Next-Generation Imaging

"We are very pleased to have reached our recruitment target for the COBRA trial. The data generated thus far on the SAR-bisPSMA product is very encouraging and shows high uptake of the agent by prostate cancer cells,” said Neal Shore, MD.

Benjamin Lowentritt, MD, discusses how the phase 3 SPOTLIGHT trial showed the efficacy of the PSMA-PET imaging agent 18F-rhPSMA-7.3 PET across a variety of subgroups in prostate cancer.

“This study is one of the most highly anticipated of all of the metastatic hormone-sensitive setting trials that we have going on at this time,” says Alicia Morgans, MD, MPH.

MRI-guided SBRT reduced both acute toxicity effects and decrements in quality-of-life measures when compared with CT-guided SBRT, according to findings published in JAMA Oncology.

“There are a slew of ongoing trials looking at 177Lu-PSMA-617 in earlier stages of disease,” says Praful Ravi, MB, BChir, MRCP.

“We have to remember that this is not a cure for prostate cancer…right now, it is another tool in the toolbox,” says Praful Ravi, MB, BChir, MRCP.

The SPLASH trial is examining PNT2002 in patients whose tumors express PSMA and who have experienced disease progression on an androgen receptor axis–targeted therapy.

As the year comes to a close, we revisit some of this year’s top content on next-generation imaging.

“We now have convincing evidence that these tests help identify more sites of prostate cancer," said Michael Leapman, MD.

Using MRI-directed targeted biopsy instead of systematic biopsy for screening and early detection in patients with an elevated PSA lowered the risk of overdiagnosis by half.

64Cu-SAR-bisPSMA was, “safe, well tolerated, and efficacious in detecting primary prostate cancer,” according to developer Clarity Pharmaceuticals.

“In terms of both numbers of centers [administering radionuclides] as well as the amount of drug that’s available, [both] are going to increase over the next several months and certainly, year,” says Scott T. Tagawa, MD, MS, FACP.

177Lu-PSMA-617 is approved for the treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer in the post androgen receptor pathway inhibition, post taxane-based chemotherapy setting.

Emerging research includes combining radionuclides with other agents and exploring novel approaches to targeting PSMA, such as antibodies.

“MRI-based screening showed lower proportions of screening-positive cases, lower false positive rates, and higher PPVs [positive predictive values] than those of PSA-based screening,” noted Taek Min Kim, MD.

According to Novartis, the developer of 177Lu-PSMA-617, the PSMAfore study is the first clinical trial of a PSMA-targeted radioligand therapy to demonstrate a clinically meaningful benefit in the pre–taxane-based chemotherapy mCRPC setting.

"The idea that we may have reliable and consistently interpretable tests for these patients is exciting for the future," says Benjamin Lowentritt, MD, FACS.

“As the PSMA-PET market for access has grown, the coverage has actually been better than we anticipated when it first launched,” says David Morris, MD.

“PSMA scanning is definitely a game-changer with regard to imaging in advanced prostate cancer in urology,” says Evan R. Goldfischer, MD.

177Lu-PSMA-617 is approved by the FDA for the treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer in the post androgen receptor pathway inhibition, post taxane-based chemotherapy setting.

The co-primary end points have been achieved in the phase 3 ZIRCON trial exploring the novel PET imaging radiopharmaceutical TLX250-CDx in clear cell renal cell carcinoma.

64Cu SAR-Bombesin targets the Gastrin Releasing Peptide receptor, which is found on prostate tumors as well as several other tumors.

"During treatment with 177Lu-PSMA-617, patients should be counseled to increase oral fluid intake and to void frequently to reduce bladder radiation exposure," writes Stephanie Trexler, PharmD, BCOP.

New findings from the phase 3 SPOTLIGHT trial show the impact of PSA level, PSA doubling time, Gleason score, and prior therapy on 18F-rhPSMA-7.3 detection rates.

A recent study suggests that radiomics analysis based on 68Ga-PSMA-11 PET may non-invasively predict intraprostatic lesions in patients with prostate cancer.

Illuccix is indicated for use in patients with suspected metastasis who are candidates for initial definitive therapy, or in patients with suspected recurrence based on elevated PSA level.

“I think that we’re going to see more and more advances in how we use mpMRI from a pre-treatment planning perspective,” William P. Parker, MD.

The target of 64Cu SAR-Bombesin is the Gastrin Releasing Peptide receptor, which is found on prostate tumors as well as several other tumors.

“From a screening perspective, mpMRI really has changed how we evaluate men at risk for prostate cancer. It has improved the selection of men for biopsy and certainly improved our diagnostic rates,” says William P. Parker, MD.

"HP 13C MRI provides a quick five-minute, non-radioactive, metabolic imaging add-on exam to standard-of-care MRI that, in conjunction with guided biopsies, has great potential to improve the care of prostate cancer patients,” said Robert Bok, MD, PhD.