ASCO GU 2025: Real-World Comparison of Cabazitaxel vs. 177-Lutetium-PSMA Radioligand Therapy in Metastatic Castration Resistant Prostate Cancer

(UroToday.com) The 2025 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between February 13^th and 15^th 2025, was host to the Poster Session A: Prostate Cancer. Dr. Mike Wenzel presented Abstract 70: Real-world comparison of cabazitaxel vs. 177-lutetium-PSMA radioligand therapy in metastatic castration resistant prostate cancer.

Dr. Wenzel began his presentation by stating that ¹⁷⁷Lu-PSMA therapy is under extensive scientific investigation and is increasingly becoming an established standard of care for metastatic castration-resistant prostate cancer (mCRPC). However, despite data from two prospective trials,^1,2 real-world evidence comparing treatments remains limited and warrants further investigation.

The investigators used the Frankfurt Metastatic Cancer Database of the Prostate (FRAMCAP) to compare cabazitaxel and ¹⁷⁷Lu-PSMA therapy in patients with mCRPC. They evaluated progression-free survival (PFS) and overall survival (OS) and conducted sensitivity analyses focused on second- to fourth-line treatment to approximate patient selection criteria from current phase III trials.

A total of 373 patients with mCRPC were studied, 14% received cabazitaxel vs. 65% Lu-PSMA vs. 21% both treatments. Patients undergoing Lu-PSMA therapy were significantly older (median 72 vs. 66 years, p<0.01) and had an ECOG performance status ≥2 (12 vs. 5.0%, p=0.1), compared to cabazitaxel patients. Notably, PSA50 response rates were 32% for ¹⁷⁷Lu-PSMA therapy and 0% for cabazitaxel.

In oncological outcome analyses, median PFS was significantly longer with ¹⁷⁷Lu-PSMA than cabazitaxel (13.4 vs. 7.1 months, p<0.001), and this association persisted after multivariable adjustment, with ¹⁷⁷Lu-PSMA showing a 62% lower risk of progression (HR: 0.38, p<0.001). Median OS also significantly differed between groups, with survival times of 14.7 months for cabazitaxel, 16.5 months for ¹⁷⁷Lu-PSMA, and 29.6 months for patients who received both treatments (p<0.01).

Sensitivity analyses of second- to fourth-line mCRPC treatment showed similar trends in PFS and OS compared to the entire cohort.

Dr. Wenzel concluded his presentation with the following key message:

In the real-world setting, ¹⁷⁷Lu-PSMA therapy provides significantly better PFS compared to cabazitaxel chemotherapy
¹⁷⁷Lu-PSMA therapy and should be considered a valuable treatment option for patients with advanced mCRPC.

Presented by: Mike Wenzel, MD, Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.

Written by: Julian Chavarriaga, MD – Urologic Oncologist at Cancer Treatment and Research Center (CTIC) via Society of Urologic Oncology (SUO) Fellow at The University of Toronto. @chavarriagaj on Twitter during the 2025 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, CA, Thurs, Feb 13 – Sat, Feb 15, 2025.

Related content: 177-Lutetium-PSMA vs Cabazitaxel: A Real-World mCRPC Study - Mike Wenzel

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