New Precision Medicine Approaches in Advanced Prostate Cancer

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

In the fifth video of the series, Nicholas J. Vogelzang, MD, FASCO, FACP, of Comprehensive Cancer Centers considers implications of the VISION trial and reflects on the futures of lutetium PSMA and theranostic precision medicine more broadly.

The VISION trial was an exciting advance, but it also left us with a hard, cold reality[:]…these cancers are resistant to treatment as we expected.

[W]e were not considering lutetium-177 as a breakthrough drug for castrate-resistant prostate cancer…[I]t's a well-tolerated drug administered to patients, but it does not cure the patients. That being said, we're looking forward to using it, and it will be something that will again extend life for our patients.

It gets the cancer no matter where it is in the body, be it bone or lymph nodes. And it builds upon previous generations of radionucleotides such as radium-223, which, although very effective and life-extending, did not hit this off-tissue disease.

Some…patients are going to be PSMA-negative in certain metastatic sites, and that…heterogeneity is going to only be amplified as the tumor volume gets larger....[T]hat's going to negatively impact use of lutetium-177 and the other radioisotopes.

…I think Novartis is right to link their PSMA scanning and their PS[M]A therapy in a package. I'm very eager to look at POINT [Biopharma]. They [and Convergent Therapeutics] are going to move the lutetium earlier into the hormone-sensitive phase where there is probably going to be a little less tumor heterogeneity, and that hormone-sensitive phase should be able to show more effectiveness of lutetium in the hormone-sensitive phase….[W]e're looking forward to having that trial open here as well. So all in all, a very rich field and potentially one that will eliminate tumor cells earlier before they develop resistance to castration.

And linking…radioactive drugs to target cancer cells—not only in prostate cancer but other cancers—will be a wave of the future. And we already have many examples of that in leukemia, lymphoma, and now in bladder cancer, and lutetium will be a good example in prostate cancer.