Establishing Lutetium-177 PSMA (Pluvicto) Programs throughout the United States: Initial Experience in the VA Healthcare System

Introduction: Lu-177 PSMA (Pluvicto) radioligand therapy received FDA approval on March 23, 2022, for the treatment of patients with PSMA-positive metastatic castrate resistant prostate cancer previously treated with anti-androgen therapy and taxane-based chemotherapy. Since FDA approval, there has been a sharp rise in interest in developing theranostic clinics to facilitate access to radionuclide therapies across the country and throughout the world. Academic and private hospitals utilized their experiences with Lu-177 Dotatatate (Lutathera) treatment as a framework for establishing Pluvicto administration protocols. Multiple VA medical centers have established Pluvicto therapy programs. Several more VA hospitals throughout the US are interested in pursuing development of their own, while others are in process of establishing their own Pluvicto therapy programs. Established VA sites can provide guidance, helping other sites become ready in a more timely and safe manner. With the aim of facilitating the process of deploying Pluvicto programs at other institutions, we outline the challenges faced at multiple sites and the resources created to aid in the safe deployment of Pluvicto therapy programs.

Methods: The experiences of establishing Pluvicto therapy sites within the VA system can serve as a guide for other VA hospitals, academic and private hospital systems, and other nationwide healthcare networks. Our initial focus on the West Los Angeles VA widened over this past year as we worked with other VA medical centers. These interactions are organized in a manner that provides a useful framework for patient care discussion and allows for development of consensus on best practices. At the VA, our process includes monthly national VA tumor boards and a separate monthly theranostic workgroup committee meeting with a focus on guidance and sharing of experiences between separate VA medical centers located around the country. A white paper was developed by Dr. Farukhi et al, and a recorded presentation with multiple speakers expounding on the key points of this article are a shared resource amongst all VA sites. A variety of topics including training of Nuclear Medicine staff, protocols, scheduling, clinical workflow from monitoring laboratory studies, imaging before and during the course of treatment, and follow-up treatment plans will be explored. Similarities and differences between different VA medical center theranostic program sites will also be reviewed.

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Conclusions: In order to establish successful Pluvicto treatment programs throughout the US in the VA system, we have found that communication between established and developing sites is essential to ensure the safe and successful deployment of Pluvicto treatment programs.