mCRPC in focus
Transcript: PSMA-4 can improve quality of life
Dr Alexander Chehrazi-Raffle
Interview recorded June 2024. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
Yeah, this was a great ASCO for quality of life studies. There were several presented at this year that really focused on some of those metrics, including PSMAfore. So in this study, it was an early mCRPC study in which Dr. Fizazi presented quality of life, and it's a randomised phase 3 open-label study that's looking at lutetium-PSMA-617 versus something called ARPI switch, meaning that a patient received an ARPI of a hormone-sensitive setting and they're then switched to a different ARPI once they convert to castration resistance. In this patient population, patients needed to have PSMA PET-CT positive findings and needed to be taxane-naive. Of note, crossover was permitted from the control arm upon progression and about 80% of patients did, in fact, cross over to receive lutetium once progressing on their ARPI switch. This is important because, one, it allows for patients, I'm sorry, it allows for a clear perspective of benefit of the therapeutic sequencing and, two, it also ensures equal access of care to all patients on trial, something that I think should be commended and encouraged in future studies.
As previously reported at ESMO, the study did meet its primary endpoint of rPFS with the interim analysis nearly doubling those values. So six months with the ARPI switch and 12 months with the lutetium arm. However, interim OS showed a concerning positive hazard ratio suggesting that there was no survival advantage and maybe, in fact, some thought, could be causing harm. So this caused a bit of controversy regarding whether this would be appropriate to prove in this treatment context 'cause it's not prolonging survival. However, whereas overall survival measures a quantity of life, I think the focus of this study, this kind of exploratory analysis, was that the investigators sought to determine whether quality of life might be improved by lutetium.
So to that end, the investigators assessed quality of life using FACT-P, which is a prostate specific quality of life metric, EQ-5D-5L, a more generic quality of life metric, and BPI-sf, which is a scoring system for chronic pain. Importantly, this was a pre-specified analysis, and a time worsening per FACT-P, there is significantly better outcomes with lutetium compared to ARPI switch with a median of about seven and a half months compared to four months respectively. Similarly, composite EQ-5D-5L favoured lutetium at six to four months. And time to pain worsening with the BPI-sf was also better with lutetium at 5 to 3.7 months respectively. And all hazard ratios ran about 0.6 to 0.7 and were significant. So to me, this was one of the most informative prostate abstracts from the conference. We knew that from the previous interim analysis, RPFS was longer, but that its utility in early CRPC had been drawn into question. And so with these pre-specified quality of life analyses, we can safely say that it improves quality of life compared to ARPI switch, which is really of paramount importance to our patients as they navigate this incurable disease.
Updates in your area
of interest
of interest
Articles your peers
are looking at
are looking at
Bookmarks
saved
saved
Days to your
next event
next event
Developed by EPG Health. This content has been developed independently of the sponsor, Pfizer, which has had no editorial input into the content. EPG Health received funding from the sponsor to help provide healthcare professional members with access to the highest quality medical and scientific information, education and associated relevant content. This content is intended for healthcare professionals only.