Real-World Comparison of Cabazitaxel Versus177Lu-PSMA Radiopharmaceutical Therapy in Metastatic Castration-Resistant Prostate Cancer

作者：Mike Wenzel, Florestan Johannes Koll, Benedikt Hoeh, Clara Humke, Carolin Siech, Nicolai Mader, Amir Sabet, Daniel Groener, Thomas Steuber, Markus Graefen, Tobias Maurer, Christian Brandts, Séverine Banek, Felix K.‐H. Chun, Philipp Mandel · 发表于：Journal of Nuclear Medicine · 年份：2024 · DOI：10.2967/jnumed.124.268807 · 被引用次数：10 · 研究领域：Prostate Cancer Treatment and Research、Radiopharmaceutical Chemistry and Applications、Cancer, Lipids, and Metabolism

177Lu-vipivotide tetraxetan prostate-specific membrane antigen (177Lu-PSMA) therapy is under current scientific investigation and aims to become established in the treatment of metastatic castration-resistant prostate cancer (mCRPC). However, real-world evidence in treatment comparison is scant. Methods: We relied on the FRAMCAP database and compared cabazitaxel versus 177Lu-PSMA therapy in mCRPC patients regarding progression-free survival (PFS) and overall survival (OS). Sensitivity analyses addressed second- to fourth-line mCRPC treatment to approximate current phase III patient selection criteria. Results: Of 373 patients, 14% received cabazitaxel, 65% received 177Lu-PSMA, and 21% received both. Patients undergoing 177Lu-PSMA therapy were significantly older than cabazitaxel patients (median, 72 y vs. 66 y; P < 0.01), and a higher proportion had an Eastern Cooperative Oncology Group score of 2 or more (12% vs. 5.0%, P = 0.1). Rates of a prostate-specific antigen decline of at least 50% were 32% versus 0% for 177Lu-PSMA versus cabazitaxel. In outcome analyses, significant superior median PFS was observed for 177Lu-PSMA versus cabazitaxel (13.4 mo vs. 7.1 mo, P < 0.001), even after multivariable adjustment (hazard ratio, 0.38; P < 0.001). Regarding OS, rates also significantly differed, with median OS of 14.7 mo versus 16.5 mo versus 29.6 mo for cabazitaxel versus 177Lu-PSMA versus both treatments (P < 0.01). In sensitivity analyses of second- to fourth-line mCRPC treatment...