For patients starting Pluvicto, do you have patients stop their ARPI?

While the VISION trial allowed for concomitant use, it was only about half (53%) in the Lu-177-PSMA arm, and 2/3 (68%) of those on the standard of care arm - Garje et al., PMID 36693228. And the PSMAfore trial did not, as noted above by @Dr. First Last

The bigger question is, will you continue the AR...

From the PSMAfore trial, ARPI was not allowed concurrently with Pluvicto. Notably, these were patients with prior exposure to at least one ARPI (inclusion was "eligible for a change in ARPI")

Permitted and prohibited concomitant treatments:
Androgen deprivation therapy was continued, and concomitant s...

In patients who start Pluvicto after multifocal progression on an ARPI, I favor discontinuing the ARPI. Concomitant ARPIs can add significant toxicity and, in these situations, may not offer additional clinical benefit. Retrospective data from Mayo showed that after adjusting for baseline clinical d...