Dr. Ravi on the increased burden of the 177Lu-PSMA-617 shortage for newly referred patients

"Where it's feasible and where the patients are eligible, I and others are trying to use alternative therapies, which have probably a similar impact in terms of improving longevity of life for patients [with prostate cancer]," says Praful Ravi, MD, BChir, MRCP.

In this interview, Praful Ravi, MD, BChir, MRCP, discusses the impact of the ongoing 177Lu-PSMA-617 (Pluvicto) shortage in the United States. Ravi is a medical oncologist at the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute in Boston, Massachusetts.

Video Transcript:

In terms of patient care, the shortage obviously [affects] clinical decision-making. We have patients who are eligible for Lutetium per the FDA label and per the VISION criteria and meeting the trial requirements and eligibility, but unfortunately, we're not able to start them on treatment. The shortage is currently predominantly affecting new patients, patients newly referred for this treatment, or potentially eligible. Existing patients who have already started their treatment are generally being on the whole, less affected, although some have still been affected in terms of delays, but it's really the new patients. Some of these patients newly referred don't have any other proven therapies remaining. All other therapies have failed them. This is the only one on the shelf that has a proven benefit. Unfortunately, we can't offer them that at this stage.

So clearly, we're trying to think about what can we do? Are there alternatives? Some people, they may have other alternatives. I think it's very important for the community to realize that [although] the label for Lutetium is having just had 1 prior chemotherapy and 1 prior novel hormone agent, there are other chemotherapies and hormone agents and other classes of therapy, including, for example, radium, which are available, as well, which all have a proven benefit in terms of prolonging life. So, where it's feasible, and where the patients are eligible, I and others are trying to use alternative therapies, which have probably a similar impact in terms of improving longevity of life for patients. It's really for those patients who've been through everything, and we don't have anything else left. They're the ones really impacted.

I'll also say clinical trials are a big thing. [Although] not all trials are beneficial for everyone, some patients do benefit from trial drugs, from experimental drugs. We're always trying to look out for clinical trials that someone might be eligible for. It's really all about sequencing and buying time and adding each agent, adding a little bit of time. If you string all those out, then you can make that time longer. It's really trying to think about alternatives, trying to think about clinical trials, trying to think what else have they been through? What have they been through in the past? Can we use similar or the same drugs again? And really, that's how we decide how we are managing this in clinic.

This transcription has been edited for clarity.

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