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Pluvicto without ADT for Castrate sensitive patients
Castrate sensitive patients treated with Pluvicto could delay the need for hormone therapy after BCR following radiation or a prostatectomy where new metastasis appeared.
In the BULLSEYE phase 2 trial, Dutch researchers in Lancet Oncology looked at whether lutetium-177 PSMA-617, a targeted radioactive treatment, could do exactly that in men with oligometastatic hormone-sensitive prostate cancer.
Lead author Bastiaan Privé, MD, PhD, of the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands, said, PSMA therapy may play a significant role in treating limited metastatic prostate cancer.
“We see that we can postpone more burdensome hormone therapy. In addition, PSMA therapy sometimes reduces the cancer enough for men to become once again eligible for targeted radiation. This may further contribute to delaying hormone treatment in the future,” he added.
The study enrolled men whose cancer had returned after surgery or radiation, whose PSA was rising quickly, and whose scans showed PSMA-positive metastatic spots, then randomly assigned them either to receive lutetium-177 PSMA-617 or to standard care with active monitoring and delayed androgen deprivation therapy (ADT).
Lutetium-177 PSMA-617 is a radioligand therapy, which means it is designed to seek out prostate cancer cells that carry PSMA and deliver radiation directly to them, rather than treating the whole body in the same way standard hormone therapy does.
The results were striking.
During the first 30 weeks of the study, disease progression was seen in only 2 of 29 men in the treatment group, compared with 27 of 29 men in the control group, and the median progression-free survival was 25 months with treatment versus 5 months with monitoring alone.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00762-4/abstract
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While this study discusses using Pluvicto there is something people should be aware of.
It works really well for 33% of people OK for 33% of people and not at all for 33% of people.
If you have certain genetic issues, either hereditary or somatic, it can affect how well Pluvicto Works. You can ask for a somatic test before doing Pluvicto To find out if you’ve got Genetic changes due to the cancer.
If you have BRCA2 or ATM It seems to work better. If you have RB1, PTEN or TP53 They are Pluvicto resistant.
Sounds very similar to a clinical trial (NCT05939414) going on at multiple locations (including the cancer center where I’m being monitored) evaluating the efficacy and safety of lutetium (177Lu) vipivotide tetraxetan (AAA617) in patients with oligometastatic prostate cancer progressing after definitive therapy to their primary tumor. The data generated from this study will provide evidence for the treatment of AAA617 in early-stage prostate cancer patients to control recurrent tumor from progressing to metastatic disease while preserving quality of life by delaying treatment with ADT.
This study started in 2024; estimated completion is 2031. It’s in Phase 3.
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Hug
2 ReactionsI often need a dumbed down version of things. This is indeed a remarkable finding!
The BULLSEYE trial found a massive, statistically significant improvement in progression-free survival (PFS) for patients treated with Pluvicto compared to those on active monitoring (deferred hormone therapy).
At a median follow-up of 27 months, the key findings for PFS were:
* Median Progression-Free Survival: Pluvicto Group: 25 months (more than 2 years of disease control).
* Control Group (Deferred ADT): 5 months.
Risk Reduction: This means the radioligand therapy reduced the risk of disease progression by a staggering 93% compared to the surveillance group. Early Progression (First 30 Weeks): During the first 30 weeks of the trial, only 7% (2 out of 29) of the patients in the treatment group experienced disease progression, compared to 93% (27 out of 29) in the control group.
It's the word "survival" that can be confusing. No one is talking about dying (that's Overall Survival). This is talking about the amount of time before you need ADT.
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Hug
3 Reactions@smoore4 Can Pluvicto be used more than once or is there also a lifetime dose for radioligands?
I would think that it could be used as long as the areas in question were different from the first round of treatment.
Phil
@heavyphil
I already mentioned this, but you may have missed it.
I know more than one person that’s had it done twice in the United States. The first time it was done in a clinical trial the second time it was done with insurance paying for it. Insurance in this country won’t pay for it twice.
In Australia, it’s pretty standard for people to be able to do it more than once.
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