A promising new approach using targeted radioactive drugs, known as radioligand therapy (RLT), is being integrated into the treatment plans for men with metastatic prostate cancer.
According to Dr. Praful Ravi, a medical oncologist at the Dana-Farber Cancer Institute, these therapies are now a key piece on the treatment chessboard. He explains that they are increasingly used in combination with existing hormonal treatments to improve patient outcomes.
Dr. Ravi breaks down the current treatment landscape into three main categories. The first is hormonal agents, called androgen receptor pathway inhibitors (ARPIs). The second is taxane-based chemotherapy. The third is radioligand therapy (RLT).
For patients whose cancer is still sensitive to hormone therapy, the first-line treatment typically involves hormone-blocking drugs (ADT) combined with an ARPI. Sometimes chemotherapy is added. RLT is usually considered later, after the first treatment has stopped working.
Emerging research now suggests that using RLT and ARPIs together could be more effective than using RLT alone. Dr. Ravi points to a follow-up analysis from the large VISION clinical trial. That analysis showed that patients who received the RLT drug ¹⁷⁷Lu-PSMA-617 at the same time as an ARPI had better outcomes.
Additional data from a smaller study, called ENZA-p, hinted that ARPI drugs might actually make cancer cells more visible to the RLT, potentially enhancing its effect.
Based on this growing evidence, Dr. Ravi has adjusted his own clinical practice. If a patient is already taking an ARPI and needs to start RLT, he now often continues the ARPI. He makes this decision if the patient is not experiencing significant side effects and can afford the combined cost. The goal is to maximize the treatment’s benefit.
The future of this approach looks active. Dr. Ravi notes that several ongoing clinical trials are now formally testing RLT-based combinations. These studies, including some at his own institution, aim to find the best ways to use these powerful therapies to further improve survival and quality of life for men with prostate cancer.
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