Radioligand Therapy 177Lu-PSMA-617 in Patients With Progressive PSMA-positive mCRPC - Episode 3

Patient Response to LuPSMA Therapy in mCRPC

An expert in prostate cancer comments on patient response to 177Lu-PSMA-617 therapy, particularly for patients with mCRPC who have liver metastases.

Evan Y. Yu, MD: I think, when you look at the patient populations in the VISION trial, and you are looking at different baseline characteristics, people are always looking at specific things like the location of the disease. We know, from many other studies, that nodal disease only is generally a better prognostic patient population. Those with liver metastases are a worse population. I think a lot of attention has been given to patients who have liver metastases with prostate cancer because they generally tend to be prognostically worse. They generally tend to not respond as well to therapy. I think that is one interesting thing that we see in the VISION trial. If you look at the waterfall plots and the forest plots from the study, what you will see is that the patients who have liver metastases seem to do quite similarly as the other populations that have a better prognosis, especially for radiographic progression-free survival, which really points toward the fact that the agent lutetium-177 PSMA-617 is efficacious for those who have liver metastases.

When you look at the overall survival, not surprisingly, it looks a little bit worse than it is for those who do not have liver metastases, but that just shows how liver metastases are a prognostic measure. I do not think, however, that it is a predictive measure for a lack of response in this situation because they seem to do just as well in terms of progression-free survival. That is one thing that I teased out when I was looking at the data in regard to the locations of the metastases—picking out the worst prognostic situation, like liver metastases, and seeing that they seem to respond and have very similar radiographic progression-free survival to patients who do not harbor that poor prognostic situation.

This transcript has been edited for clarity.