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Zachary Klaassen: Hi, my name is Zach Klaassen, Urologic Oncologist. I'm with UroToday at GU ASCO 2025 in San Francisco. We're discussing some really interesting data on the platform. Today I'm joined by Dr. Oliver Sartor, who is a Medical Oncologist at Mayo, Rochester. Oliver, thanks so much for joining us today.

Oliver Sartor: Thank you, Zach. Glad to be here.

Zachary Klaassen: So we're going to be discussing a really cool new data set that maybe some people haven't heard about yet, called the PRECISION Data Platform. And there's a lot of nuances to all the questions you guys can ask using this data set. Specifically, we're going to talk today about what do people get after Lutetium-617 radioligand therapy. So before we get into that, maybe just a brief intro as to how many patients are in this data set, what it's looking at exactly.

Oliver Sartor: Yeah. So first of all, let me back up. It turns out to be about 500 practices, both urology and medical oncology, both academic and community sites. So really broad representation. And for advanced prostate cancers, over 65,000 patients. So it's really a lot of patients. Of those, there are about 18,000 in the metastatic CRPC. And by the way, it's almost equally divided in metastatic CRPC between urology, medical oncology.

Now, the follow-up is relatively brief right now. We're talking really only starting in 2022, data cutoff 2024, median follow-up about 17 months. So there's a lot of things that are going. By the way, just as an insight, we already have some data on the overall survival median for metastatic CRPC: it's about 29 months. So it is good. So brand new registry. Lots of patients. Starting to drill down. Starting to get some specific questions. We're going to learn a lot from this registry over the next couple of years.

Zachary Klaassen: And I think this is a perfect question that you guys asked, looking at—obviously, of those 18,000 mCRPC patients—taking the lutetium patients and then seeing what they got afterwards. And as we know, each year there's going to be more patients, more data, more follow-up. So that cohort will grow. But just set up how you guys looked at that specific question for looking at post-lutetium therapy.

Oliver Sartor: Yeah. So first of all, we had to determine a lutetium start and stop date. And then after lutetium was stopped, we started to look at what therapies were taken after the lutetium was stopped. So what we have is a little snapshot in time.

Now, we don't have 18,000 of these patients. We're only talking about a couple hundred here, because there's an evolution in time with the FDA approval, with Pluvicto beginning to get into the mainstream. We don't have a lot of follow-up. But what they asked is a very important question.

And by the way, I don't want to delve into it now, but I want to mention the PSMAfore trial, which will make this post-Pluvicto space even larger. And if we get that FDA approval in the taxane-naive space, this is going to explode into a really important topic. But as it stands now, they're looking at ARPI use, taxane use, post-Pluvicto. So I'll cut it off there and back to you and let you probe.

Zachary Klaassen: That's perfect. So I think we know from VISION that we have approval, we have overall survival benefit with Pluvicto in that space. But what happens to these patients after? What did you guys see? What are they getting? What are they receiving?

Oliver Sartor: It's interesting. They're continuing to have use of the ARPIs, and they're getting some taxanes as well. And that's kind of what you expect. Now, if we go beyond the taxane and ARPIs—which might include, say, radium or PARP inhibitors—it's not a lot. So those are probably being used in the pre-Pluvicto space, if you will. But between the ARPIs and the taxanes, actually some of the patients are responding.

We just have kind of PSA data right now. We don't have a lot of data to really be able to talk about. But a substantial proportion of patients can get a taxane, respond to a taxane, get an ARPI, respond to an ARPI. And so I think that's kind of the good news: there is therapy beyond the PSMA-617 lutetium.

But to go back to the point I said a little bit earlier, we're in front of the FDA in February 2025 for the consideration of the PSMAfore space, which is taxane-naive. If you go before the taxane, still metastatic CRPC, post-dated ARPI, then you're going to have a bigger space that is going to occur in the post-PSMA treatment space.

So this is going to be extremely interesting to watch over time, and we'll have more duration of follow-up. And then we'll end up having overall survival data. We'll have the PSA data in more detail. And then we'll get to sequencing, which we don't really have a lot about now. So there's a lot we're going to learn.

Zachary Klaassen: It's a great dovetail to my next question, because I think as we look at mCRPC over the last, let's say, three to five years, there's been a ton of activity. We're still figuring out how to use it. Some of that's laid out for us with the VISION criteria. But I could see if we're having this conversation in three years, and you've got way more patients, way more follow-up, we could really learn something in a real-world setting—a robust real-world setting—about how do we sequence these patients, at least on a general basis? Could you see that happening? Is that sort of something you guys are looking to look at?

Oliver Sartor: Absolutely. And I like the term you used, robust. I mean, we're talking about a huge number of practices, basically 500 different practices contributing, 18,000 patients today. So this is robust. Then we're going to be able to look at the individual treatment sequences. We're going to be able to look at when are people going to be getting the PSMA lutetium, how it's sequenced relative to docetaxel, cabazitaxel. Probably we'll have more PARP inhibitor data. And then we'll be able to look at the pre-PSMA lutetium patients, as well as the post-PSMA lutetium patients, put together some timeline sequences, and probably pick up some practice patterns that’ll be really interesting, and outcomes. So this is a cool database. We're going to learn a lot from it.

Zachary Klaassen: Absolutely. Great conversation. Appreciate your time as always. Maybe just a couple take-home messages for our listeners, either on PRECISION or the specific question we're talking about looking at sequencing.

Oliver Sartor: Yeah. So PRECISION: big, robust—your term—database incorporating 500-plus practices and now gaining more and more longitudinal follow-up. Keep an eye on the PRECISION database. We're going to have some good outputs coming in the future.

Second of all, thinking about the use of PSMA lutetium today in what I call the VISION space, but anticipating that maybe there’ll be a different space—maybe the PSMAfore space, the pre-taxane patient, if you will, in the future. And looking at these sequences, and maybe even combinations and outcomes, I think we have a lot to learn.

Zachary Klaassen: Absolutely. We'll be on the lookout for it. Thanks so much, Oliver.

Oliver Sartor: Thank you, Zach.