This interview is part four of a roundtable led by Dr. Daniel George, Professor of Medicine, and Surgery in the Duke Cancer Institute, featuring Dr. Oliver Sartor, Medical Director of the Tulane Cancer Center; Dr. Preston C. Sprenkle, urologic surgeon and a urologic oncologist at Yale University; and Dr. Rana McKay, GU medical oncologist at the University of California-San Diego.

In this segment, Dr. Sartor gave his honest take on Lutetium-177 PSMA as a treatment. The basis: Some patients respond well to it; others don’t. However, Dr. Sartor noted that while no therapy is “perfect”, Lutetium-177 is a good therapy.

Dr. Daniel George:

Oliver, you put a lot of patients on the VISION study. Does this data really kind of recapitulate your own experiences from that study?

Dr. Oliver Sartor:

You know, it’s kind of interesting. I’m not sure it does, Dan. When you start doing the health-related quality of life and follow the parameters — FECP, EQ-5D, and those sort of things — a lot of the questions are not necessarily relevant for how the patient feels day-to-day. I’ll simply say that some of the patients really did feel much better, even though we didn’t really functionally measure that in a formal way.

One of the things that’s potentially missing from a health-related quality of life is something as important as analgesic consumption. What happens if you’re taking something like an oxycodone three or four times a day, and then you’re taking it once or twice a week? That’s not necessarily well captured here.

I’ll simply say that some of the patients do extremely well, and, of course, others don’t. That’s part of the art and the science that we need to press forward now. I’m very interested in like, who’s really going to be a responder? Who’s really going to be resistant?

In fact, because I just finished putting in a proposal earlier today — or I should say working on a proposal in which we’re trying to be able to predict this — I’ll simply say that the dosimetry, and the uptake in the PSMA PET scan, yes, that’s important. But there’s much more to the story.

So, a little bit of a long answer to your short question is, I’m not sure that all the surveys fully capture what we need to measure. I think Rana said that as well. Some of the patients do well. Others don’t. I don’t really want to sort out who’s going to do better, who’s going to do worse, because we always need more therapies. I mean, no therapy is perfect. And this is another example of a good therapy, but it’s certainly not perfect.

Dr. George:

I think that’s exactly right. I mean, when you look at these median kind of effects, it’s really kind of diluting to some extent these extraordinary responders that we see, and it’s really being mitigated by some of the folks that aren’t going to respond.

As Rana said, this is a really refractory population that we’re dealing with. So, I think that the fact that we see any signals here at all is really encouraging for this really pretty diffuse patient population, heterogeneous patient population, and pretty refractory patient population.

Watch part five of the roundtable segment to learn about the limitations and advantages of lutetium-177-PSMA.

In additional segments, the panel discusses an overview of lutetium-177-PSMA and the VISION study, PSMA PET scans, palliative benefits of lutetium-177-PSMA, and additional PSMA therapies being studied.