Cited by 125Prostate Cancer Treatment and ResearchRadiopharmaceutical Chemistry and ApplicationsProstate Cancer Diagnosis and Treatment

The DOI matches its Crossref record; 33 of the 34 references it cites were found in a registry or an index; none of the 11 sources its claims cite is checked for support yet.

Health-related quality of life and pain outcomes with [177Lu]Lu-PSMA-617 plus standard of care versus standard of care in patients with metastatic castration-resistant prostate cancer (VISION): a multicentre, open-label, randomised, phase 3 trial

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Abstract

Background In VISION, the prostate-specific membrane antigen (PSMA)-targeted radioligand therapy lutetium-177 [177 Lu]Lu-PSMA-617 (vipivotide tetraxetan) improved radiographic progression-free survival and overall survival when added to protocol-permitted standard of care in patients with metastatic castration-resistant prostate cancer. Here, we report additional health-related quality of life (HRQOL), pain, and symptomatic skeletal event results.Methods This multicentre, open-label, randomised, phase 3 trial was conducted at 84 cancer centres in nine countries in North America and Europe. Eligible patients were aged 18 years or older; had progressive PSMA-positive metastatic castration-resistant prostate cancer; an Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2; and had previously received of at least one androgen receptor pathway inhibitor and one or two taxane-containing regimens. Patients were randomly assigned (2:1) to receive either [177 Lu]Lu-PSMA-617 plus protocol-permitted standard of care ([177 Lu]Lu-PSMA-617 group) or standard of care alone (control group) using permuted blocks. Randomisation was stratified by baseline lactate dehydrogenase concentration, liver metastases, ECOG performance status, and androgen receptor pathway inhibitor inclusion in standard of care. Patients in the [177 Lu]Lu-PSMA-617 group received intravenous infusions of 7·4 gigabecquerel (GBq; 200 millicurie [mCi]) [177 Lu]Lu-PSMA-617 every 6 weeks for four cycles plus two optional additional cycles. Standard of care included approved hormonal treatments, bisphosphonates, and radiotherapy. The alternate primary endpoints were radiographic progression-free survival and overall survival, which have been reported. Here we report the key secondary endpoint of time to first symptomatic skeletal event, and other secondary endpoints of HRQOL assessed with the Functional Assessment of Cancer Therapy-Prostate (FACT-P) and EQ-5D-5L, and pain assessed with the Brief Pain Inventory-Short Form (BPI-SF). Patient-reported outcomes and symptomatic skeletal events were analysed in all patients who were randomly assigned after implementation of measures designed to reduce the dropout rate in the control group (on or after March 5, 2019), and safety was analysed according to treatment received in all patients who received at least one dose of treatment. This trial is registered with ClinicalTrials.gov, NCT03511664, and is active but not recruiting.Findings Between June 4, 2018, and Oct 23, 2019, 831 patients were enrolled, of whom 581 were randomly assigned to the [177 Lu]Lu-PSMA-617 group (n=385) or control group (n=196) on or after March 5, 2019, and were included in analyses of HRQOL, pain, and time to first symptomatic skeletal event. The median age of patients was 71 years (IQR 65-75) in the [177 Lu]Lu-PSMA-617 group and 72·0 years (66-76) in the control group. Median time to first symptomatic skeletal event or death was 11·5 months (95% CI 10·3-13·2) in the [177 Lu]Lu-PSMA-617 group and 6·8 months (5·2-8·5) in the control group (hazard ratio [HR] 0·50, 95% CI 0·40-0·62). Time to worsening was delayed in the [177 Lu]Lu-PSMA-617 group versus the control group for FACT-P score (HR 0·54, 0·45-0·66) and subdomains, BPI-SF pain intensity score (0·52, 0·42-0·63), and EQ-5D-5L utility score (0·65, 0·54-0·78). Grade 3 or 4 haematological adverse events included decreased haemoglobin (80 [15%] of 529 assessable patients who received [177 Lu]Lu-PSMA-617 plus standard of care vs 13 [6%] of 205 who received standard of care only), lymphocyte concentrations (269 [51%] vs 39 [19%]), and platelet counts (49 [9%] vs five [2%]). Treatment-related adverse events leading to death occurred in five (1%) patients who received [177 Lu]Lu-PSMA-617 plus standard of care (pancytopenia [n=2], bone marrow failure [n=1], subdural haematoma [n=1], and intracranial haemorrhage [n=1]) and no patients who received standard of care only.Interpretation [177 Lu]Lu-PSMA-617 plus standard of care delayed time to worsening in HRQOL and time to skeletal events compared with standard of care alone. These findings support the use of [177 Lu]Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer who received previous androgen receptor pathway inhibitor and taxane treatment.Funding Advanced Accelerator Applications (Novartis).

