Radiopharmaceutical therapy moving up to earlier disease stages
PSMAfore trial by Novartis (Phase III trial of 177Lu-PSMA-617 in taxane-naïve patients with mCRPC) has not only met its primary endpoint of radiographic progression-free survival (rPFS) but has shown amazing results with the potential to change the clinical practice, as presented at 2023 ESMO conference. Radioligand therapy (RLT) with 177Lu-PSMA-617 in pre-chemo patients brought about the median rPFS of 12 months compared to only 5,6 months in the control group under standard care. The radioligand treatment is also better tolerated with fewer grade 3 adverse effects. The results seem to demonstrate – the earlier in the course of the disease the RLT is applied, the more effective it is. Our own clinical practice certainly corroborates this in relevant cases.
The use of radioligand therapies in earlier lines of treatment is being presently explored across all fields where nuclear medicine has found its application. For example, Phase III NETTER-2 trial with 177Lu-DOTATATE (Lutathera®) in patients with Grade 2 and 3 advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has also met its primary endpoint of improvement in PFS.