How do you sequence Pluvicto vs docetaxel in a fit, chemotherapy-naïve patient with high-volume PSMA-avid mCRPC progressing on an ARPI?
This question is part of our collaboration with ASTRO to highlight impactful data from the 2026 Multidisciplinary Radiopharmaceutical Symposium. This question is inspired by the Plenary Session Presentation "Safety and Efficacy of Lu-177 PSMA-617 Versus Established Therapies in mCRPC: Pooled Evidence from Randomized Phase II/III Trials" by Dr. Mohammad Arfat Ganiyani
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How would you generally sequence Pluvicto vs docetaxel in a chemo-naive patient with high-volume PSMA-avid mCRPC post-ARPI?
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2 Answers
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Radiation Oncology · Hospital of the University of Pennsylvania
Answered on
I generally favor starting with docetaxel, though both are reasonable options. CCTG Study PR21 did not show a difference in radiographic progression-free survival between starting with docetaxel versus starting with Pluvicto in this setting. However, OS favored patients who started with docetaxel, a...
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Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
Answered on
Pluvicto is useful for patients with PSMA-positive metastases who are considered appropriate to delay a taxane-based chemotherapy for the post-ARPI/pre-docetaxel setting. For a fit, symptomatic patient with high-volume disease, docetaxel remains the evidence-based first choice. For asymptomatic or m...
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