Novartis recently announced the topline results from the Phase III Pluvicto prostate cancer trial. The addition of Pluvicto™ (lutetium (177Lu) vipivotide tetraxetan) to standard hormone therapy significantly improved radiographic progression-free survival (rPFS) for patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). It also indicated a positive trend in overall survival (OS).
This development marks Pluvicto’s third successful Phase III trial, following earlier approvals in metastatic castration-resistant prostate cancer (mCRPC). It positions Pluvicto as a potential game-changer for earlier stages of the disease. The company plans regulatory submissions in late 2025, aiming to broaden access to this treatment for a population with substantial unmet medical needs.
Impactful Findings and Trends
The success of the Pluvicto prostate cancer trial emphasizes the increasing significance of radioligand therapies (RLTs) in oncology, particularly for targeting PSMA-expressing prostate cancers. Pluvicto’s unique mechanism delivers beta radiation directly to cancer cells via PSMA-binding ligands. It has demonstrated efficacy across the disease continuum, extending from mCRPC (post-chemotherapy and androgen receptor pathway inhibitor [ARPI] failure) to mHSPC. The rPFS benefit, alongside a manageable safety profile, indicates that Pluvicto could effectively delay progression to castration-resistant disease. This is a common outcome for nearly all mHSPC patients. This aligns with broader trends in precision oncology, where therapies targeted via biomarkers aim to reduce reliance on non-selective approaches like chemotherapy.
Background Context and Epidemiological Burden
Prostate cancer continues to be a leading cause of male cancer mortality. Projections for 2025 indicate 313,000 new cases and 35,000 deaths in the U.S. While localized cases exhibit a 97% five-year survival rate, metastatic cases, especially mCRPC, demonstrate a significantly lower survival rate of 36.6% at five years. The shift towards the earlier application of advanced therapies reflects necessary efforts to change this grim trajectory. Notably, the 2023 PSMAfore trial led to Pluvicto’s FDA approval in pre-chemotherapy mCRPC. The recent results from the PSMAddition trial may further extend its use to mHSPC. The global economic burden of prostate cancer is significant, with North America facing the highest costs relative to GDP, estimated at 0.83% annually.
Health Economics and Market Access Considerations
The high cost of Pluvicto—approximately $52,000 per dose in the U.S., with six doses required for a full treatment course—raises important considerations regarding cost-effectiveness and equitable access. The Australian Medical Services Advisory Committee (MSAC) accepted an incremental cost-effectiveness ratio (ICER) of around $100,000 per quality-adjusted life year (QALY) for mCRPC. It acknowledged the high clinical need and patient preference. However, the U.K.’s National Institute for Health and Care Excellence (NICE) initially declined to recommend reimbursement due to doubts about the cost-effectiveness of Pluvicto compared to alternatives like cabazitaxel. Similar discussions are anticipated for mHSPC, where longer treatment durations and earlier intervention could amplify both the clinical advantages and associated costs.
Conclusion
The expansion of Pluvicto into the mHSPC setting signifies a transformative shift in managing prostate cancer, advocating for early intervention with targeted therapies. While the clinical advantages are evident, health systems must address the cost-effectiveness of treatment options, operational challenges in RLT delivery, and equity issues. Collaborative frameworks that balance innovation incentives with affordability will be essential to maximizing patient access and achieving a broader impact on population health. For further information, you can view the full details of the press release here.
