A Treatment Paradigm Shift: Targeted Radionuclide Therapies for Metastatic Castrate Resistant Prostate Cancer (2022, Review, preprint, Full Text)
(Authors are at the Mayo Clinic)

https://www.preprints.org/manuscript/202208.0071/v1
(url returns an error as a hyperlink--copy and paste it into your browser)

Abstract

The recent approval of 177Lu PSMA-617 (Pluvicto®) by the United States Food and Drug Administration (FDA) is the culmination of decades of work in advancing the field of targeted radionuclide therapy for metastatic prostate cancer. 177Lu PSMA-617, along with the bone specific radiotherapeutic agent, 223RaCl2, are now commonly used in routine clinical care as a tertiary line of therapy for men with metastatic castrate resistant prostate cancer and for osseus metastatic disease respectively. While these radiopharmaceuticals are changing how metastatic prostate cancer is classified and treated, there is relatively little guidance to the practitioner and patient as to how best utilize these therapies, especially in conjunction with other more well-established regimens including hormonal, immunologic, and chemotherapeutic agents. This review article will go into detail about the mechanism and effectiveness of these radiopharmaceuticals and less well known classes of targeted radionuclide radiopharmaceuticals including alpha emitting prostate specific membrane antigen (PSMA) -, gastrin-releasing peptide receptor (GRPR) -, and somatostatin targeted radionuclide therapeutics. Additionally, a thorough discussion of the clinical approach of these agents is included and required futures studies.

(Paste the url above into your browser and navigate to the paper. Then click on "Download PDF" to get the Full Text.)

IMO, review papers are one of the best ways to become informed/updated on a topic. The literature search has been done for you, the poorer papers weeded out, study/trial results are summarized, and there are often helpful guidelines, provisional as they may be.

Djin

Olmanhunk said...
I don’t see the download pdf tab??

After you navigate to the paper using the url, it's a dark-blue rectangle with the text "Download PDF," a bit under the Abstract, on the left.

Djin

Post Edited (DjinTonic) : 8/8/2022 10:56:52 AM (GMT-7)

Thanks so much for posting this article. I'm wondering what the "protocol path" will be for medicare and other insurers. Like, will you have to have had chemo? How much PSA increase would be needed while on the Lupron/Zytiga/xTandi/Nubeqa TXs to be defined MCRPC? And what if you have bone mets, and PSA has gone from say, 1 to 3 over the past year whil on these TXs? Does that qualify??

We should make sure we post any insurance info / experiences for Pluvicto so we can start to see what's going on in that world. Thanks again for the article!

I believe (!) that this therapy will only be covered in the USA if the patient is metastatic, has had chemo and is 'castrate resistant'. This relates to the patient population that was studied in the trial that was used to get FDA approval.

On March 23, 2022, the Food and Drug Administration approved Pluvicto (lutetium Lu 177 vipivotide tetraxetan, Advanced Accelerator Applications USA, Inc., a Novartis company) for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor (AR) pathway inhibition and taxane-based chemotherapy.

I concur that earlier use might be of great interest. I believe that there are many trials that are evaluating such possibilities.

More in general, a great deal of experience with these therapies has been obtained in Europe and elsewhere.