How do you sequence Pluvicto vs docetaxel in a fit, chemotherapy-naïve patient with high-volume PSMA-avid mCRPC progressing on an ARPI?

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...

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...