Cohort study of survival outcomes with Lu-177 PSMA by treatment line and taxane sequencing in metastatic prostate cancer

Lutetium Lu 177 vipivotide tetraxetan (Lu-177) PSMA is a targeted radioligand therapy approved for patients with metastatic androgen pathway modulator-resistant (mAPMR) prostate cancer after progression on androgene receptor pathway inhibitors (ARPIs). Data to guide treatment sequencing are limited. A cohort study using a deidentified electronic health record research database evaluated survival outcomes in patients with mAPMR prostate cancer receiving Lu-177 PSMA by line of therapy and the timing of taxane exposure. In this cohort study of 850 patients, 466 (54.8%) received taxane before Lu-177 PSMA, 35 (4.1%) received taxane after Lu-177 PSMA, and 349 (41.1%) never received taxane. The figure shows time to next treatment (TTNT) and overall survival (OS) in the three groups. Median TTNT and OS with Lu-177 PSMA were 8.0 months (95% CI 7.4-9.0) and 12.0 months (11.0-13.0) in the group receiving taxane before Lu-177 PSMA, 10.0 months (9.2-11.0) and 14.0 months (13.0-17.0) in the group never receiving taxane, and 6.0 months (4.9-8.0) and 16.0 months (13.0-NR) in the group with taxane exposure after Lu-177 PSMA. The authors conclude thatin this cohort study, outcomes with Lu-177 PSMA were broadly consistent across treatment lines and taxane sequencing groups. These findings may help inform patient counseling, although prospective studies are needed to determine the optimal treatment sequencing strategy.