RESEARCH! (Azad et al., The Lancet Oncology, September 15,...

RESEARCH! (Azad et al., The Lancet Oncology, September 15, 2024)

Sequential [177Lu]Lu-PSMA-617 and docetaxel versus docetaxel in patients with metastatic hormone-sensitive prostate cancer (UpFrontPSMA): a multicentre, open-label, randomised, phase 2 study
[Simplified, this is Pluvicto plus Docetaxel (Chemotherapy) in metastatic PSMA positive prostate cancer.]

A brief extract is presented below this image.



A bit of detail (mostly directly lifted from the paper)

NOTE: I have replaced [177Lu]Lu-PSMA-617 with its trade name, Pluvicto.

Objective
To evaluate Pluvicto used before docetaxel treatment in patients with de-novo high-volume metastatic hormone-sensitive prostate cancer.

Methods (in brief)
Open label randomised trial.
Patients randomly assigned (1:1) to the experimental treatment (Pluvicto followed 6 weeks later by docetaxel) or standard-of-care treatment (docetaxel alone).
All patients received continuous androgen deprivation therapy (ADT) during the trial.

Results Interpretation
(Pluvicto) followed by docetaxel improved antitumour activity (in this group of patients) compared with docetaxel alone, without increased toxic effects. Our data potentially support a role for (Pluvicto) in metastatic hormone-sensitive prostate cancer.

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MY TAKEAWAYS:
a) Adding Pluvicto (a Beta emitter like 67Cu-SAR-bisPSMA ) to the Chemo + ADT treatment protocol for high volume PSMA positive prostate disease, improves patient outcomes without increasing toxic effects.
b) This trial defines the place for potentially inserting 67Cu-SAR-bisPSMA into a trial protocol. This could be in a head to head trial versus the Pluvicto protocol (assuming the current SOC will soon be deemed unethical), or a 3 way trial if the current SOC survives. Bring it on!
c) Let me finish off by saying that, for the DREAMERS that are as conflicted as I am: How I would love to see the winner being 67Cu-SAR-bisPSMA plus RC220 (the new Bisantrene), especially without ADT!

As they say: DYOR! I am conflicted.