Treatment Patterns and Survival Outcomes in a Real-World Cohort of Lutetium 177 Vipivotide Tetraxetan (LuPSMA)-Experienced Patients With Metastatic Castration-resistant Prostate Cancer (mCRPC).
Patients with mCRPC who received treatment after LuPSMA had a median overall survival of only 8.0 months, indicating a need for improved treatment strategies.
Where it sits
this study against the rest of the vipivotide corpusSummary and findings
This study evaluated treatment patterns and survival outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC) who received subsequent treatment after Lutetium 177 vipivotide tetraxetan (LuPSMA). A total of 161 patients initiated subsequent therapy, with a median overall survival of 8.0 months. The study highlights the short duration of treatments and limited survival in this population.
Abstract
Introduction To evaluate treatments and survival in patients with metastatic castration-resistant prostate cancer (mCRPC) who received subsequent treatment after Lutetium 177 vipivotide tetraxetan (LuPSMA) in the real-world. Methods This retrospective cohort study included patients with mCRPC who initiated subsequent treatment after LuPSMA up to 07/31/2024 in the US-based Flatiron Health Research Database (FHRD) with follow-up through 07/31/2025. Overall survival was measured from initiation of systemic treatment after LuPSMA until death using the Kaplan-Meier method. Key subgroups were prior taxane exposure in mCRPC (taxane-naïve/post-taxane). Results Among 743 patients treated with LuPSMA in the FHRD, 339 (46%) died prior to initiating subsequent therapy and 161(22%) initiated subsequent therapy during the study period. Of the 161 patients who initiated subsequent therapy, 65% (n = 105) had prior taxane therapy. Patients received 43 distinct regimens after LuPSMA; half were chemotherapy-based. The most common regimens were cabazitaxel (19%), cabazitaxel-carboplatin (12%), and enzalutamide (9%). Median duration of post-LuPSMA therapy was 2.4 months. Median overall survival was 8.0 (95% CI: 6.8-11.5) months overall and 6.8 (95% CI: 5.5-9.3) months in post-taxane subgroup (median 4 prior lines of therapy). Conclusions The study population reflects real-world LuPSMA use and includes a heterogeneous group of heavily pretreated patients. Systemic therapies after LuPSMA were primarily chemotherapy-based. The short duration of treatments and limited survival highlights the need for novel treatments and sequencing strategies in the post-LuPSMA setting.
Background
This paper addresses treatment patterns and survival outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC) who have undergone treatment with Lutetium 177 vipivotide tetraxetan (LuPSMA). Prior studies have indicated that LuPSMA is used in heavily pretreated populations, but data on subsequent treatment outcomes in a real-world setting are limited. Understanding these patterns is crucial for developing future treatment strategies.
Methods
This retrospective cohort study included patients with mCRPC who initiated subsequent treatment after LuPSMA, with data sourced from the Flatiron Health Research Database (FHRD). The study followed patients until 07/31/2025, measuring overall survival from the initiation of systemic treatment after LuPSMA using the Kaplan-Meier method. Key subgroups included those with prior taxane exposure.
Results
Among 743 patients treated with LuPSMA, 339 (46%) died prior to initiating subsequent therapy. Of the 161 patients who initiated subsequent therapy, 65% (n = 105) had prior taxane therapy. Median overall survival was 8.0 months (95% CI: 6.8-11.5) overall and 6.8 months (95% CI: 5.5-9.3) in the post-taxane subgroup.
Interpretation
The findings indicate a limited survival duration following LuPSMA treatment, which aligns with previous literature suggesting poor outcomes in heavily pretreated mCRPC populations. The median overall survival of 8.0 months may not be clinically meaningful given the advanced stage of disease and treatment history of the patients. Confounding factors include the retrospective design and the potential for selection bias, which may affect the generalizability of the results.
Key findings
- 339 (46%) died prior to initiating subsequent therapy.
- 161 (22%) initiated subsequent therapy during the study period.
- 65% (n = 105) had prior taxane therapy.
- Median duration of post-LuPSMA therapy was 2.4 months.
- Median overall survival was 8.0 months (95% CI: 6.8-11.5).
- Median overall survival in post-taxane subgroup was 6.8 months (95% CI: 5.5-9.3).
Limitations
- retrospective study design
- small n for subgroup analysis
- short duration of follow-up
- limited generalizability due to selection bias
- heterogeneous patient population