Pluvicto Treatment for Prostate Cancer

Pluvicto (lutetium Lu 177 vipivotide tetraxetan) is a targeted radioligand therapy that can be used to treat metastatic castration-resistant prostate cancer (mCRPC). Based on the results of the VISION trial, this groundbreaking radioactive medication is approved by the U.S. Food and Drug Administration (FDA) for patients who have prostate-specific membrane antigen (PSMA)-positive prostate cancer, as detected by a specialized PSMA positron emission tomography (PET) scan. Pluvicto may be a particularly good option for a patient whose cancer has spread beyond the prostate to other areas of the body despite hormone therapy, chemotherapy and other treatments.

How does Pluvicto work?

Pluvicto works by delivering radiation directly to prostate cancer cells. The medication consists of a radioactive component (lutetium-177) linked to a molecule that specifically binds to PSMA, a protein often found in high levels on the surface of prostate cancer cells. Pluvicto contains a PSMA-targeting ligand that binds specifically to these cells, ensuring that the treatment focuses on cancerous tissues rather than healthy cells.

Once Pluvicto binds to a PSMA-expressing cell, it delivers lutetium-177, a beta-emitting radioactive isotope. The radiation emitted by lutetium-177 can damage the DNA of cancer cells, preventing them from growing and dividing. This process can lead to cell death, reducing the size and spread of prostate tumors.

Because Pluvicto precisely targets PSMA-expressing cells, it spares most healthy tissues, minimizing the likelihood of side effects commonly seen with traditional chemotherapy or external radiation therapy. However, some normal tissues, such as the salivary glands, also express low levels of PSMA, which can sometimes cause mild side effects like dry mouth (xerostomia).

What does Pluvicto treatment for prostate cancer involve?

Before starting Pluvicto, the patient will undergo PSMA PET imaging to confirm that their prostate cancer cells express PSMA, which is necessary for the treatment to be effective. The physician will also evaluate the patient’s blood cell counts, kidney function and overall health to ensure they can tolerate the therapy.

Pluvicto is administered through intravenous (IV) infusion, typically once every six weeks for up to six cycles, depending on how well the patient responds. Each infusion takes approximately 30 to 60 minutes, during which the radiopharmaceutical circulates throughout the body, targeting and binding to PSMA-expressing cancer cells.

What are the risks and complications of Pluvicto for prostate cancer treatment?

Pluvicto has shown promising results in slowing prostate cancer progression and improving outcomes. However, it comes with potential risks and complications that the patient should be aware of.

Common side effects

Like many cancer treatments, Pluvicto can cause general side effects that may impact the patient’s daily life and overall well-being. These include:

• Fatigue – Many patients feel weak and tired after Pluvicto treatment.
• Nausea and vomiting – Some individuals may experience mild to moderate nausea, which can usually be managed with medications.
• Xerostomia – Radiation exposure to the salivary glands can cause dry mouth, leading to discomfort and difficulty swallowing.

Hematologic (blood-related) complications

Pluvicto can cause bone marrow suppression, reducing the body’s production of red blood cells, white blood cells and platelets. This may cause:

• Anemia – Fatigue and weakness can result from low red blood cell levels.
• Leukopenia – The risk of infection can increase due to low white blood cell levels.
• Thrombocytopenia – Excessive bleeding and bruising may occur due to low platelet levels.

Kidney- and bladder-related effects

The radioactive component of Pluvicto is processed and eliminated by the kidneys. For this reason, the treatment carries a risk of:

• Kidney damage – Pluvicto can reduce kidney function over time, especially in a patient with pre-existing kidney disease.
• Urinary issues – Some patients may experience urinary frequency or discomfort during urination.

Gastrointestinal symptoms

Pluvicto may cause digestive issues, which can affect the patient’s comfort and nutritional intake. Symptoms can include:

• Bowel changes – Persistent diarrhea or constipation is possible but can usually be managed with dietary adjustments or medications.
• Reduced appetite and weight loss – Some patients may experience loss of appetite, leading to unintended weight loss.

Radiation-related considerations

Because Pluvicto contains a radioactive component (lutetium-177), the patient must take steps to limit any radiation exposure to other people. Recommended safety precautions include:

• Avoiding close contact with others – The patient should limit interactions with other people, especially children and pregnant women, for a short period (approximately three to seven days) after each infusion.
• Staying well hydrated – The patient should drink plenty of water and other fluids to help flush the radiation out of their body.

Monitoring and management

To reduce the likelihood of serious complications, the patient will be closely monitored throughout the Pluvicto treatment process. This may include:

• Periodic blood work and kidney function monitoring – Blood testing can help the physician assess the patient’s response to treatment and detect any potential issues early.
• Dose adjustments and supportive care – If the side effects of Pluvicto treatment become severe or disruptive, the physician may adjust the dose or prescribe supportive therapies, such as medications or blood transfusions to boost blood cell production.

How effective is Pluvicto for prostate cancer treatment?

While Pluvicto is not a cure for prostate cancer, clinical trials have shown that it can help slow cancer progression, reduce the tumor burden and improve the outcome and quality of life for patients with advanced prostate cancer. That said, the potential risks and complications should be carefully considered and discussed with the physician before starting treatment.

Benefit from Pluvicto treatment for prostate cancer at Moffitt Cancer Center

Moffitt is proud to be among the first hospitals in the nation to offer Pluvicto, a first-in-kind treatment for cancer in general and prostate cancer in particular. The multispecialty team in our Radionuclide Therapy Program was heavily involved in the VISION trial, and we are enthusiastic about the FDA approval of Pluvicto, which represents a potentially life-changing form of precision medicine for certain men with advanced prostate cancer.

If you have questions about Pluvicto, you can request an appointment with a prostate cancer specialist in the Urologic Oncology Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.