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Research ArticleContinuing Education

Prostate Cancer Treatment: 177Lu-PSMA-617 Considerations, Concepts, and Limitations

Oliver Sartor and Ken Herrmann
Journal of Nuclear Medicine June 2022, 63 (6) 823-829; DOI: https://doi.org/10.2967/jnumed.121.262413
Oliver Sartor
1Tulane University School of Medicine, Tulane Cancer Center, New Orleans, Louisiana; and
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Ken Herrmann
2University of Duisburg–Essen and German Cancer Consortium, University Hospital Essen, Essen, Germany
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    FIGURE 1.

    Schema of clinical disease state model of prostate cancer before VISION. (Adapted from (33).)

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    FIGURE 2.

    Protocol schema for VISION trial. ECOG = Eastern Cooperative Oncology Group; LDH = lactate dehydrogenase.

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    TABLE 1.

    Anticancer Therapeutic Radiopharmaceuticals Currently Approved by Regulators in United States

    AgentTrade nameYear of FDA approvalPrimary endpointIndication
    89Sr-chlorideMetastron (GE Healthcare)1993Pain/analgesicsPainful skeletal metastases
    153Sm-lexidronamQuadramet (Dow Chemical Co.)1997Pain/analgesicsPainful osteoblastic metastases
    90Y-ibritumomab tiuxetanZevalin (Acrotech Biopharma)2002Tumor response rateLow-grade or follicular lymphoma
    131I-tositumomabBexxar (GlaxoSmithKline)2003Tumor response rateLow-grade or follicular lymphoma
    223Ra-dichlorideXofigo (Bayer)2013OSmCRPC
    177Lu-DOTATATELutathera (Advanced Accelerator Applications)2018Progression-free survivalSelect neuroendocrine tumors
    131I-iobenguaneAzedra (Progenics Pharmaceuticals)2018Lower blood pressure and tumor response rateSelect pheochromocytoma or paraganglioma
    177Lu-PSMA-617Pluvictoa (Advanced Accelerator Applications)2022OS and rPFSPSMA PET-positive mCRPC after ARPI and taxane
    • PSMA = prostate-specific membrane antigen.

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    TABLE 2.

    Life-Prolonging Phase III Trials in mCRPC

    TrialFront-line mCRPC
    TAX 327Docetaxel/prednisone vs. mitoxantrone/prednisone (10)
    SWOG 9916Docetaxel plus estramustine vs. mitoxantrone/prednisone (11)
    IMPACTSipuleucel-T vs. nonactivated immune cell control (19)
    COU-AA-302Abiraterone/prednisone vs. placebo/prednisone (13)
    ALSYMPCASOC ± 223Ra (18)
    PREVAILEnzalutamide vs. placebo (15)
    After docetaxel
    TROPICCabazitaxel/prednisone vs. mitoxantrone/prednisone (16)
    COU-AA- 301Abiraterone/prednisone vs. placebo/prednisone (12)
    AFFIRMEnzalutamide vs. placebo (14)
    ALSYMPCASOC ± 223Ra (18)
    After ARPI or ARPI plus docetaxel in HRR mutated subset only
    PROfoundOlaparib vs. abiraterone or enzalutamide (20)
    After ARPI and DOCETAXEL)
    CARDCabazitaxel vs. abiraterone or enzalutamide (17)
    VISIONSOC ± PSMA-617 177Lu
    • HRR = homologous recombination repair.

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Journal of Nuclear Medicine: 63 (6)
Journal of Nuclear Medicine
Vol. 63, Issue 6
June 1, 2022
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Prostate Cancer Treatment: 177Lu-PSMA-617 Considerations, Concepts, and Limitations
Oliver Sartor, Ken Herrmann
Journal of Nuclear Medicine Jun 2022, 63 (6) 823-829; DOI: 10.2967/jnumed.121.262413

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Prostate Cancer Treatment: 177Lu-PSMA-617 Considerations, Concepts, and Limitations
Oliver Sartor, Ken Herrmann
Journal of Nuclear Medicine Jun 2022, 63 (6) 823-829; DOI: 10.2967/jnumed.121.262413
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  • Article
    • Abstract
    • THERANOSTICS
    • VISION STUDY DESIGN ENDPOINTS
    • VISION ELIGIBILITY CRITERIA
    • VISION STRATIFICATIONS, RANDOMIZATION, AND TREATMENTS
    • VISION STATISTICAL ANALYSIS PLAN
    • VISION PATIENT CHARACTERISTICS
    • VISION RESULTS
    • LIMITATIONS
    • FUTURE PHASE III TRIALS
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  • [177Lu]Lu-PSMA-617 Versus Docetaxel in Chemotherapy-Naive Metastatic Castration-Resistant Prostate Cancer: Final Survival Analysis of a Phase 2 Randomized, Controlled Trial
  • Clinical Trials of Prostate-Specific Membrane Antigen Radiopharmaceutical Therapy
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Keywords

  • prostate cancer
  • castration-resistant
  • PSMA
  • theranostics
  • clinical trials
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