News in brief: Targeted radioligand therapy in prostate cancer; Wider access to encorafenib for mCRC;  Risk assessment test will allow personalised treatment plans for DCIS

24 Jun 2021

Targeted radioligand therapy promising in prostate cancer

Radioligand therapy with Lutetium-177-PSMA-617 prolongs imaging-based survival when added to standard care in patients with advanced PSMA-positive metastatic castration-resistant prostate cancer.

A open-label phase 3 trial of 831 PSMA-positive metastatic castration-resistant prostate cancer patients found PFS was 8.7 months with the radioligand therapy compared to 3.4 months with standard care (HR for progression or death 0.40; p <0.001).

Overall survival was 15.3 months versus 11.3 months respectively (HR for death 0.62; p <0.002).

Key secondary endpoints of objective response, disease control and time to symptomatic skeletal events, also favoured 177Lu-PSMA-617.

The study said adverse events of grade 3 or above were more common with 177Lu-PSMA-617 (52.7% vs. 38.0%), but quality of life was not adversely affected.


Wider access to encorafenib for mCRC recommended by PBAC

The Pharmaceutical Benefits Advisory Committee has made a positive recommendation in response to a request for an Authority Required (STREAMLINED) listing for encorafenib (Braftovi) in combination with cetuximab in the treatment of BRAF V600E-variant metastatic (Stage IV) colorectal cancer.

The committee has previously deferred a recommendation for the targeted treatment of patients who have received prior systemic therapy, pending a decision from MSAC on the funding of the co-dependent BRAF V600 testing.

At an intracycle meeting in May 2021, the PBAC recommended the listing, acknowledging there was a high clinical need in a patient population with poor prognosis, and that it considered the clinical benefit was meaningful.

 DCISionRT test will allow personalised treatment plans for DCIS

A ‘biological signature’ risk assessment test for ductal carcinoma in situ (DCIS) is now available in Australia that provides estimates of the risk of recurrence after surgery and the likely benefit of radiation therapy.

DCISionRT uses nonlinear modelling of tumour-recurrence biomarkers from tumour specimens combined with traditional clinicopathological factors (age, palpability, lesion extent and margin status) to estimate the 10-year risk of DCIS returning or progressing to local invasive breast cancer. And according to sponsor GenesisCare, it also predicts whether radiation therapy will be of additional benefit to surgery alone.

Professor Bruce Mann, Specialist Breast Surgeon and Director of Breast Cancer Services for Royal Melbourne and Royal Women’s Hospital, who was a co- investigator in a DCISionRT study, said it offered advantages over traditional prognostic markers such as tumour grade and size, to determine treatment plans for patients with DCIS.

“Patients with a low DCISionRT score are considered at low risk of their DCIS returning or progressing to potentially life-threatening invasive breast cancer. For these patients, surgery alone may be appropriate. However, women with elevated risk scores may benefit from receiving radiation therapy post-surgery,” he said.

The tests are reported to cost more than $1300, but GenesisCare will provide 1500 tests for Australian women as part of a research project in the form of a prospective registry in partnership with PreludeDx.

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