Dr Antonarakis on Community Enrollment in the ECLIPSE Trial in Prostate Cancer

Emmanuel Antonarakis, MD, associate director, Translational Research, Masonic Cancer Center, University of Minnesota, Clark Endowed Professor of Medicine, University of Minnesota Medical School, provides insights into the phase 3 ECLIPSE trial (NCT05204927), detailing how collaboration with community oncologists spurred increased awareness and enrollment for eligible patients with prostate cancer.

The study evaluated 177Lu-PSMA-I&T vs standard-of-care hormone therapy (abiraterone acetate [Zytiga] or enzalutamide [Xtandi]) in patients with metastatic castration-resistant prostate cancer (mCRPC) who had progressive disease and received prior treatment with an androgen receptor (AR)–directed therapy. The trial enrolled 439 patients with mCRPC and documented positive prostate-specific membrane antigen PET imaging. The M Health Fairview Ridges Cancer Clinic in Burnsville, Minnesota, in partnership with the Masonic Cancer Center, University of Minnesota, was 1 of the study sites, and patients treated during this study were also enrolled from nearby community cancer centers.

Antonarakis says that the trial targeted patients who had progressed on at least 1 novel AR-targeted therapy but had not undergone chemotherapy. Since this subset of patients was chemotherapy naive, it presented an opportunity to explore the potential benefits of administering radioligand therapy earlier in the treatment continuum. Drawing parallels to the FDA-approved lutetium Lu 177 vipivotide tetraxetan (Pluvicto; formerly 177Lu-PSMA-617), which mandates prior failure of both novel hormone therapy and taxane-based chemotherapy for eligibility, Antonarakis highlights the ECLIPSE trial's objective of expanding treatment options to patients at an earlier stage to potentially enhance clinical outcomes.

The rationale behind the ECLIPSE trial lies in addressing these challenges by offering radioligand therapy to patients who have failed hormone therapy but have not yet undergone chemotherapy. Antonarakis highlights the significance of extending this treatment option to patients earlier in their disease course, particularly those who are fitter and prefer to avoid chemotherapy-related toxicities. Notably, ECLIPSE represents a pioneering effort in the region, marking the first instance where radioligand therapy is available to patients in Minnesota and nearby states without the prerequisite of prior chemotherapy.

Antonarakis underscores the importance of the study for exploring the feasibility and efficacy of administering radioligand therapy earlier in the treatment paradigm for patients with mCRPC with the ultimate goal of expanding access to this innovative treatment modality to a wider patient population.