Exposure-adjusted safety analyses of the VISION phase 3 trial of 177 Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer.

Kim N. Chi, Nabil Adra, Rohan Garje, Jeff M. Michalski, Jules Lavalaye, Mette Moe Kempel, Marcia Brackman, Kevin Perraud, Geoffrey Holder, Andrew J. Armstrong

Research output: Contribution to journalConference abstract in journalResearchpeer-review


85 Background: In the VISION trial, targeted radioligand therapy with 177 Lu-PSMA-617 significantly prolonged radiographic progression free survival (rPFS) and overall survival when added to standard of care (SoC) in patients with advanced prostate-specific membrane antigen (PSMA)-PET-positive metastatic castration-resistant prostate cancer. There was a higher incidence of treatment-emergent adverse events (TEAEs) with 177 Lu-PSMA-617 + SoC vs SoC. However, treatment exposure was more than three times longer in the 177 Lu-PSMA-617 + SoC arm and thus relative toxicity may have been overestimated. A post hoc analysis of the relationship between exposure and frequency of TEAEs was performed to facilitate comparison of rates between arms. Methods: In this international, open-label study, adult patients previously treated with ≥ 1 androgen receptor pathway inhibitors and 1–2 taxane regimens were randomized 2:1 to 177 Lu-PSMA-617 (7.4 GBq Q6W, ≤ 6 cycles) + SoC or SoC. Safety was a secondary endpoint. TEAEs (regardless of causality) were reported from start of randomized treatment for up to 30 days after last treatment administration (including SoC) or 1 day before subsequent anticancer treatment, whichever occurred first. Overall TEAE incidence was adjusted for treatment exposure by calculating incidence per 100 patient treatment-years (PTY). The analysis was performed for the first occurrence of TEAEs. Results: Exposure-adjusted incidence of any grade, grade ≥ 3 and selected TEAEs are listed in the table. There was similar exposure-adjusted incidence of gastrointestinal events and fatigue and higher exposure-adjusted incidence of musculoskeletal and renal events with SoC compared with 177 Lu-PSMA-617 + SoC suggesting an association with treatment exposure rather than 177 Lu-PSMA-617. Dry mouth, dry eye and acute myelosuppression maintained a higher incidence, confirming relationship with 177 Lu-PSMA-617 treatment. Conclusions: The adjusted safety analysis, accounting for a longer safety observation due to longer rPFS in patients receiving 177 Lu-PSMA-617, reveals a comparable incidence of TEAEs between arms. This confirms a favorable risk/benefit profile of 177 Lu-PSMA-617 added to SoC in this patient population. Clinical trial information: NCT03511664. [Table: see text]
Original languageEnglish
JournalJournal of Clinical Oncology
Issue numberSuppl. 6
Pages (from-to)85
Publication statusPublished - 2022
EventASCO Genitourinary Cancers Symposium - Moscone West & Online, San Francisco, United States
Duration: 17 Feb 202219 Feb 2022


ConferenceASCO Genitourinary Cancers Symposium
LocationMoscone West & Online
Country/TerritoryUnited States
CitySan Francisco


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