Infusion Therapy Shows Great Promise in Treating mCRPC
WellSpan has added to its treatment modalities Pluvicto®, a treatment specifically for metastatic castration-resistant prostate cancer (mCRPC) that has previously not responded to chemotherapy; this new treatment is a six-dose infusion administered once every six weeks. It is not chemotherapy: it is a radioligand therapy that finds mCRPC everywhere in the body and directly attacks those cells. It has few side effects.
Osigbemhe Iyalomhe, MD, PhD
Castration-resistant prostate cancer is a disease that persists under extremely low or no testosterone levels. Dr. Osigbemhe Iyalomhe, MD, PhD, Nuclear Medicine and Diagnostic Radiology, said before Pluvicto, patients received some combination of androgen ligand therapy, radiation therapy and taxane-based chemotherapy drugs. “When all of these fail, the disease is classified as mCRPC,” said Iyalomhe. “In clinical trials, researchers found mCRPC patients do better with Pluvicto than patients who received standard of care alone. We expect to start delivering this a lot more.”
To determine whether a patient is a candidate for Pluvicto, a prostate-specific membrane antigen (PSMA) PET scan is performed, using a ligand that binds to the PSMA expression on the cell membrane. “Pluvicto is a radioactive compound that specifically targets PSMA, a marker found on prostate cancer cells,” said Dr. Navesh K. Sharma, DO, PhD, FACRO, Medical Director, Radiation Oncology. “Not all prostate cancer cells display that antigen. The PSMA PET-CT looks for cells that have PSMA on them to get an idea of how much PSMA-positive disease they have.”
If the scan shows metastasis and the patient has already had taxane-based chemotherapy, they may be approved for Pluvicto. “If they don’t show anything on the PSMA PET-CT scan, they are not candidates because it only works against PSMA,” said Sharma. “Patients with one small area may be candidates for other cancer radiation, such as short-course external radiation therapy.” Iyalomhe and Sharma said very few side effects have been reported, the most common being fatigue, nausea and dry mouth. “Side effects are pretty low compared to other treatments,” said Sharma. “It’s pretty well tolerated. Just like any drug, it can have a whole gamut of side effects. There are certain people who may have an allergy to it, but that is quite rare.”
Since Pluvicto targets cells carrying the PSMA marker, there is less damage to surrounding tissue. "You are confident that when you infuse Pluvicto, it is usually hitting only the PSMA-expressing tumor cells,” Iyalomhe said. “Chemotherapy goes everywhere and impacts many other cells, and that’s what causes side effects. Pluvicto is targeted and based on radiation therapy, resulting in much less damage to healthy tissues.” Sharma agreed, “One of the big benefits of Pluvicto is that it goes after cancer cells directly,” he said. “It targets PSMA-positive cancer cells in the entire body. It’s not limited to use in certain areas. Other radioisotope based drugs used for mCRPC may only work for bone metastases. Pluvicto works anywhere PSMA positive cells exist. Another great thing is that it decays quickly, so patients don’t have a significant amount of radioactivity in the body.”
All of this adds up to improved quality of life. Sharma said it’s also easy to administer. “Patients come in, get the treatment and go home,” he said. “We don’t have to keep them long for observation.” “Pluvicto is a new therapeutic program,” said Iyalomhe. “It’s an encouraging agent for treating prostate cancer. Even for patients with widespread metastasis, the drug prolongs survival, and we are seeing fewer new lesions compared to patients who receive only standard of care. Survival is better.”
“Instead of having spot radiation therapy to multiple areas, patients with multiple sites of disease in the body that cause pain may experience improved quality of life from pain and disease burden perspectives, as Pluvicto will attack all those sites,” said Sharma. Pluvicto treatment is offered at WellSpan York, and WellSpan Gettysburg at the Adams Cancer Center. “Patients have exceptional support, expertise, excellent physicians trained in nuclear medicine and radiation oncology, and we have the people who want to provide the best care for our patients,” said Iyalomhe.
Sharma said WellSpan is known for offering individualized care. We focus on the patient,” Sharma said. “We want the patient to understand the treatment process so they can make an informed decision in a setting where you have two specialties – nuclear medicine and radiation oncology – working alongside their medical oncologist and urologist. That is a very powerful way of having cancer treatment delivered.”
“Any healthcare institution is defined by its people,” said Iyalomhe. “Since coming to WellSpan Health, I’ve been impressed with my colleagues. I brought certain expectations for excellence and quality, and I can say our department exemplifies these qualities. I’m very impressed with my colleagues in Medical and Radiation Oncology. When a patient has a clean follow-up PET scan, it means our doctors gave the patient the right care and are doing the best anyone can to help improve health and quality of life.”
“Physicians should know their patients are going to get excellent care,” said Sharma. “Physicians will get feedback on therapies and have open communication with the WellSpan team. They can rest assured their patient will be treated by someone who has experience dealing with complex cases. When we see patients, we do everything possible to treat them not just as somebody with a disease diagnosis, but as someone with a whole life.
“We don’t want to add stress; they have enough of that. We take that very seriously. I take it very seriously because I have had a lot of cancer in my family. I take it very personally.”
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