Dr Oh on the Development of Targeted Therapies in Prostate Cancer

“Prostate cancer is very much in evolution. We have new PET imaging—PSMA PET—that’s completely transformed how I think of prostate cancer from early diagnosis all the way to advanced disease. Tied to that are new ways of developing therapy.”

William K. Oh, MD, director, Precision Medicine, Yale Cancer Center and Smilow Cancer Hospital; service line medical director, Smilow Cancer Hospital, Greenwich Hospital, highlights the evolution of the prostate cancer treatment paradigm regarding targeted therapies.

In recent years, the field of prostate cancer has significantly changed, particularly regarding imaging with the emergence of prostate-specific membrane antigen (PSMA) PET scans, Oh begins. The integration of this approach has improved prostate cancer treatment from early diagnosis to the management of advanced disease, he says. Along with this, he notes that there are also new ways to deliver therapy to patients with prostate cancer, such as with the PSMA targeted therapy, lutetium Lu 177 vipovotide tetraxetan (Pluvicto). Previously, prostate cancer treatments included androgen-targeted therapies and chemotherapies, but treatment with lutetium Lu 177 vipovotide tetraxetan offers a new approach, Oh shares.

In 2022, the FDA approved lutetium Lu 177 vipovotide tetraxetan for the treatment of patients with PSMA–positive metastatic castration-resistant prostate cancer who received prior anticancer therapies, including androgen receptor pathway inhibition and taxane-based chemotherapy. Simultaneously, the FDA approved gallium Ga 68 gozetotide (Locametz), a radioactive diagnostic agent for PET of PSMA–positive lesions, which included for the population of patients in which the therapy was indicated.

Lutetium Lu 177 vipovotide tetraxetan delivers the radioactive payload, Lu 177, to PSMA–carrying targets, primarily in prostate cancer cells, Oh explains. Following the approval of this agent, he emphasizes that the field is continuing to grow as more targeted treatments become available. Notably, he adds that these targeted agents will help deliver treatment beyond radiopharmaceuticals; chemotherapy payloads could be administered via antibody-drug conjugates, or an immunotherapy method could be used with bispecific antibodies. These new treatment strategies could help deliver prostate cancer treatments more precisely to the tumor cells, Oh concludes.