Overview

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Crossref · 10.1016/s1470-2045(23)00158-4

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  • It may state two separate claims as one. 14
  • Probably not a substantial claim. 11
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  • The authors state this as an assumption.

    Patients who did not complete questionnaires because they died or experienced disease progression were assumed to have worsened in health-related quality of life and pain.

    “Death and disease progression were included in the prespecified composite endpoints of HRQoL and pain worsening, which were therefore assumed to have worsened in patients who did not complete questionnaires because they died or experienced disease progression.”
  • The paper relies on this without support.

    The VISION population was heavily pre-treated with short remaining life expectancy, so deterioration in health-related quality of life and pain was likely to manifest within the follow-up time.

    “The VISION population was heavily pre-treated with short remaining life expectancy, so deterioration in HRQoL and pain was likely to manifest within the follow-up time.”
  • The paper relies on this without support.

    Patients with advanced and highly pre-treated metastatic castration-resistant prostate cancer inevitably experience declining health-related quality of life and death.

    “Sustained worsening was not assessed in VISION because of the relatively long interval between PRO assessments (6 or 12 weeks), and because of inevitable declining HRQoL and death in patients with advanced and highly pre-treated mCRPC.”
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Metadata

Authors
Fizazi, K., Herrmann, K., Krause, B. J., Rahbar, K., Chi, K. N., Morris, M. J., Sartor, O., Tagawa, S. T., Kendi, A. T., Vogelzang, N., Calais, J., Nagarajah, J., Wei, X. X., Koshkin, V. S., Beauregard, J.-M., Chang, B., Ghouse, R., DeSilvio, M., Messmann, R. A., & de Bono, J.
Affiliations
  • Université Paris-Saclay (FR)
  • Essen University Hospital (DE)
  • Universitätsmedizin Rostock (DE)
  • University Hospital Münster (DE)
  • BC Cancer Agency (CA)
  • Memorial Sloan Kettering Cancer Center (US)
  • Tulane University (US)
  • Weill Cornell Medicine (US)
  • Mayo Clinic (US)
  • Comprehensive Cancer Centers of Nevada (US)
  • Radboud University Medical Center (NL)
  • Dana-Farber Cancer Institute (US)
  • University of California, San Francisco (US)
  • CHU de Québec-Université Laval (CA)
  • Radiation Oncology Associates (US)
  • Novartis (Switzerland) (CH)
  • Novartis (United States) (US)
Corresponding author
Fizazi, Karim
Venue
The Lancet Oncology
Publisher
Elsevier BV
Published
2023-06
Volume
24
Issue
6
Pages
597-610
ISSN
1470-2045 (ISSN-L)
OpenAlex
W4378800385
Cited by
125
References
34
Citations by year
2026: 32 · 2025: 43 · 2024: 41 · 2023: 9
FWCI
23.03
Type
journal article
Language
en
Open access
Locations
  • The Lancet Oncology (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
Funders
  • Novartis
  • Advanced Accelerator Applications SA
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Prostate Cancer Treatment and Research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiopharmaceutical Chemistry and Applications
  • Health Sciences › Medicine › Urology › Prostate Cancer Diagnosis and Treatment
Keywords
177Lu-PSMA-617, PSMA radioligand therapy, metastatic castration-resistant prostate cancer, health-related quality of life, pain, FACT-P, EQ-5D-5L, Brief Pain Inventory, treatment-related adverse events
MeSH terms
Aged, Antineoplastic Combined Chemotherapy Protocols, Bridged-Ring Compounds, Dipeptides, Heterocyclic Compounds, 1-Ring, Humans, Male, Pain, Quality of Life, Receptors, Androgen, Prostate-Specific Antigen, Taxoids, Androgen Receptor Antagonists, Standard of Care, Prostatic Neoplasms, Castration-Resistant

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