EP. 6A: After VISION: Phenotypic Theranostics in the Future of Precision Medicine

EP: 1.EP. 1A: The Role of Imaging and Genomic Testing in Prostate Cancer Treatment

EP: 2.EP. 1B: The Role of Imaging and Genomic Testing in Prostate Cancer Therapy

EP: 3.EP. 2A: The Role of Nuclear Imaging (PET) and PSMA in Prostate Cancer Therapy

EP: 4.EP. 2B: New Horizons in Nuclear Medicine for Prostate Cancer

EP: 5.EP. 3A: Androgen Deprivation Therapy Failure and Second-Line Options in Advanced Prostate Cancer

EP: 6.EP. 3B: Expert Perspective on the Changing Treatment Spectrum for Advanced Prostate Cancer

EP: 7.EP. 4A: New Lutetium PSMA, Metastatic Castration-Resistant Prostate Cancer (mCRPC), and the VISION Trial

EP: 8.EP. 4B: How the VISION Trial May Change Prostate Cancer Therapy

EP: 9.EP. 5A: The VISION Trial Lutetium PSMA, and the Future of Theranostic Precision Medicine

EP: 10.EP. 5B: PSMA and the Future of Targeted Therapy

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EP: 11.EP. 6A: After VISION: Phenotypic Theranostics in the Future of Precision Medicine

EP: 12.EP. 6B: Phenotypic Theranostics in the Future of Precision Medicine

So the VISION trial was a very typical advanced, advanced patient with chemotherapy exposure. [W]e're hopeful that these earlier stage trials with PSMA-617 lutetium are going to result in more regulatory approvals for less heavily pretreated patients than were present in VISION.

PSMA lutetium-177 is being evaluated in combination with things like PSMA actinium-225. It's being looked at in combination with DNA repair inhibitors such as the PARP inhibitor olaparib. It's being looked at in combination with the PD-1 inhibitors like pembrolizumab. It’s being evaluated in combination with stereotactic body radiotherapy. So as we move forward, combination therapies are important.

Different ways to image PSMA may also be important. There [are] also image-based biomarkers related to the use of immunotherapy. And being able to image things like PD-L1 is also quite important, potentially. So as we go forward, I'm seeing a whole series of newer PET markers being evaluated and utility, perhaps growing out of even combinations.

I think the short-term horizon in prostate cancer is going to revolve about moving these novel radiopharmaceuticals closer to the front of therapy. In addition, we're going to see the rise of these combination therapies initially in phase 1, moving on to phase 2. And then I think we're going to evolve a whole series of novel biomarkers, and these are going to require additional testing, of course, but the field of biomarkers is alive and well and evolving so, so rapidly right now.

When we talk about precision medicine, I think most of what we've become accustomed to—but not all—is related to the genomic alterations that occur in the context of cancer. But phenotypic alterations such as PSMA expression—this is not going to be something you can detect with a gene rearrangement. It's really about protein expression. I think this area also has a bright future. I envision many, many more theranostics going forward.