Dr George on Other Potential Roles for Radioligand Therapy in Prostate Cancer

Daniel J. George, MD, medical oncologist, Eleanor Easley Distinguished Professor of Medicine, Duke University School of Medicine, professor of medicine, professor of surgery, Duke Cancer Institute, discusses the emerging potential use of lutetium Lu 177 vipivotide tetraxetan (Pluvicto) and other radioligand therapies earlier in the treatment paradigm and in novel combinations for patients with prostate cancer.

In March 2022, the FDA approved lutetium Lu 177 vipivotide tetraxetan for the treatment of adult patients with prostate-specific membrane antigen (PSMA)–positive metastatic castration-resistant prostate cancer (mCRPC) who have previously received other anticancer therapies, such as androgen receptor pathway inhibitors (ARPIs) and taxane-based chemotherapy. The approval was based on findings from the phase 3 VISION trial (NCT03511664).

George explains that using radioligands such as lutetium Lu 177 vipivotide tetraxetan in earlier disease settings could help improve responses when patients have a lower tumor volume and provide an option for patients who may not be candidates for chemotherapy. Patients in earlier settings could also have less heterogeneous disease, George adds.

In terms of potential combination therapies, research is ongoing to evaluate the potential synergy of lutetium Lu 177 vipivotide tetraxetan with other standard agents, such as hormonal therapy, George continues. For example, the phase 3 PSMAddition trial (NCT04720157) is evaluating the radioligand therapy in combination with standard-of-care ARPIs plus androgen deprivation therapy for patients with metastatic hormone-sensitivie prostate cancer.

Previous trials, such as VISION and the phase 3 PSMAfore trial (NCT04689828), investigated lutetium Lu 177 vipivotide tetraxetan in patients with mCRPC, George notes.

Ongoing studies such as PSMAddition examining the earlier use of lutetium Lu 177 vipivotide tetraxetan, especially in chemotherapy-naive patients, may solidify its role as a key therapeutic option in the management of earlier stages of prostate cancer, George continues. Should this study demonstrate generate positive outcomes, it could support the rationale for using radioligands such as lutetium Lu 177 vipivotide tetraxetan in earlier lines of therapies as a part of different combinations, he concludes.