Dr Garje on the Utility of Lu 177 Vipivotide Tetraxetan in mCRPC

Rohan Garje, MD, chief, Genitourinary Medical Oncology, Baptist Health Miami Cancer Institute, discusses the utility of lutetium Lu 177 vipivotide tetraxetan (formerly known as 177Lu-PSMA-617) in patients with metastatic castration-resistant prostate cancer (mCRPC).

Lutetium Lu 177 vipivotide tetraxetan has established itself as a standard of care (SOC) in the treatment of patients with mCRPC, particularly in later lines of therapy following androgen receptor pathway inhibitors (ARPIs) and chemotherapy, Garje begins. However, ongoing research is exploring avenues to expand its use and optimize treatment outcomes. One direction of investigation involves moving this agent into earlier lines of therapy, prior to the initiation of chemotherapy, she explains. The phase 3 PSMAfore trial (NCT04689828) investigated this approach and demonstrated a significant progression-free survival (PFS) benefit with lutetium Lu 177 vipivotide tetraxetan compared with switching to another ARPI, Garje reports, saying that this shift toward earlier use of the radioligand reflects efforts to enhance treatment efficacy.

Additionally, there is growing interest in evaluating lutetium Lu 177 vipivotide tetraxetan in the first-line setting of mCSPC, she expands. The ongoing PSMAddition trial (NCT04720157) has recently completed enrollment, and the results of this study will provide valuable insights into the efficacy and safety of this radioligand in earlier stages of prostate cancer treatment, he elucidates. The movement of radioligands into earlier lines of therapy underscores the evolution of prostate cancer management and the quest for more effective treatment options across different disease stages, Garje explains.

In parallel, researchers are exploring combination strategies to maximize the therapeutic potential of lutetium Lu 177 vipivotide tetraxetan, he continues. Studies are investigating its use in combination with immunotherapy agents, PARP inhibitors, chemotherapy, and radiation therapy with the goal of enhancing treatment responses and durability. Despite the benefits with this radioligand observed in studies such as the phase 3 VISION trial (NCT03511664), there remains a need to address the issue of response durability, Garje notes. Identifying predictive biomarkers to select patients who will benefit most from this therapy and exploring novel combination approaches are critical steps toward achieving more durable and impactful treatment outcomes for patients with metastatic prostate cancer, he concludes.