ASCO GU 2022: Community Oncologists’ Perceptions of and Barriers To Access for 177LU-PSMA-617 in Metastatic Castration-Resistant Prostate Cancer

( On the first day of the American Society for Clinical Oncology (ASCO) Genitourinary Cancer Symposium 2022, Poster Session A focussed on the care of patients with prostate cancer. Dr. Garja presented a poster focused on understanding how community-based medical oncologists plan to integrate 177Lu-PSMA-617 into patient management. As of June 2021, 177Lu-PSMA-617 was granted U.S. FDA breakthrough designation for the treatment of metastatic castration-resistant prostate cancer (mCRPC) on the basis of the results from the phase III VISION trial, demonstrating a 4-month increased median overall survival (15.3 v 11.3 months; HR 0.62 [0.52-0.74], P< 0.001) and a 5.3-month increased radiographic progression-free survival (8.7 v 3.4 months; HR 0.40 [0.29-0.57] for 177Lu-PSMA-617 versus standard of care (SOC). However, how 177Lu-PSMA-617 approval will affect the treatment landscape of mCRPC depends on how community-based medical oncologists uptake this new treatment approach.

To better understand this, the authors invited practicing U.S.-based community-based medical oncologists to a virtual meeting between June and October 2021. In this meeting, they were presented with the data from the VISION trial and their reactions to the data and preferences were collected using audience response technology.

A total of 287 community-based medical oncologists participated in this process. Their median time in practice was 17 years (range 1-45). These clinicians spend the vast majority of their time in direct patients care (median 90%, range 20-100%). In the past year, 46% of community-based medical oncologists managed 6-15 patients with mCRPC while and 27% managed 16 or more. The participating community-based medical oncologists reported that at the time of referral, their patients with mCRPC had commonly been treated with androgen deprivation therapy (77%) and one (49%) or two or more (20%) novel hormonal agents.


After being presented with the data from the VISION trial demonstrating improved outcomes among patients treated with 177Lu-PSMA-617, 51% of participating community-based medical oncologists reported that both the safety and efficacy data were compelling, and they were very likely to prescribe 177Lu-PSMA-617 if approved while 33% indicated that the efficacy data alone was compelling and were likely to prescribe 177Lu-PSMA-617.


In terms of limitations of the VISION trial, respondents highlighted the requirement for PSMA gallium positivity for eligibility (54%) and the disallowance of radium-223 on the SOC arm (48%), among other factors.


Regarding perceived barriers to future use of 177Lu-PSMA-617, the availability/requirement for PSMA-gallium scan (68%) and availability of therapy (64%) were the two most cited issues. However, others including cost, reimbursement, and others were also noted, highlighting the importance of addressing access and financial considerations associated with 177Lu-PSMA-617.


In summary, Dr. Gajra concluded that most community-based medical oncologists found the data from VISION compelling and were likely to prescribe 177Lu-PSMA-617 in mCRPC. However, there remain major barriers to its widespread adoption, many of which relate to the health system, rather than clinical details.

Presented by: Ajeet Gajra FACP, MD, Cardinal Health, Dublin, OH

Written By: Christopher J.D. Wallis, MD, Ph.D., Assistant Professor in the Division of Urology at the University of Toronto, @WallisCJD on Twitter during the 2022 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Thursday Feb 17 – Saturday Feb 19, 2022  


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