Blood biomarker pinpoints patients for LuPSMA therapy in prostate cancer

A blood test is set to predict which advanced prostate cancer patients will respond to the radioligand therapy 177-Lutetium prostate-specific membrane antigen (LuPSMA). This development gains critical significance as Medicare funding for LuPSMA treatment in metastatic castrate-resistant prostate cancer (mCRPC) came into effect on 1 July.

The findings from the ANZUP TheraP trial revealed that patients exhibiting lower levels of circulating tumour DNA (ctDNA) experienced markedly better responses to intravenous Lutetium PSMA therapy compared to those receiving the standard chemotherapy, cabazitaxel.

“Unlike traditional approaches that rely on tissue biopsies, blood tests offer a contemporary, non-invasive snapshot of what’s happening in a patient’s body now, shaped by the cancer’s evolution in response to previous therapies,” explained medical oncologist, Dr Edmond Kwan, Eastern Health Clinical School and Monash Biomedicine Discovery Institute.

“This new approach could allow doctors and patients to select treatments that are more appropriate for a particular person, and reduce unnecessary exposure to side effects from a treatment less likely to give benefit. That is particularly important for patients from regional and rural areas, where Lutetium PSMA treatment may not be readily available and access might be difficult.”

Novartis’ radioligand therapy Pluvicto (¹⁷⁷Lu–PSMA-617) represents a new and effective option for treating mCRPC. However, this milestone has been somewhat overshadowed by a patent dispute in the Federal Court of Australia. The case, brought by Novartis subsidiary Endocyte against GenesisCare, was scheduled for hearing on 31 July before Justice Stephen Burley. It was dismissed by consent orders ahead of the hearing, with no public details yet released regarding settlement or discontinuance terms.

Professor Ian Davis, ANZUP Chair and joint senior author of the TheraP trial, highlighted the broader impact of the predictive genomic biomarker.

“A simple tool like this to help people choose the best treatment options for their cancer will reduce trial-and-error decision-making, improve the chance of optimal sequencing of treatments, and preserve scarce resources,” he said.

“Ultimately, we hope this clinical trial result leads to better outcomes for the estimated 72 Australians who are diagnosed with prostate cancer every day, and for the millions affected globally.”

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