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Louis Crain Garrot, MD, medical oncologist, Georgia Cancer Specialists, Northside Hospital Cancer Institute, discusses the role of lutetium Lu 177 vipivotide tetraxetan (Pluvicto) in the treatment paradigm for patients who are older or frail with metastatic castration-resistant prostate cancer (mCRPC).

George begins by stating that in his own clinical experience, lutetium Lu 177 vipivotide tetraxetan is increasingly used due to its favorable safety profile and efficacy among older or frail patients. This radioligand therapy is generally well-tolerated, with common adverse effects such as fatigue and xerostomia, that are manageable with hydration and supportive care, he explains.

The primary concern with lutetium Lu 177 vipivotide tetraxetan is bone marrow toxicity, Garrot notes. Hematologic monitoring is critical, as patients are at risk for anemia, thrombocytopenia, and leukopenia during treatment. To mitigate these risks, Garrot highlights the importance of conducting regular complete blood counts at consistent intervals—typically 2 weeks after each lutetium Lu 177 vipivotide tetraxetan dose and again 1 to 2 weeks before the subsequent dose.

This approach enables early detection of bone marrow suppression, allowing for timely interventions such as dose adjustments or delays, Garrot explains. Regular monitoring of hematologic parameters helps identify anemia, thrombocytopenia, or leukopenia early, ensuring prompt action to prevent severe complications, he reports. These measures help maintain the safety and effectiveness of lutetium Lu 177 vipivotide tetraxetan therapy while minimizing risks to the patient's health.

Garrot also notes that most institutional protocols can provide guidance for managing these adverse effects. Clinicians can also refer to the lutetium Lu 177 vipivotide tetraxetan treatment package insert and clinical trial data for structured approaches to dose adjustments, Garrot continues. These guidelines ensure that patients can safely continue therapy while minimizing hematologic complications.

Garrot projects that as ongoing research continues, findings will continue to refine the use of lutetium Lu 177 vipivotide tetraxetan and optimize outcomes for patients in this setting. This agent offers a valuable treatment option for patients with mCRPC, particularly those who are older or frail, he emphasizes With appropriate monitoring and dose management, Lu-177 provides an effective and tolerable therapeutic approach, expanding the arsenal of treatment options available for prostate cancer patients, Garrot concludes.

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Louis Crain Garrot, MD, discusses the role of lutetium Lu 177 in older patients with metastatic castration-resistant prostate cancer.

Louis Crain Garrot, MD

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Dr Garrot on Lutetium Lu 177 Vipivotide Tetraxetan in Older Patients with MCRPC