Experts are voicing their concerns regarding stumbling blocks that have occurred during the implementation of a newly approved prostate cancer radiotherapy.
A new report shared in the Journal of Nuclear Medicine cites several obstacles clinicians have encountered when trying to initiate treatment with 177Lu-PSMA-617 (also known as Pluvicto) for prostate cancer patients. In March of 2022, 177Lu-PSMA-617 was approved by the U.S. Food and Drug Administration for the treatment of metastatic castration-resistant prostate cancer in men with PSMA-avid disease who have previously undergone chemotherapy and a novel androgen receptor-directed therapy.
Following its approval, clinicians at the Dana Farber Cancer Institute report that 146 patients were referred to them to undergo therapy using 177Lu-PSMA-617 between May and October of 2022. Of those patients, 127 were approved for the therapy, and by the end of October 2022, less than half (41%) of the approved patients had completed one cycle of 177Lu-PSMA-617.
These delays in care have brought to light a number of issues clinicians have encountered when trying to initiate treatment using the new therapy.
Corresponding author of the editorial Praful Ravi, with the Dana-Farber Cancer Institute, and colleagues highlight three of these obstacles below:
The referral process. The authors noted a need for better referral processes that include case reviews during a multidisciplinary tumor board (TB). They suggested that TBs facilitate open dialogue from multiple practitioners and help to determine which patients would benefit most from the therapy. Thus far, this has proven difficult for scheduling reasons, the authors indicated.
Supply issues. During the institute's implementation, patients’ treatments were delayed by three months due to low supply of 177Lu-PSMA-617 and some (5%) patients even died while awaiting treatment. Because treatment plans are often based on PSMA PET/CT imaging, these delays also present issues with whether original treatment plans remain appropriate by the time the radiotherapy becomes available. The authors suggested that this could impact how disease is managed, especially if imaging is used to guide treatment plans.
Patient selection. The authors noted that a patient being PSMA-avid does not automatically qualify them for 177Lu-PSMA-617 therapy. Of the 146 patients referred to their institution, 18 were either deferred or declined for the therapy for reasons like a lack of PSMA-avid disease or not having completed chemotherapy prior to their referral. They reiterated that to be approved for the new radiotherapy, patients need to have already undergone chemotherapy and a novel androgen receptor-directed therapy, and that other lines of chemotherapy still need to be considered before initiation 177Lu-PSMA-617.
The full text of the report is available here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.