A drug that “substantially helps” extend survival for patients with incurable late-stage prostate cancer is available in Palm Beach County exclusively at the Eugene M. & Christine E. Lynn Cancer Institute, part of Baptist Health, at Boca Raton Regional Hospital.
PluvictoTM (lutetium Lu 177 vipivotide tetraxetan) was approved in 2022 by the U.S. Food and Drug Administration (FDA) “for the treatment of adult patients with prostate-specific membrane antigen–positive metastatic castration-resistant prostate cancer (PSMA-positive mCRPC) that has spread to other parts of the body.” It is used only for those with late-stage prostate cancer who have already exhausted most other anti-cancer treatments.
According to the Prostate Cancer Foundation, metastatic prostate cancer may initially respond to hormone therapy and other medications. Over time, however, “the cancer often ‘outsmarts’ the drugs, developing adaptations that allow it to thrive even in a low-testosterone environment, and it begins to grow.” This is the point where new options such as Pluvicto are needed.
Radiation oncologist Michael Kasper, M.D., medical director of radiation oncology at Lynn Cancer Institute, part of Baptist Health, at Boca Raton Regional Hospital.
Palm Beach County’s only source for Pluvicto
Lynn Cancer Institute and Baptist Health Miami Cancer Institute are the only cancer centers south of Orlando to offer Pluvicto, according to radiation oncologist Michael Kasper, M.D., medical director of radiation oncology at Lynn Cancer Institute. He says the innovative radiopharmaceutical therapy can extend survival and increase quality of life for patients with stage 4 metastatic prostate cancer.
“Pluvicto has been shown to improve overall survival and progression-free survival (PFS) compared with standard-of-care chemotherapy. PFS more than doubled and the median overall survival improved by more than a third, from 11.3 months to 15.3 months,” says Dr. Kasper. “It was pretty substantial – we usually don’t see improvements like that.” He points out that, for patients with incurable prostate cancer, an extra four months is “a gift” – more time that they can spend with their family, wrap up their affairs and enjoy life’s special moments.
Delivering radiation directly to cancer cells
Dr. Kasper says Pluvicto treatments are part of the “burgeoning” field of theranostics, a highly targeted form of radiation therapy that has been “very successful” for patients with difficult-to-treat cancers. PSMA is a protein found on the surface of all prostate cancer cells but not on most normal tissue.
PSMA theranostics refers to a type of cancer treatment that combines both diagnosis and therapy using a PSMA. The approach uses a radioactive substance attached to a molecule that targets PSMA protein on cancer cells. This molecule is injected into the patient’s bloodstream and can be used for both imaging the cancer cells with a PET scan (PSMA PET imaging) and delivering radiation directly to the cancer cells (PSMA-targeted radioligand therapy), with the aim of minimizing damage to healthy tissue.
“In many ways, theranostics has some parallels to immunotherapy because it’s very targeted. But instead of ‘programming’ the body’s own immune system to attack and kills cancer cells, theranostics combines a targeting compound, or ligand, with a radioactive particle known as a therapeutic radioisotope that specifically binds to cancer cells and delivers the radiation directly to those cells,” Dr. Kasper explains. The radiation travels only a short distance outside the target cell, largely sparing surrounding normal tissue.
An added benefit of decreasing cancer pain
Pluvicto not only offers patients with late-stage disease extended survival, it also offers a better quality of life by decreasing cancer-related pain, which Dr. Kasper says can be significant for patients with advanced prostate cancer.
“One of the significant problems with metastatic prostate cancer is that it often spreads to bones and causes pain. By killing the cancer cells in that spot in the bone where it has spread, radiation decreases the inflammation and the tumor size and it helps the bone heal,” Dr. Kasper says. “Pluvicto does this on a cellular level by delivering the radioisotope directly to the prostate cancer cells. By killing those cells, it relieves the pain associated with cancer.”
Dr. Kasper adds that Pluvicto is generally very well tolerated with minimal side effects. “Some men can have fatigue. Some can have mild fever and chills. The biggest concern is with the patient’s blood counts because Pluvicto can affect the marrow,” he notes. “In addition, some patients experience infusion reactions, but those are pretty rare. Most people tolerate it very well.”
Because kidney function can be affected by Pluvicto, a patient’s kidneys must be tested prior to being approved for treatment. Fertility can also be affected, Dr. Kasper says.
Pluvicto treatment can “travel” with patient
Dr. Kasper says he has some “snowbird” patients who spend winters in South Florida and have needed to complete their treatment at Lynn Cancer Institute.
“In most cases involving radiation, we don’t like to continue treatments begun elsewhere because it’s extremely difficult to replicate the exact treatment a patient receives from one cancer center to another. From a quality assurance perspective, it can be very challenging,” he says.
Pluvicto, however, is a standard dose radiopharmaceutical delivered via infusion monthly over the course of six months. Like chemotherapy, which can be administered in multiple locations, Dr. Kasper says patients can get part of their Pluvicto treatment at one facility back home and the rest of it at Lynn Cancer Institute. “People appreciate knowing they can continue their treatment here while they’re in South Florida.”
