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Treatment for Advanced Prostate Cancer Available at Lehigh Valley Topper Cancer Institute

Pluvicto is the first radiopharmaceutical to target specific prostate cancer cells

Pluvicto can be used to target PSMA-positive cancer cells.

Pluvicto therapy is a novel treatment that offers fresh hope to certain individuals with advanced prostate cancer. After a much-anticipated launch last year, the manufacturer temporarily paused production. Now production has resumed, and the leading-edge treatment is once again offered at Lehigh Valley Topper Cancer Institute.

Candidates for Pluvicto have metastatic castrate-resistant prostate cancer (mCRPC) that is prostate-specific membrane antigen-positive (PSMA+). Their cancer is progressive even after prior treatment with other anti-cancer therapies, including an androgen-receptor pathway inhibitor and a taxane-based chemotherapy regimen.

“There is a significant unmet need for more treatment options in this group of patients,” says Paul Palyca, MD, a hematologist oncologist with the Cancer Institute. “About 10 to 20 percent of individuals with existing metastatic prostate cancer will reach the castrate-resistant state within three years, and this state remains lethal despite all the advancements we’ve made over the past decade.”

PSMA-targeted therapy

Pluvicto represents a step toward meeting that need through precision medicine. As the only FDA-approved radiopharmaceutical targeting PSMA+ cancer cells, it has two main components:

  • A cell-targeting ligand that binds with very high affinity to PSMAexpressing tumor cells
  • A therapeutic radioisotope that delivers radiation treatment directly to these cells

The treatment is given intravenously for up to six cycles spaced six weeks apart. “That has proved to be a convenient treatment schedule for most patients,” Dr. Palyca says.

At the Cancer Institute, medical oncologists identify individuals who may benefit from Pluvicto treatment with the aid of specialized PSMA PET scans. When Pluvicto treatment is indicated, it is administered by the nuclear medicine team.

Increasing survival time

In one large clinical trial, individuals with PSMA+ mCRPC who received Pluvicto plus best standard of care lived a median of four months longer than those who received best standard of care alone (15.3 months versus 11.3 months). In another large trial that compared Pluvicto to second-line chemotherapy, Pluvicto had a higher initial response rate and was better tolerated.

“In sum, these two major trials support the use of Pluvicto in patients with PSMA+ mCRPC after a single line of chemotherapy,” Dr. Palyca says.

Minimizing side effects

Interestingly, PSMA is also expressed in the salivary glands, so people undergoing Pluvicto treatment experience dry mouth. Other possible side effects include fatigue, nausea, decreased appetite, anemia and low platelets. There is also the potential for nephrotoxicity.

“Overall, however, Pluvicto therapy tends to be extremely well tolerated,” Dr. Palyca says. “Clinical trials are now investigating its use in combination with other effective therapies and also in the early stages of disease, which will significantly broaden the range of patients who may benefit from this novel therapeutic.”

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