March 28, 2025 — Novartis has announced that the US Food and Drug Administration (FDA) approved Pluvicto (lutetium Lu 177 vipivotide tetraxetan) for patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who have been treated with an androgen receptor pathway inhibitor (ARPI) therapy and are considered appropriate to delay chemotherapy.
The expanded indication, which approximately triples the number of patients eligible to receive Pluvicto, is based on results of the Phase III PSMAfore trial. In the study, Pluvicto reduced the risk of radiographic progression or death by 59% (HR=0.41; 95% CI: 0.29, 0.56; p<0.0001) compared to a change in ARPI in patients with PSMA-positive mCRPC after treatment with ARPI therapy. At an updated exploratory analysis, Pluvicto more than doubled median radiographic progression-free survival (11.6 months vs. 5.6 months)*.
"The earlier indication for Pluvicto could really change our treatment paradigms for patients with mCRPC. It offers a targeted therapy that better delays disease progression compared to a second ARPI," said Michael Morris, MD, Prostate Cancer Section Head, GU Oncology, Memorial Sloan Kettering Cancer Center, and the Principal Investigator of the study in the US. "This approval is a significant step forward and should open the doorway to a therapy that has clear clinical advantages for the patient with mCRPC who has progressed on one ARPI and has not received chemotherapy."
In PSMAfore, the final overall survival (OS) analysis numerically favored Pluvicto, with a hazard ratio of 0.91 (95% CI: 0.72, 1.14), but was not statistically significant. The OS analysis was confounded by the high rate of patients who crossed over from the control arm to Pluvicto (60.3%). When adjusted for crossover, the OS hazard ratio was 0.59 (95% CI: 0.38, 0.91) with the inverse probability of censoring weighting (IPCW) method**.
Additional findings from the PSMAfore study showed Pluvicto demonstrated a consistent and favorable safety profile. The most frequently reported all-grade adverse events for Pluvicto were primarily Grade 1-2 and included dry mouth (61%), fatigue (53%), nausea (32%), and constipation (22%). Pluvicto did not impair the ability of patients to be treated with subsequent chemotherapy.
"The clinical development of PSMA-targeting radioligand therapy has provided important insights into the treatment of metastatic castration-resistant prostate cancer," said Oliver Sartor, MD, Chair of Genitourinary Cancer Disease Group and Director of Radiopharmaceutical Clinical Trials, Mayo Clinic. "The trial data demonstrated a clear clinical benefit in delaying disease progression in eligible patients, offering an additional therapeutic approach in this setting."
More than 35,000 men die from prostate cancer each year, and the incidence of the disease is rising.2 Half of patients with mCRPC will not live long enough to receive a second treatment.1 While hormone therapy and chemotherapy are essential treatments for mCRPC, they may not be appropriate for all patients.3 Many patients and their healthcare providers prefer to avoid or delay chemotherapy due to side effects, and treatment guidelines recommend avoiding the use of multiple ARPIs.4-7
"With worsening outcomes after each successive line of treatment, patients with this type of metastatic prostate cancer and their families have long faced limited options and uncertain outcomes," said Gina Carithers, CEO and President of the Prostate Cancer Foundation.8 "The now expanded approval of Pluvicto is an empowering development for the prostate cancer community. We now have more choices earlier in the treatment journey, enabling patients to advocate for their preferences and work with their oncologist or urologist to determine the treatment option that best suits their needs."
"Today's approval for an expanded indication for Pluvicto brings more choice to nearly three times as many patients, enabling us to further establish radioligand therapies as a pillar in cancer care," said Victor Bultó, President US, Novartis. "As pioneers in the RLT space, Novartis is committed to providing education, resources, and practical solutions to healthcare providers to help ensure access for all patients navigating this challenging disease."
References
1. Shore ND, Laliberté F, Ionescu-Ittu R, Yang L, Mahendran M, Lejeune D, et al. RealWorld Treatment Patterns and Overall Survival of Patients with Metastatic Castration Resistant Prostate Cancer in the US Prior to PARP Inhibitors. Adv Ther. 2021;38(8):4520-40.
2. American Cancer Society. Key statistics for prostate cancer. Accessed January 21, 2025. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
3. Shore N, Heidenreich A, Saad F. Predicting response and recognizing resistance: improving outcomes in patients with castration-resistant prostate cancer. Urology 2017;109:6–18. [https://pubmed.ncbi.nlm.nih.gov/28797685/]
4. Broyelle A, Delanoy N, Bimbai AM, Le Deley MC, Penel N, Villers A, et al. Taxanes Versus Androgen Receptor Therapy as Second-Line Treatment for Castrate-Resistant Metastatic Prostate Cancer After First-Line Androgen Receptor Therapy. Clin Genitourin Cancer. 2023;21(3):349-56.e2.
5. EAU-EANM-ESTRO-ESUR-SIOG. Guidelines on Prostate Cancer, 2024. [https://uroweb.org/guideline/prostate-cancer]
6. NCCN. Clinical Practice Guidelines in Oncology. Prostate cancer, v4.2024. [https://www.nccn.org]
7. ESMO. Pocket Guidelines. Urogenital Cancers, 2023. [https://www.esmo.org/guidelines/pocket-guidelines-mobile-app]
8. Moreira DM, Howard LE, Sourbeer KN et al. Predicting time from metastasis to overall survival in castration-resistant prostate cancer: results from SEARCH. Clin Genitourin Cancer 2017;15(1):60–66.e2. [https://pubmed.ncbi.nlm.nih.gov/27692812/]
July 24, 2024 
