177Lu-PSMA-617 is a valid treatment option for PSMA-positive mCRPC

¹⁷⁷Lu-PSMA-617 (LuPSMA) displayed a higher prostate-specific antigen response, a larger progression-free survival (PFS) benefit, more quality-of-life improvements, a favourable safety profile, and similar survival outcomes compared with cabazitaxel in patients with PSMA-positive, progressive metastatic castration-resistant prostate cancer (mCRPC) who progressed on docetaxel and androgen-receptor pathway inhibitors, supporting the choice for LuPSMA in these patients.

LuPSMA is a radioligand therapy that has demonstrated to deliver greater prostate-specific antigen reductions (66% vs 37%), improved 12-month PFS rates (19% vs 3%), and fewer grade 3–4 adverse events (33% vs 53%) compared with cabazitaxel in the randomised, phase 2 TheraP trial (NCT03392428), including 200 patients with PSMA-positive, progressive mCRPC [1]. Here, Prof. Michael Hofman (Peter McCallum Cancer Centre, Australia) presented the 3-year overall survival (OS) results [2].

The updated PFS results confirmed the superiority of LuPSMA over cabazitaxel (restricted mean survival time 7.1 vs 5.0 months; HR 0.62; P=0.0028). In contrast, the OS data did not demonstrate a difference between the 2 treatment regimens (19.1 vs 18.6 months; HR 0.97; P=0.99). According to Prof. Hofman, withdrawals from the cabazitaxel arm after randomisation and post-protocol cross-over confounded the OS results. Furthermore, no new safety issues emerged in this updated analysis.

“With greater activity, fewer adverse events, similar OS results as cabazitaxel, and a life prolonging treatment by itself, LuPSMA appears to be the preferred choice in patients with PSMA-positive mCRPC who progressed on docetaxel,” stated Prof. Hofman.

1. Hofman MS, et al. Lancet. 2021;397(10276):797–804.
2. Hofman M, et al. TheraP: ¹⁷⁷Lu-PSMA-617 (LuPSMA) versus cabazitaxel in metastatic castration-resistant prostate cancer (mCRPC) progressing after docetaxel—Overall survival after median follow-up of 3 years (ANZUP 1603). Abstract 5000, ASCO 2022 Annual Meeting, 3–7 June, Chicago, IL, USA.

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Posted on 5 August 202217 May 2024