Phillip H. Kuo, MD, PhD, assesses future research on PSMA-PET parameters and 177Lu-PSMA-617 response in mCRPC

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Phillip H. Kuo, MD, PhD, spoke about the future of therapeutic imaging in patients with metastatic castration-resistant prostate cancer.

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

Transcription:

Many parameters were evaluated. These different parameters need to be explored further. As you can imagine, these are all retrospective analyses. The original VISION trial was not designed to test these, so this gives us the opportunity to conduct further hypothesis-driven clinical trials. One of the things going on right now is that the only set of PET scans that we present in this substudy was the one that was [from patients who were] randomized to the treatment arm. We are now in the process of analyzing the scans that came from the standard care alone arm so that we can make a direct comparison between patients with similar PSMA-PET characteristics in the 177Lu-PSMA-617 arm. This will also provide interesting results.

This is just the beginning of this PSMA theragnostic approach. We’ve seen the promise of it for so long and we finally have the FDA approval of this theragnostic combination.2 Now is the next step to refine this and make it even more personalized. There is a lot of talk about doing additional analysis and whether we can personalize and detect who is going to respond earlier. The most effective and powerful indicator comes from the basic analysis even before they receive the first treatment. If we can extract as much information from it as possible, we can see how well the patient will do with that prognostic information. Hopefully we will get even more analyzes and good information from these basic analyzes so that we can provide this prognostic information to all members of the care team to know what will be the best therapy for this patient, in especially when we hope that even more and more treatment options will be offered to patients in the future, so we know where it is best suited for each individual patient

References

  1. Kuo P, Hesterman J, Rahbar K, et al. [68Ga]Reference Ga-PSMA-11 PET Imaging as a Prognostic Tool for Clinical Outcomes at [177Lu]Lu-PSMA-617 in patients with mCRPC: a VISION sub-study. J Clin Oncol. 2022;40(supplement 16):5002. doi:10.1200/JCO.2022.40.16_suppl.5002
  2. Novartis Pluvicto approved by the FDA as the first targeted radioligand therapy for the treatment of metastatic PSMA-positive progressive and castration-resistant prostate cancer. Press release. Novartis. March 23, 2022. Accessed July 22, 2022. https://bit.ly/36lu4Ct

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