Prostate Cancer Management in Focus: Dr. Karine Tawagi’s Thoughts on 177Lu-PSMA-617

In the fourth panel of the  Advancements in Oncology event, held on Saturday, June 1, The Oncology Brothers, Rahul Gosain, MD, MBA, and Rohit Gosain, MD, sat down with Karine Tawagi, MD, of the University of Illinois Chicago.

Despite the absence of groundbreaking developments at the 2024 American Society of Clinical Oncology Annual Meeting, the significance of prostate cancer management within community practices remained evident. A general focus of this part of the discussion was granted to ¹⁷⁷Lu-PSMA-617 and the PSMAfore trial updates.

¹⁷⁷Lu-PSMA-617 for Chemotherapy-Naïve mCRPC

“The approval of ¹⁷⁷Lu-PSMA-617as a second-line treatment for metastatic castration-resistant prostate cancer (mCRPC) marked a notable development,” according to Dr. Rohit Gosain. Ongoing discussions are centered on its potential as a first-line option, particularly in the context of enhancing quality of life (QOL) and addressing pain management, he added. But what about in scenarios where patients have exhausted abiraterone and enzalutamide treatments? What are the options for docetaxel-naïve patients?

Dr. Tawagi noted findings from an abstract on the PSMAfore trial QOL data, focusing on patients who had progressed on androgen deprivation therapy with an anti-androgen. The study randomized patients to receive either ¹⁷⁷Lu-PSMA-617 or an androgen receptor pathway inhibitor switch. While improvements in QOL metrics were noted in the former group, the issue of crossover to ¹⁷⁷Lu-PSMA-617 in the control arm complicated overall survival (OS) analysis. However, despite lacking a significant OS difference, therapy involving ¹⁷⁷Lu-PSMA-617 post-docetaxel showcased improvements in QOL and pain management.

When to Use ¹⁷⁷Lu-PSMA-617 in the Clinic

“The discussion highlighted the potential role of ¹⁷⁷Lu-PSMA-617  in the prechemotherapy space, particularly for elderly patients or those resistant to chemotherapy,” noted Dr. Tawagi. Insights from ongoing trials comparing ¹⁷⁷Lu-PSMA-617  with docetaxel are anticipated to provide further guidance on treatment sequencing. As for right now, she is using it post-docetaxel and before administering cabazitaxel.

Dr. Rohit Gosain recalled that “the shortage of ¹⁷⁷Lu-PSMA-617  following its approval posed significant challenges in clinical practice.” However, despite these hurdles, clinicians have begun integrating ¹⁷⁷Lu-PSMA-617 into post-docetaxel treatment regimens, considering patient preferences and treatment tolerability.

View the next segment of this session: Advancing RCC Treatment: Insights From Dr. Karine Tawagi.