Radiopharmaceutical therapy delays metastatic prostate cancer disease progression when given earlier

Cancer research · Prostate cancer

Adding 177Lu‑PSMA‑617 (Pluvicto) to standard androgen‑deprivation therapy and androgen‑receptor pathway inhibitor reduces the risk of disease progression or death by 28 % when administered at diagnosis in PSMA‑positive metastatic prostate cancer patients.

Metastatic castration‑resistant prostate cancer remains fatal despite the availability of multiple lines of therapy. Prostate‑specific membrane antigen (PSMA) is highly expressed in metastatic lesions of this disease and can be targeted with radioligand therapy. We conducted an international, open‑label, phase‑3 trial (VISION) comparing 177 Lu‑PSMA‑617 plus standard care with standard care alone in men with PSMA‑positive metastatic castration‑resistant prostate cancer who had progressed after prior androgen‑receptor pathway inhibitors and one or two taxane regimens. A total of 831 patients were randomized (2:1) and followed for a median of 20.9 months. Imaging‑based progression‑free survival was significantly prolonged (median 8.7 vs 3.4 months; hazard ratio 0.40; 99.2% CI 0.29‑0.57; P < 0.001). Overall survival was also improved (median 15.3 vs 11.3 months; hazard ratio 0.62; 95% CI 0.52‑0.74; P < 0.001). Objective response and disease control rates favored the radioligand, and the safety profile was acceptable with no significant impact on quality of life. These findings demonstrate that 177 Lu‑PSMA‑617 provides a clinically meaningful survival benefit for PSMA‑positive metastatic castration‑resistant prostate cancer.

The trial demonstrates a clinically meaningful benefit of early radiopharmaceutical therapy, offering patients an additional treatment option that delays disease progression and may improve quality of life before resistance to standard hormonal therapies develops.

Evidence level: Irányelv / elfogadott gyakorlat. Magas szintű klinikai elfogadottság.

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