REAL-WORLD COMPARATIVE EFFECTIVENESS OF LUTETIUM-177-PSMA-617 VERSUS CABAZITAXEL FOR METASTATIC CASTRATION-RESISTANT PROSTATE CANCER
Author(s)
Ifechukwu B. Nwogu, MPH1, Noemi Kreif, MA, MSc, PhD1, Hiba Khan, MD, MPH2, Ruth Etzioni, MSc, PhD3, Josh J. Carlson, MPH, PhD1;
1University of Washington, Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, Seattle, WA, USA, 2University of Washington School of Medicine, Division of Hematology and Oncology, Seattle, WA, USA, 3Fred Hutch Cancer Cancer, Seattle, WA, USA
1University of Washington, Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, Seattle, WA, USA, 2University of Washington School of Medicine, Division of Hematology and Oncology, Seattle, WA, USA, 3Fred Hutch Cancer Cancer, Seattle, WA, USA
OBJECTIVES: While Lutetium-177-PSMA-617 (Lu-PSMA) is a novel radioligand therapy approved for metastatic castration-resistant prostate cancer (mCRPC) patients with PSMA-avid disease, the pivotal VISION clinical trial lacked a clinically relevant comparator, and real-world evidence remains limited. This study compared Lu-PSMA versus cabazitaxel in patients previously treated with docetaxel and at least one androgen receptor pathway inhibitor (ARPI).
METHODS: Using the Komodo Health Claims Database, we identified men aged ≥18 years diagnosed with mCRPC who received Lu-PSMA or cabazitaxel between January 2022 and June 2024. Patients were required to have prior treatment with docetaxel and one or more ARPI (abiraterone, apalutamide, enzalutamide, or darolutamide) before index treatment. Patients with other cancer types were excluded. Follow-up extended through June 2025. Primary outcomes included overall survival (OS; time from index treatment to death) and progression-free survival (PFS; time to new systemic mCRPC treatment initiation). Given Lu-PSMA’s screening requirement, we employed weighted Cox proportional hazards models with average treatment effect in the treated (ATT) weights to estimate hazard ratios and 95% confidence intervals, controlling for baseline characteristics. Sensitivity analysis was conducted using 1:1 greedy propensity score matching.
RESULTS: Among 2,843 patients with mCRPC, 954 received Lu-PSMA and 1,889 received cabazitaxel. After weighting, Lu-PSMA demonstrated significantly longer OS (median: not reached vs. 25.8 months [95% CI: 21.4-30.9]; aHR: 0.87 [95% CI: 0.87-0.99, p=0.04]) and PFS (median: 20.6 months [95% CI: 17.5-24.0] vs. 6.18 months [95% CI: 5.5-6.8]; aHR: 0.40 [95% CI: 0.36-0.45; p<0.0001]) compared to cabazitaxel. Similar estimates were observed on a matched cohort of 1,908 patients.
CONCLUSIONS: In this real-world analysis of mCRPC patients with prior docetaxel and ARPI exposure, Lu-PSMA demonstrated superior OS and PFS compared to cabazitaxel. These findings support Lu-PSMA's clinical benefit in this population and warrant further investigation in chemotherapy-naïve patients, given its most recent pre-chemotherapy approval.
METHODS: Using the Komodo Health Claims Database, we identified men aged ≥18 years diagnosed with mCRPC who received Lu-PSMA or cabazitaxel between January 2022 and June 2024. Patients were required to have prior treatment with docetaxel and one or more ARPI (abiraterone, apalutamide, enzalutamide, or darolutamide) before index treatment. Patients with other cancer types were excluded. Follow-up extended through June 2025. Primary outcomes included overall survival (OS; time from index treatment to death) and progression-free survival (PFS; time to new systemic mCRPC treatment initiation). Given Lu-PSMA’s screening requirement, we employed weighted Cox proportional hazards models with average treatment effect in the treated (ATT) weights to estimate hazard ratios and 95% confidence intervals, controlling for baseline characteristics. Sensitivity analysis was conducted using 1:1 greedy propensity score matching.
RESULTS: Among 2,843 patients with mCRPC, 954 received Lu-PSMA and 1,889 received cabazitaxel. After weighting, Lu-PSMA demonstrated significantly longer OS (median: not reached vs. 25.8 months [95% CI: 21.4-30.9]; aHR: 0.87 [95% CI: 0.87-0.99, p=0.04]) and PFS (median: 20.6 months [95% CI: 17.5-24.0] vs. 6.18 months [95% CI: 5.5-6.8]; aHR: 0.40 [95% CI: 0.36-0.45; p<0.0001]) compared to cabazitaxel. Similar estimates were observed on a matched cohort of 1,908 patients.
CONCLUSIONS: In this real-world analysis of mCRPC patients with prior docetaxel and ARPI exposure, Lu-PSMA demonstrated superior OS and PFS compared to cabazitaxel. These findings support Lu-PSMA's clinical benefit in this population and warrant further investigation in chemotherapy-naïve patients, given its most recent pre-chemotherapy approval.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO24
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Oncology