PSMA radioligand therapy in patients with advanced prostate cancer

Background Based on significant progress in recent years, metastatic castration-resistant prostate cancer (mCRPC) patients can be treated better and better. The medications include androgen signaling inhibitors, chemotherapy, Ra-223, and sipuleucel-T. Most patients treated with these agents will still develop primary or secondary resistance against any given drug. The (177)Lutetium-PSMA radioligand therapy (Lu-177-PSMA-RLT) represents a good reserve option and can be used within compassionate use provisions demonstrating promising efficacy in the majority of patients in Germany. Objectives Establishment of status quo of Lu-177-PSMA-RLT in mCRPC in 2020. Materials and methods Presentation of the therapy landscape in mCRPC and the current evidence on Lu-177-PSMA-RLT after PubMed based literature search. Results Several larger retrospective studies and the first prospective trials on Lu-177-PSMA-RLT show premature but encouraging evidence on Lu-177-PSMA-RLT to be a promising new option in mCRPC patients. The toxicity profile seems to be favorable. The phase III trial VISION aims to provide evidence for the approval of Lu-177-PSMA-RLT in combination with abiraterone or enzalutamide in patients having been pretreated with enzalutamide or abiraterone and docetaxel. Conclusions Despite the promising preliminary results of Lu-177-PSMA-RLT, the efficacy results of VISION need to be awaited prior to using the therapy outside of compassionate use provisions.