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PEER-TO-PEER CLINICAL CONVERSATIONS
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How Prior Exposure to Radiopharmaceuticals Affects The Treatment Paradigm Using Radium-223 for mCRPC
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Michael Morris, MD
Michael Morris joins Alicia Morgans in a discussion on the sequencing of therapies in the context of radium for metastatic castration-resistant prostate cancer treatment. Their conversation focuses on thinking about prior exposure to radiopharmaceuticals when thinking about incorporating other radiopharmaceuticals into the treatment paradigm.
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Finding the Right Patient for Lutetium-177 PSMA Treatment
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Kara Cossis, PA-C, MPH
Phillip Koo converses with Kara Cossis about the critical aspect of patient selection for PLUVICTO® (lutetium Lu 177 vipivotide tetraxetan) treatment. Ms. Cossis outlines the criteria for identifying suitable candidates, emphasizing the role of castrate-resistant metastatic prostate cancer, disease burden, and eligibility based on scans.
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| Clinical Implications and Patient Care: The SNMMI Consensus on Lutetium PSMA 617 Therapy for Advanced Prostate Cancer |
Heather Jacene, MD, and A. Oliver Sartor, MD
Alicia Morgans facilitates a discussion with Heather Jacene and Oliver Sartor regarding the SNMMI consensus statement on the use of Lutetium PSMA-617 radionuclide therapy for advanced prostate cancer. This multidisciplinary consensus, crafted by nuclear medicine physicians and medical oncologists, dives deep into the complexities of the metastatic CRPC space.
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| Safety and Survival Outcomes in Patients With mCRPC Treated With 177Lu-PSMA After Radium-223: Interim Analysis of the RALU Study
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| Kambiz Rahbar, MD
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| Kambiz Rahbar presents an interim analysis of the RALU study, focusing on the safety and survival outcomes in patients with mCRPC treated with lutetium-177–prostate-specific membrane antigen (177Lu-PSMA) after radium-223. The results showed that this sequential therapy was feasible, with manageable safety profiles, and demonstrated a median overall survival of 12.6 months from the start of 177Lu-PSMA therapy.
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| Observations on the Biology of PSMA Implications for Targeting
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| Neil Bander, MD
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| Neil Bander discusses the regulation of PSMA by androgen receptors and the internalization of PSMA-targeting antibodies and ligands. He emphasizes the kinetics of PSMA upregulation, and the limited cellular retention time of radioligands, and proposes a synergistic approach using both small molecular ligands and J591 antibody radionuclides for enhanced therapeutic efficacy in preclinical studies.
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| Improvements in Symptoms Related to Bone Metastasis in Recipients of Lutetium-177 PSMA-617 for Prostate Cancer
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| Brian Gonzalez Ph.D.
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| In this presentation, Brian Gonzalez discusses findings on the effects of prostate-specific membrane antigen radioligand therapy (PSMA-RLT) using Lutetium-177 on symptoms related to bone metastasis in patients with mCRPC. Based on the data, the results showed that patients reported reduced bone metastasis-related pain over time, with 38-42% reporting clinically meaningful improvements in bone metastasis-related pain during follow-up.
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| Extension of a 68Ga-PSMA PET-Based Nomogram for Outcome Prediction of 177Lu-PSMA Radioligand Therapy for the Use of 18F-rhPSMA -7.3
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| Isabel Rauscher, MD,
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| Isabel Rauscher presents a study focusing on the extension of a 68Ga-PSMA PET-based nomogram for predicting outcomes of 177Lu-PSMA radioligand therapy, using 18F-rhPSMA-7.3. The study demonstrated that the nomogram performs well with 18F-rhPSMA-7.3, although its predictive accuracy remains suboptimal, emphasizing the need for cautious interpretation and consideration of other factors in treatment decisions.
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| Mechanisms of Resistance to Radiopharmaceuticals
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| Johannes Czernin, MD
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| In this presentation, Johannes Czernin discusses mechanisms of resistance to radiopharmaceuticals. While emphasizing the remarkable responses to 177Lu-PSMA-617, he highlights the potential for dramatic resistance. The VISION trial demonstrated improved overall survival with 177Lu-PSMA-617, but 50% of patients were non-responders, suggesting resistance mechanisms. Possible factors include suboptimal patient selection, radiation therapy issues, and biological tumor resistance mechanisms, such as mutation status and DNA damage response.
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