In patients with progressive metastatic castration-resistant prostate cancer, results from early studies indicate that men treated with 177Lu-PSMA, a type of radioligand therapy (Rlt), in addition to the best standard of care, achieved a significant advantage in overall survival and free from progression. It is the last frontier of nuclear therapy-diagnostics – defined for this theragnostics – which, initially used in neuroendocrine tumors, of which the most common is pancreatic tumors, is also giving interesting results in prostate cancer, as shown by the results obtained from the phase 3 Vision study recently updated by new data on tolerability and quality of life. An article recently published in ‘Allies for Health‘, the portal dedicated to medical-scientific information created by Novartis.
Theragnostics – explains the article – is the most innovative concept in nuclear medicine because it is capable of combine the potential of diagnostic imaging with that of therapy. In fact, radioligands act selectively on diseased cells, without damaging healthy cells because the radioactive isotope performs diagnostic and/or therapeutic activity because it is associated with a ‘ligand’, a molecule capable of recognizing and binding to tumor cells and make them recognizable in the diagnostic phase with Pet/Tc equipment, improving staging, the selection of responsive patients and defining subsequent therapies as well as follow-up. If, on the other hand, it is used for therapeutic purposes, the radioisotope releases radiation directly into the neoplastic cells wherever they are present, acting in a highly specific way and with extreme precision.
Starting from the experience in neuroendocrine tumors (Net), numerous international studies, many of which are still ongoing, have evaluated the potential use of radioligands in the diagnostic (Rli) and therapeutic (Rlt) fields in various solid and non-solid tumors, such as prostate, breast and pancreatic cancer, melanoma, lung cancer but also in haematological diseases such as lymphoma and multiple myeloma. Rlt is currently intended for a small number of gastro-entero-pancreatic neuroendocrine tumors (Gep-Net) and represents the first theragnostic radiopharmaceutical approved and which has been recognized as fully innovative by the Italian Medicines Agency (Aifa).
The therapeutic offer against advanced castration-resistant prostate cancer (mCrpc), a disease that has escaped the control of androgen deprivation therapy – reports the article – has been enriched in recent years with treatments that have demonstrated efficacy in terms of control of disease and an advantage in survival and treated to date with new generation chemotherapy or hormonal drugs. However, new therapies able to improve survival and quality of life remain necessary and of priority importance, in a pathology in which changes in androgen resistance (mCrpc) play a fundamental role.
Research in the field of Rlt is very active, both to better define the applications of radiopharmaceuticals already available, and to validate new ones. Just think, for example, of the therapeutic opportunities offered by in the treatment of prostate cancer. In the Vision study, compared with best standard of care alone, men treated with the specific radioligand in addition to best standard of care achieved a 38% reduction in the risk of death, with a median overall survival benefit of 4 months. and a 60% decrease in the risk of radiographically detected disease progression or death, with a median progression-free survival benefit of 5 months.
Furthermore, analysis of health-related quality of life (HRQoL) showed, in addition to standard of care, an estimated 54% reduction in the risk of worsening HRQoL – compared to standard of care alone. The results obtained in patients with cancer in the metastatic stage and heavily pretreated such as those of the Vision study make it legitimate to expect the use of the radioligand in an earlier stage of the disease. Several studies are underway in this regard. The full article is available at Prostate cancer: Radioligand therapy (RTL) works
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