Prostate cancer patients whose cancer has spread have a game-changing new option for treatment. Patients can now receive radiopharmaceutical treatment at BAMF Health BEFORE chemotherapy!
Treatment guidelines were adjusted in March 2025, which means patients have the opportunity to defer or delay the potential side effects of chemo and move straight into treatment with PLUVICTO®.
BAMF Health Medical Director, Dr. Brandon Mancini, answers questions about the impact this new indication has on patient care and outcomes.
Q: What does pre-chemo approval of PLUVICTO® mean?
Dr. Mancini: Since PLUVICTO® was FDA approved in March 2022, it has only been available to patients with PSMA+ metastatic prostate cancer who had previous treatment with androgen deprivation therapy (ADT), androgen receptor pathway inhibition (ARPI), and chemotherapy. With this new indication, patients can now be considered for PSMA-targeted radiopharmaceutical therapy after treatment with ADT and ARPI. Chemotherapy often has undesirable side effects and can impact a patient’s quality of life. Our patients at BAMF experience very mild side effects and maintain a high quality of life throughout treatment.
Q: Who is eligible for pre-chemo treatment?
Dr. Mancini: First, patients must be diagnosed with metastatic prostate cancer that is PSMA+. This means their cancer has spread outside of the prostate and expresses a unique protein called prostate-specific membrane antigen (PSMA) on the cancer cell surface. We determine this through a PSMA PET scan, which we do here at BAMF.
Second, patients must have first been treated with testosterone-blocking therapy or hormone therapy. Historically, patients with metastatic prostate cancer whose disease progressed while on hormone therapy were prescribed chemotherapy, after which they could then consider coming to BAMF. But now, patients whose hormone therapy is no longer controlling their disease have the option to be considered for radioligand therapy without the requirement of treatment with chemo first.
Q: Why was this change made, and why does it matter?
Dr. Mancini: The PSMAfore phase 3 clinical trial revealed that radioligand therapy with 177Lu-PSMA-617 (PLUVICTO®) more than doubled the radiographic progression-free survival in patients with metastatic castration-resistant prostate cancer who were previously treated with hormone therapy (ARPI) compared to an ARPI change. As a result, the National Comprehensive Cancer Network® (NCCN) Guidelines, which physicians across the country use when discussing treatment options, now include 177Lu-PSMA-617 as an earlier treatment option. For some patients, chemotherapy might still be the best next step in their care, but this new indication is expected to triple the number of prostate cancer patients who are eligible for radioligand therapy before chemo.
This new indication is important because many patients would prefer to delay or defer chemotherapy when possible. While it can be an effective treatment strategy, many patients are concerned about the side effects and impact on quality of life. Chemotherapy is a systemic treatment used to kill or stop the growth of cancer cells, but it can also affect healthy, fast-growing cells. It may cause fatigue, hair loss, nausea/vomiting, fluid retention, and more.
Q: What does a typical treatment plan with PLUVICTO® look like?
Dr. Mancini: If a patient hasn’t had a PSMA PET scan, that’s the first step. That will tell us if the cancer is PSMA+. Once confirmed, the treatment plan can begin.
PLUVICTO® is given via an IV injection every six weeks for up to six treatments, depending on how the cancer and body respond. On treatment days at BAMF, patients are typically here for 60-90 minutes. They have their own private room and bathroom and can customize the room lighting, color, and temperature. Family members are welcome to join and have access to seating that maintains a safe distance from their loved one.
What makes BAMF especially unique is that every patient receives a SPECT/CT scan 24 hours after treatment. This scan allows us to visualize the treatment working inside the patient’s tumors. This information can help us determine the next best step in their treatment journey. On average, our patients receive three to four doses of PLUVICTO® during their treatment course, and many see significant improvement in their cancer. If their cancer responds especially well, we can safely pause treatment and restart it later if the cancer comes back.
Q: Do you have any final thoughts?
Dr. Mancini: The new, pre-chemotherapy indication for PLUVICTO® is a very exciting change to the therapy landscape for metastatic prostate cancer patients. At BAMF Health, we look forward to assisting as many patients as possible through their cancer journeys and continuing to contribute to the advancements in radiopharmaceutical therapy for years to come.
PLUVICTO® (lutetium Lu 177 vipivotide tetraxetan) is indicated for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor pathway inhibition (ARPI) therapy and:
- are considered appropriate to delay taxane-based chemotherapy, or
- have received prior taxane-based chemotherapy
The most common side effects include fatigue, dry mouth, nausea, bone marrow suppression, and renal toxicity.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified medical provider with questions you have about your medical condition. Never disregard professional medical advice or delay in seeking it because of something you’ve read or seen from BAMF Health.
