VISIONary.

Headline: Adding therapeutic 177Lu-PSMA to other standard therapy for metastatic castrate resistant prostate cancer (mCRPS) prolongs overall survival.

The Study: In the phase 3 VISION trial, presented this week in abstract form, 831 men with mCRPC receiving standard therapy as determined by their physician (excluding cytotoxic chemo and radium-223) were randomized 2:1 to +/- the addition of 177Lu-PSMA. Uniform dosing was 7.4 GBq every 6 weeks x 6 cycles. The first primary endpoint of survival free from radiographic progression was more than doubled with the addition of 177Lu-PSMA (median of 8.7 months) versus without (3.4 months). The other, more elusive, primary endpoint of overall survival was also significantly longer with 177Lu-PSMA (15 months) versus without (11 months). This came at the cost of more frequent high-grade toxicities with 177Lu-PSMA (53%) versus without (38%). Nonetheless, the overall survival advantage positions this as a practice changing clinical trial. What’s not addressed in this abstract? How to best collaborate among urology, med onc, rad onc, and nuc med for an exciting new therapy.

TBL: Who at your hospital and/or medical group is going to get licensed for 177Lu-PSMA infusions? | Morris, ASCO 2021