Dr Srinivas on the Role of Lutetium Lu 177 Vipivotide Tetraxetan in mCRPC

Sandy Srinivas, MD, medical oncologist, urologic specialist, genitourinary specialist, professor, Medicine (Oncology) and Urology, Stanford Medicine, discusses the role of the radiopharmaceutical lutetium Lu 177 vipivotide tetraxetan (Pluvicto) in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC).

On March 23, 2022, the FDA approved lutetium Lu 177 vipivotide tetraxetan for the treatment of adult patients with prostate-specific membrane antigen (PSMA)–positive mCRPC who have previously received other anticancer therapies, such as androgen receptor pathway inhibition and taxane-based chemotherapy. This approval has been an important advancement in the field of prostate cancer treatment, particularly for patients with mCRPC who have limited therapeutic options, Srinivas begins. The key benefit of lutetium Lu 177 vipivotide tetraxetan is its favorable tolerability profile compared with chemotherapy, she states. The agent also offers a more convenient treatment schedule, with 1 infusion administered every 6 weeks. Accordingly, lutetium Lu 177 vipivotide tetraxetan may be more manageable for older patients who may not tolerate more aggressive therapies, Srinivas notes.

Lutetium Lu 177 vipivotide tetraxetan is administered to patients who show PSMA positivity on diagnostic imaging, making the selection process relatively straightforward, Srinivas continues. With a favorable adverse effect (AE)profile, patients may experience mild fatigue, dry mouth, and some impact on bone marrow, but these AEs are generally less severe than those associated with chemotherapy, she details. This makes lutetium Lu 177 vipivotide tetraxetan a suitable option for patients who require a gentler treatment approach, Srinivas emphasizes.

The phase 3 VISION trial (NCT03511664), which supported the drug's approval, demonstrated that less than 15% of patients who undergo PSMA imaging fail the screening, Srinvas reports. She clarifies that this means the majority of patients tested are eligible for treatment. With ongoing evaluation, clinicians are becoming better at determining who benefits most from the full 6-cycle regimen and who should stop early if disease progression is identified, avoiding unnecessary treatment. Overall, lutetium Lu 177 vipivotide tetraxetan represents a significant addition to the therapeutic arsenal for managing mCRPC with minimal toxicity and substantial clinical benefit, Srinivas concludes.