Dose-intense 177Lu-PSMA-617 regimen for mCRPC: promising efficacy and manageable toxicity

Scott Tagawa, MD, MS, FACP, Weill Cornell Medical Center, New York, NY, discusses the development and results of a dose-intense regimen using 177Lu-PSMA-617 for progressive metastatic castration-resistant prostate cancer (mCRPC) in the Phase I/II study (NCT03042468). This fractionated dose strategy aims to maintain high levels of radiation in tumors over an extended period to potentially overcome resistance and improve outcomes. In this first dose-escalation study, efficacy results were promising, with an 8.3-month radiographic progression-free survival (rPFS), 17.5-month overall survival (OS), and a 54% PSA response rate without pre-selection for PSMA expression. The regimen showed manageable toxicity, primarily dry mouth, fatigue, and nausea, with few grade 3 or 4 adverse events, suggesting a favorable efficacy-toxicity ratio compared to traditional multi-cycle approaches. This interview took place during the 2024 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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