Dr Shore on Ongoing Research With Radioligand Therapy in nmCSPC

Neal Shore, MD, FACS, United States chief medical officer, Surgery and Oncology, GenesisCare USA; medical director, Carolina Urologic Research Center, discusses current and ongoing research withradioligand therapy in patients with nonmetastatic castration-sensitive prostate cancer (nmCSPC), highlighting the current landscape of PARP inhibitors and radiopharmaceuticals in metastatic prostate cancer. 

In the realm of prostate cancer research, numerous advancements have taken place, Shore begins. Recently, oncologists reported on the phase 3 VISION trial (NCT03511664) involving lutetium Lu 177 vipivotide tetraxetan (Pluvicto; formerly 177Lu-PSMA-617) radioligand therapy plus standard of care in patients with castration-resistant disease who had not undergone chemotherapy and had progressed on an androgen receptor pathway inhibitor, he explains. This study successfully achieved its primary end point of radiographic progression-free survival (rPFS), with an HR of 0.40, Shore says, adding that oncologists are also monitoring these patients for potential overall survival (OS) benefits with the combination.

Previous research had demonstrated both OS and rPFS benefits with lutetium Lu 177 vipivotide tetraxetanin post-chemotherapy mCRPC, he expands. Typically, research focus has been on patients at the advanced end of the disease spectrum, according to Shore. However, there is a growing interest in examining treatment interventions earlier in the disease course, Shore elucidates. Research into other radiopharmaceuticals in this disease is ongoing, providing important treatment options for use by experts in urologic oncology and medical oncology, he reports.

Already, radium-223 dichloride (Xofigo) serves as a viable treatment option in mCRPC, he continues. Additionally, for patients with homologous recombination repair (HRR) mutations, particularly BRCAmutations, PARP inhibitors are available, Shore states. Phase 3 trials such as PROpel (NCT03732820), TALAPRO-2 (NCT03395197), and MAGNITUDE (NCT03748641) explored the potential of PARP inhibitor combinations in this patient population, he says. In the castration-sensitive arena, investigations are underway into both radiopharmaceuticals and HRR-targeted drugs for all-comer populations with metastatic disease. This area represents another exciting frontier in the field, Shore concludes.