From the Guidelines
For patients with castration-resistant prostate cancer, Docetaxel is the preferred initial treatment option, while Lutetium-177 (Lu-177) is considered for patients with PSMA-positive metastatic disease who have progressed after androgen receptor pathway inhibitors and taxane chemotherapy. The decision between these two treatments depends on several factors, including disease characteristics, prior treatments, comorbidities, and patient preferences.
- Docetaxel (75 mg/m² every 3 weeks with prednisone 5 mg twice daily) remains a standard first-line chemotherapy option, particularly for patients with high-volume disease, visceral metastases, or rapid progression 1.
- Lu-177-PSMA therapy is often preferred for patients with PSMA-positive metastatic castration-resistant prostate cancer who have progressed after androgen receptor pathway inhibitors and taxane chemotherapy, due to its targeted approach and favorable side effect profile 1.
- Treatment sequencing is important, with Docetaxel typically used earlier in the disease course, while Lu-177 is often reserved for later lines of therapy after chemotherapy has been tried.
- Both treatments require careful monitoring for side effects, with Lu-177 potentially causing dry mouth, fatigue, and bone marrow suppression, while Docetaxel commonly causes neuropathy, fatigue, and more severe bone marrow suppression.
- The choice between Lu-177 and Docetaxel should be individualized based on patient-specific factors, including prior treatments, disease characteristics, and patient preferences, as supported by the NCCN guidelines 1.
From the FDA Drug Label
- 3 Prostate Cancer Docetaxel Injection in combination with prednisone is indicated for the treatment of patients with metastatic castration-resistant prostate cancer. There is no information about Lutetium-177 (Lu 177) in the provided drug label.
- The label only discusses the use of Docetaxel in combination with prednisone for metastatic castration-resistant prostate cancer.
- No comparison or mention of Lutetium-177 (Lu 177) is made in the label. The FDA drug label does not answer the question.
From the Research
Treatment Options for Castration-Resistant Prostate Cancer
When prostate cancer becomes castration-resistant, treatment options such as Lutetium-177 (Lu 177) and Docetaxel are considered. The choice between these two treatments depends on various factors, including the patient's overall health, the extent of the disease, and previous treatments.
Comparison of Lu 177 and Docetaxel
- Lu 177, also known as Lutetium-177-PSMA-617, is a radioligand therapy that targets prostate-specific membrane antigen (PSMA)-expressing cells 2.
- Docetaxel is a chemotherapy drug that has been used to treat various types of cancer, including prostate cancer 3.
- A phase 2 randomized, controlled trial compared Lu 177 with Docetaxel in chemotherapy-naïve metastatic castration-resistant prostate cancer patients and found that the overall survival rates were similar between the two groups 4.
Efficacy and Safety of Lu 177
- Lu 177 has been shown to prolong imaging-based progression-free survival and overall survival in patients with advanced PSMA-positive metastatic castration-resistant prostate cancer 2.
- The incidence of adverse events of grade 3 or above was higher with Lu 177 than with standard care, but quality of life was not adversely affected 2.
- Real-world outcomes of Lu 177 treatment have shown that a prostate-specific antigen (PSA) decrease of ≥30% after the first two cycles is an early marker of response and can be used to personalize treatments for patients 5.
Considerations for Treatment Sequencing
- The optimal treatment sequence for metastatic castration-resistant prostate cancer must be considered, as cross-resistance may occur between different treatments 3.
- The sequential administration of androgen receptor-signaling inhibitors (ARSIs) and docetaxel may be associated with limited efficacy, and the use of Lu 177 may be considered as an alternative or additional treatment option 3.