Phillip H. Kuo, MD, PhD, Evaluates Future Research Surrounding PSMA-PET Parameters and Response to 177Lu-PSMA-617 in mCRPC

Phillip H. Kuo, MD, PhD, professor of medical imaging, biomedical engineering, and medicine as well as member of the Graduate Faculty at The University of Arizona College of Medicine in Tucson, spoke with CancerNetwork^® at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting. He discussed his presentation of a substudy that correlated parameters of PSMA (prostate specific membrane antigen)–PET imaging to quantitative treatment outcomes with 177Lu-PSMA-617 (Pluctivo) in patients with previously treated metastatic castration-resistant prostate cancer in the phase 3 VISION trial (NCT03511664).¹ Imaging was performed using 68Ga-PSMA-11 PET/CT imaging and quantified by standardized uptake value mean. Results showed that regardless of baseline imaging parameters, overall survival was superior with 177Lu-PSMA-617 vs standard of care treatment alone. During the interview, Kuo reviews what is necessary for future research in this area, and what he hopes his colleagues can take away from the study.

Transcript:

There were many parameters that were evaluated. We need to dig further into these various parameters. As you can imagine, these are all retrospective analyses. The original VISION trial wasn’t designed to test these, so this gives us an opportunity to drive further hypothesis-driven clinical trials. One of the things that’s in progress right now is the only set of PET scans that we present in this substudy were the ones that were [from patients who were] randomized to the treatment arm. Now we are in the process of analyzing the scans that were from standard of care alone arm so that we can do a direct comparison between patients with similar PSMA-PET characteristics in the 177Lu-PSMA-617 arm. That will provide some interesting results too.

This is just the beginning of this PSMA theragnostic approach. We’ve seen the promise of it for so long and finally have the FDA approval of this theragnostic combination.² Now, is the next step to further refine this and make it even more personalized. There’s a lot of talk about doing additional scans and whether we can personalize and detect who’s going to respond earlier on. The most efficient and most powerful indicator is from the baseline scan before they even get the first therapy. If we can extract as much information out of that as possible, we can see how well the patient’s going to do with that prognostic information. Hopefully, we will get even more analysis and good information out of these baseline scans so we can provide that prognostic information for everyone in the whole care team to know what is going to be the best therapy for this patient, particularly when we hope that even more and more therapeutic options will be coming out for patients in the future so we know where this slots in best for each individual patient

References

1. Kuo P, Hesterman J, Rahbar K, et al. [68Ga]Ga-PSMA-11 PET baseline imaging as a prognostic tool for clinical outcomes to [177Lu]Lu-PSMA-617 in patients with mCRPC: A VISION substudy. J Clin Oncol. 2022;40(suppl 16):5002. doi:10.1200/JCO.2022.40.16_suppl.5002
2. Novartis Pluvicto approved by FDA as first targeted radioligand therapy for treatment of progressive, PSMA positive metastatic castration-resistant prostate cancer. News release. Novartis. March 23, 2022. Accessed July 22, 2022. https://bit.ly/36lu4Ct