To evaluate treatments and survival in patients with metastatic castration-resistant prostate cancer (mCRPC) who received subsequent treatment after Lutetium 177 vipivotide tetraxetan (LuPSMA) in the real-world.
This retrospective cohort study included patients with mCRPC who initiated subsequent treatment after LuPSMA up to 07/31/2024 in the US-based Flatiron Health Research Database (FHRD) with follow-up through 07/31/2025. Overall survival was measured from initiation of systemic treatment after LuPSMA until death using the Kaplan-Meier method. Key subgroups were prior taxane exposure in mCRPC (taxane-naïve/post-taxane).
Among 743 patients treated with LuPSMA in the FHRD, 339 (46%) died prior to initiating subsequent therapy and 161(22%) initiated subsequent therapy during the study period. Of the 161 patients who initiated subsequent therapy, 65% (n = 105) had prior taxane therapy. Patients received 43 distinct regimens after LuPSMA; half were chemotherapy-based. The most common regimens were cabazitaxel (19%), cabazitaxel-carboplatin (12%), and enzalutamide (9%). Median duration of post-LuPSMA therapy was 2.4 months. Median overall survival was 8.0 (95% CI: 6.8-11.5) months overall and 6.8 (95% CI: 5.5-9.3) months in post-taxane subgroup (median 4 prior lines of therapy).
The study population reflects real-world LuPSMA use and includes a heterogeneous group of heavily pretreated patients. Systemic therapies after LuPSMA were primarily chemotherapy-based. The short duration of treatments and limited survival highlights the need for novel treatments and sequencing strategies in the post-LuPSMA setting.
Clinical genitourinary cancer. 2026 Jul 10 [Epub ahead of print]
Ben Tran, Tanya Dorff, Madeline Richey, Eunice Hankinson, Patrick Olsen, Smriti Karwa, Jason Sharpe, Megan Braunlin, Christopher Kim
Peter MacCallum Cancer Centre Department of Oncology, 305 Grattan Street, Melbourne, Victoria, 3000, Australia., City of Hope Department of Medical Oncology and Therapeutics Research, 1500 East Duarte Road, 91010, CA., Flatiron Health, 233 Spring St, 5th Floor, New York, NY, 10013., Amgen Center for Observational Research, Thousand Oaks, California, United States One Amgen Center Drive, CA 91320. Electronic address: ., Amgen Center for Observational Research, Thousand Oaks, California, United States One Amgen Center Drive, CA 91320.