Do you continue androgen receptor pathway inhibitors in patients receiving Lu177-PSMA for metastatic prostate cancer?

Yes, ARPIs can be continued during treatment. Just over half the patients on the VISION trial remained on enzalutamide or abiraterone. Outside of the ENZA-p trial (Phase IIR), there is no good evidence for or against the use of concurrent ARPI to my knowledge, although there really should not be synergistic toxicity. The ENZA-p trial was presented at ESMO this week and demonstrates the superior efficacy of enzalutamide with Lu-PSMA compared to enzalutamide alone. In addition, there was PSMA-adaptation (i.e. Lu-PSMA course modification based on interim PSMA PET).

Outside of trial settings, we do not permit concurrent use of cytotoxic chemotherapy (e.g., doce or cabazitaxel), even though the early phase LuCab study shows it may be safe. We als...