
What is next for this study?
This is still a small set of patients and we hope to validate it in other real-world populations. I run an Australian registry for prostate cancer called ePAD and we’ll publish some data from ePAD which looks at the same question. The selection criteria for Pluvicto in Australia differs to that from the United States so we’d perform an FDG-PET along with a PSMA-PET, which means approximately 30% of patients are screened out, are deemed not likely to benefit from Lutetium-PSMA. So therefore, as you’d expect, the patients receiving Lutetium-PSMA are a better cohort and we would hopefully report that their outcomes following Lutetium-PSMA are also better than that of the US population.
