SNMMI: Can Multimodal Monitoring Bolster Outcomes with Pluvicto in Treating mCRPC?
Multimodal treatment monitoring, including SPECT/CT exams 24 hours after treatment with Lu-177 PSMA-617, may have facilitated significantly shorter therapy durations and reduced side effects in patients with mCRPC, according to a two-year study presented at the Society for Nuclear Medicine and Molecular Imaging (SNMMI) conference.
New research suggests the inclusion of SPECT/CT exams, performed 24 hours after the use of Lu-177 PSMA-617 (Pluvicto, Novartis), in a multimodal monitoring protocol may allow for shorter treatment duration for patients with metastatic castration-resistant prostate cancer (mCRPC).
For the study, presented at the Society for Nuclear Medicine and Molecular Imaging (SNMMI) conference, researchers utilized a three-pronged approach to assess the effectiveness of the radioligand agent Lu-177 PSMA-617 in 180 patients with mCRPC. In addition to the aforementioned SPECT/CT exams, the study authors monitored therapy toxicities with the Common Terminology Criteria for Adverse Events (CTCAE v5.0) criteria and explored the use of circulating tumor DNA (ctDNA) analysis in a patient subset.
Here one can see maximum projected intensity (MIP) SPECT/CT images revealing significant remission after a first treatment cycle of Lu-177 PSMA-617. (Images courtesy of SNMMI.)
The study authors found that 48 percent of the cohort achieved greater than a 50 percent reduction in prostate-specific antigen (PSA) levels and 32 percent (deemed as “super responders”) had a greater than 80 percent reduction in PSA levels.
Twenty-nine of the super responders were able to have a median therapeutic break of 248 days, according to the researchers. Conversely, the study authors noted that identification of mCRPC progression on SPECT/CT images led to therapy cessation for 36.1 percent of the cohort.
“Personalized therapeutic strategies, informed by advanced imaging and emerging biomarkers, demonstrate the potential to improve upon outcomes for patients with mCRPC undergoing Lu-177 PSMA-617 therapy,” noted lead study author Harshad Kulkarni, M.D., a chief medical advisor with BAMF Health and a clinical associate professor of radiology at Michigan State University, and colleagues.
In comparison to the VISION trial, the researchers noted a higher median overall survival rate (17.5 months vs. 15.3 months). They also pointed out a lower occurrence of grade 3-4 hematological toxicities (17.4 percent) in contrast to similar studies and no significant kidney or liver toxicities.
The study authors maintained that multimodal monitoring, including the potential use of ctDNA as a biomarker, can facilitate more targeted treatment of patients with mCRPC.
“The integration of ctDNA analysis in select cases represents a promising approach to refine treatment monitoring and guide clinical decision-making,” added Kulkarni and colleagues. “These findings contribute to the growing evidence supporting a multimodal approach to precision oncology in mCRPC.”
Reference
- Kulkarni HR, Maupin KA, VanOss J, et al. Beyond vision: superior outcomes and personalized care in mCRPC with Lu-177 PSMA-617, exploring advanced biomarkers. Presented at the the Society for Nuclear Medicine and Molecular Imaging (SNMMI) conference, June 21-24, 2025. Available at: https://poster.econference.io/app/snmmi/B95p18u/poster/146493 .
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