Could Pluvicto Have a Role in Taxane-Naive mCRPC?: an Interview with Oliver Sartor, MD

The radiopharmaceutical agent (177Lu)Lu-PSMA-617 (Pluvicto, Novartis) may be a viable option in the treatment of patients with taxane-naïve metastatic castration-resistant prostate cancer (mCRPC), according to emerging research findings presented at the 2024 Society of Nuclear Medicine and Molecular Imaging (SNMMI) Annual Meeting.

In an interview at the SNMMI conference, Oliver Sartor, MD, said there are reimbursement challenges as well as mixed results with current androgen receptor pathway inhibitor (ARPI) treatment in this patient population.

“We know (ARPI therapy) is a viable alternative, but we also know these patients will progress and go on to need additional therapy,” noted Dr. Sartor, the director of radiopharmaceutical trials at the Mayo Clinic in Rochester, Minnesota.

In new research, which garnered Abstract of the Year honors at the SNMMI conference, researchers compared the use of Pluvicto versus a change in ARPI therapy (abiraterone or enzalutamide) in 468 taxane-naïve patients with mCRPC.

In the primary study analysis, the researchers found that patients in the Pluvicto group had a significantly higher median radiographic progression-free survival in comparison to those in the ARPI change group (9.3 months vs. 5.55 months). A second interim analysis revealed that patients in the Pluvicto group had over a 35 percent higher objective response rate (50.7 percent vs. 14.9 percent) and a significantly longer median time to PSA progression (10.55 months vs. 4.24 months) in contrast to patients in the ARPI change cohort.

Dr. Sartor, a co-author of the study, also noted that the second interim analysis showed a lower incidence of grade > 3 adverse events in patients receiving Pluvicto.

(Editor’s note: For related content, see “Emerging Perspectives on PSMA PET Radiotracers: An Interview with Kenneth J. Pienta, MD,” “SNMMI: PSMA-18F DCFPyL Changes Treatment for PCa Recurrence in Significant Number of Patients with Low PSAs” and “Study: PSMA PET/CT Agent May Rule Out csPCa in 93 Percent of PI-RADS 3 Lesions.”)

While Pluvicto was approved by the FDA for patients with PSMA-positive mRCPC who previously had ARPI therapy and taxane-based chemotherapy, Dr. Sartor suggested there is “reasonable hope” for an expanded indication for Pluvicto in the management of patients with taxane-naïve mRCPC.

“If the FDA does give an approval, it will truly be practice-changing, Insurances will cover it and patients can be treated,” added Dr. Sartor.

For more insights from Dr. Sartor, watch the video below.