Lutetium-177–PSMA-617 for Metastatic Castration-Resistant Prostate Cancer

Nomograms to predict outcomes after 177Lu-PSMA therapy in men with metastatic castration-resistant prostate cancer: an international, multicentre, retrospective study

“…30 This study has important clinical implications. Following the positive results of the phase 3 VISION trial, 4,31 approval of [¹⁷⁷Lu]Lu-PSMA-617 is imminent. There is currently little evidence on patient selection for ¹⁷⁷Lu-PSMA therapy and no standardised criteria have been developed to date.…”

“…1,2 The TheraP trial 3 showed superior prostate-specific antigen (PSA) responses and progression-free survival in patients who received [¹⁷⁷Lu]Lu-PSMA-617 compared with patients who received cabazitaxel. In the phase 3 VISION trial, 4 [¹⁷⁷Lu]Lu-PSMA-617 improved overall survival and imaging-based progression-free survival when added to standard of care in patients with mCRPC. Since the first prospective signals of its efficacy, 1 the number of clinical trials of ¹⁷⁷Lu-PSMA and compassionate use of the treatment are expanding rapidly.…”

Evolving Castration Resistance and Prostate Specific Membrane Antigen Expression: Implications for Patient Management

“…Currently, 177 Lu-PSMA-617-RLT finds application in patient treatment only after therapy failure and the lack of more treatment options until its approval. The first phase III VISION trial was accomplished, meeting both primary endpoints of overall survival and radiographic progression-free survival [20,114]. After approval, it is intended to make 177 Lu-PSMA-617-RLT an accessible targeted treatment for >80% of mCRPC patients [19].…”

“…Only a few cases displayed adverse events that required reduction, interruption, discontinuation or death related to the drug during the VISION trial. However, the therapy efficiency is described with up to 30% of all patients and a prolongation of overall survival of 15.3 vs. 11.3 months [20]. Although these numbers are robust and promising, it might be discussed whether PSMA-RLT efficiency is hampered by its current late application.…”

“…In the last few years, data on PSMA-RLT have increasingly been collected and the outcome supports its use [18]. After the phase III VISION trial, PSMA-RLT approval is impending and therefore it is time to discuss and evaluate its temporal application during treatment sequences in prostate cancer [19,20]. Patients worldwide might benefit from a PSMA-RLT that can be applied by physicians more flexibl and also at earlier stages, as well as in combination with other potent therapies.…”