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Update: New drug approved for metastatic prostate cancer

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Contents

At a glance Questions for your doctor
Study findings Clinical trials
Strengths and limitations Related resources
What does this mean for me?  
   


UPDATE AT A GLANCE

What is this update about?

This update is about approval of the drug Pluvicto for treating people with castration-resistant cancer (mCRPC). The also approved a drug called Locametz that can be used with imaging to identify patients who will likely benefit from treatment with Pluvicto.

 

Why is this update important?

castration-resistant cancer remains incurable, although many types of drugs delay progression and prolong life.

Pluvicto (177Lu-PSMA-617) is a drug that delivers radiation directly to tumor cells that express a protein known as PSMA. PSMA (also known as ) is found at low levels in normal cells but it is found at high levels in some cancer cells. Pluvicto works on tumor cells that have increased PSMA.

The also approved Locametz (Ga 68 PSMA-11) to detect PSMA levels in cancer cells that have spread throughout the body. For more information on the approval of this imaging drug, read our XRAY review here. Imaging with Locametz can determine if a person’s cancer is likely to respond to Pluvicto.

 

Study findings

The approval was based on the results of the VISION trial. VISION compared patients who were treated with Pluvicto and protocol-permitted standard care or protocol-permitted standard care alone. Standard-care therapy that was permitted included approved hormonal treatments (including abiraterone and enzalutamide), bisphosphonates, radiation therapy, denosumab, or glucocorticoid at any dose. Standard-care excluded chemotherapy, , radium-223 (223Ra), and investigational drugs. All the participants had prior treatment with an androgen receptor pathway inhibitor and chemotherapy and had tumors that expressed high levels of PSMA. High levels of PSMA were defined as at least one PSMA-positive lesion and no PSMA-negative lesions. PSMA-positive status was determined with the use of -68 (68Ga)–labeled PSMA-11 (68Ga-PSMA-11) PET–CT imaging.

Patients treated with Pluvicto had significantly improved overall and progression-free survival. Among patients treated with Pluvicto plus standard of care:

  • Overall survival was 15.3 months compared to 11.3 months for patients treated with standard of care alone.
  • Progression-free survival was 8.7 months compared to 3.4 months for patients treated with standard of care alone.

Almost 57 percent of participants who were treated with Pluvicto had an of grade 3 or higher compared to 38 percent of participants who were treated with standard of care alone. Garde 3 adverse events were defined as severe or medically significant but not immediately life-threatening. The most common adverse events were:

  • Fatigue
  • Dry mouth
  • Nausea
  • Anemia
  • Decreased appetite
  • Constipation

However, participants who were treated with Pluvicto did not report that their quality of life was adversely affected.

Strengths and limitations

Strengths

  • The VISION trial included almost 600 participants.
  • The imaging criteria that was used in this trial allowed patients with PSMA-positive castration-resistant cancer to receive life-extending therapy on the basis of only one plus conventional imaging.

Limitations

  • Adverse events were defined as occurring during the treatment period for up to 30 days after the last dose of Pluvicto or standard-of-care treatment. The 30-day post-dose period for such adverse events may have led to underestimating adverse events.
  • Most (87%) of enrolled patients were white.
  • The study was not blinded or controlled so many patients left the study if they didn’t get Pluvicto.
     

What does this mean for me?

In most patients with mCRPC, lesions are positive for PSMA. Treatments like Pluvicto are begin developed to target cancer cells while sparing healthy cells.

If you have been diagnosed with mCRPC and have previously been treated with and androgen receptoro pathway inhibitor and chemotherapy, then you may be eligible for additional imaging with Locametz to see if you would benefit from treatment with Pluvicto. 


References

approves Pluvicto for castration-resistant cancer. www.fda.gov, March 23, 2022.

Sartor O, de Bono J, Chi KN, Fizazi K, et al. Lutetium-177-PSMA-617 for Castration-Resistant Cancer. N Engl J Med. 2021 Sep 16;385(12):1091-1103. Epub 2021 Jun 23.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board before publication to assure scientific integrity.

 

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posted 5/10/22

This article is relevant for:

People who have been diagnosed with metastatic prostate cancer.

This article is also relevant for:

People with prostate cancer

People with metastatic or advanced cancer

Be part of XRAY:

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • Am I a candidate for PSMA imaging?
  • Am I a candidate for PSMA-targeted therapy?
  • Am I a candidate for other therapies for mCRPC, such as a ?
  • Should I have genetic testing?
  • Should I have tumor testing?

Open Clinical Trials
Open Clinical Trials

The following studies are looking at PARP inhibitors and similar agents for treating people with advanced  cancer.  

Other clinical trials for people with  cancer can be found here.

Updated: 08/06/2022

Open Clinical Trials
Open Clinical Trials

The following studies are looking at treatment for prostate cancer using PSMA-targeted therapies.  

Other clinical trials for people with  cancer can be found here.

Updated: 05/27/2022

Peer Support
Peer Support

The following organizations offer peer support services for people with, or at high risk for cancer:

Updated: 01/30/2022

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