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Last year, the FDA approved lutetium prostate-specific membrane antigen (PSMA), a promising new therapy for managing metastatic castrate-resistant prostate cancer.
“There are a couple of other different treatments [after frontline therapies], but once we get past one or two treatments, the options become more and more limited,” says Christopher Wee, MD, a physician in the Genitourinary Medical Oncology Program at Taussig Cancer Center. “Lutetium-PSMA offers an option and is currently FDA-approved for people who have prostate cancer that has had progression on antigen receptor or a novel hormonal agent, as well as a taxane-based chemotherapy.”
In a recent episode of Cleveland Clinic’s Cancer Advances podcast, Dr. Wee discusses standard of care for metastatic prostate cancer and the potential role of Lutetium-PSMA. He explores:
Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Cancer Advances episodes at clevelandclinic.org/podcasts/cancer-advances or wherever you get your podcasts.
Podcast host Dale Shepard, MD, PhD: Tell me about clinical trials that you are interested in with lutetium.
Dr. Wee: So, we know that this is a very effective and good option for men with castrate-resistant prostate cancer. Now we’re trying to start with the intensification in earlier line therapy – the idea that, you get your best shot at getting a meaningful response and prolonged response if you intensify therapy up front. You don’t want to save therapies for later lines because you don’t know what shape the patient will be in at that point.
We’ve seen this in a number of ways. One, we’ve seen the move from androgen deprivation alone to androgen deprivation therapy [ADT] plus one of these novel hormonal agents – apalutamide, abiraterone, enzalutamide. In the past year we’ve seen the argument some people have made for triplet therapy – both from PEACE-1 and ARASENS – demonstrating that ADT plus docetaxel, plus darolutamide in ARASENS was superior to ADT plus docetaxel.
So now currently, we’re testing in a clinical trial here at Cleveland Clinic for men that have newly diagnosed metastatic hormone sensitive prostate cancer that have PSMA avid disease on a PET scan. They can be randomized in a one-to-one fashion of standard of care. So, ADT plus abiraterone, enzalutamide or apalutamide, or standard of care plus lutetium.
This is very attractive because the control arm is standard of care. You’re getting what you would have been recommended anyway. And furthermore, if you’re randomized to the standard of care arm and you have progression of the disease, the protocol allows for crossover at that point to lutetium, which is currently not the option because a patient would have to have progression on chemotherapy as the label currently stands.