By Valerie Goodwin
Within the last few years, nuclear medicine has added to cutting edge treatment options for cancer.
One of the latest advancements is the use of a treatment called Pluvicto to treat metastatic castration-resistant prostate cancer.
Metastatic castration-resistant prostate cancer can’t be controlled with hormone therapy and leaves patients with few options for treatment, making it challenging to target and treat.
Recently approved by the Food and Drug Administration, Pluvicto is a radionuclide-labelled drug administered to patients through a vein once every six weeks for six sessions.
It provides targeted-radiation to these cancer cells, aiming to stabilize or reduce the size of metastases throughout the body, and in some cases, eliminate cancer cells altogether.
The radioactive Lutitium-177 bound to PSMA-ligand-617 binds onto the prostate specific membrane antigen expressed by cancer cells, delivering the radioactive drug directly into what’s metastasized.
Positron emission tomography scans can help identify whether the prostate cancer has these prostate specific membrane antigen receptors and accurately depict where the cancer has metastasized to.
Once the metastases have been located and confirmed to have prostate specific membrane antigen receptor expression, a patient can begin Pluvicto treatments.
“Pluvicto is effective and well-tolerated for prostate cancer that is inoperable and has metastasized into the bones and other sites, and indicated for patients that have exhausted most of the standard care options for treatment of their cancer,” said Ka Kit Wong, MBBS, a clinical professor of nuclear medicine at University of Michigan Health who’s the director of the Therapy Nuclear Medicine Clinic.
“The treatment has mild side effects, although we monitor the blood counts and kidney function closely while the patient receives Pluvicto. This gives the patient the ability to continue their daily life routines fairly uninterrupted although some simple distance radiation precautions are followed for a short time with each treatment.”
Patients receiving Pluvicto will have regular measurement of their cancer biomarker on blood testing the prostate-specific antigen levels to ensure their treatment is proceeding appropriately.
Patients also need to meet requirements for blood count, kidney function and general mobility prior to receiving Pluvicto treatment, which is fulfilled through a series of lab testing around two weeks prior to each treatment.
“So far, Pluvicto is showing positive response in the PSA levels for a group of patients (as described in the landmark VISION trial) and in some quite dramatic responses,” said Wong
“However, one thing that is important is to try to get the treatment started earlier in the disease course, as waiting too long when the metastases have spread too much in the body makes it difficult to administer this treatment in a safe manner.”
The most common side effects of Pluvicto include fatigue, dry mouth, nausea, decreased appetite and constipation.