Phenotypic Theranostics in the Future of Precision Medicine

So the VISION study was a very typical advanced, advanced patient with chemotherapy exposure. [W]We hope that these earlier studies with PSMA-617 Lutetium will result in more regulatory approvals for less pretreated patients than did VISION.

PSMA Lutetium-177 is evaluated in combination with things like PSMA Actinium-225. It is being studied in combination with DNA repair inhibitors such as the PARP inhibitor olaparib. It is being studied in combination with PD-1 inhibitors such as pembrolizumab. It is evaluated in combination with stereotactic body irradiation. Therefore combination therapies are important for the future.

Various ways of mapping PSMA may also be important. there [are] also image-based biomarkers related to the application of immunotherapy. And being able to map things like PD-L1 can be pretty important too. In the further course I see a whole series of newer PET markers that are evaluated and used, maybe even grow out of combinations.

I think the near term prostate cancer horizon will revolve around bringing these novel radiopharmaceuticals closer to the forefront of therapy. In addition, we will see the rise in these combination therapies, first in phase 1, then in phase 2. And then I think we’re going to develop a whole bunch of novel biomarkers and that will require additional testing of course, but the biomarker field is alive and well and developing just so, so fast.

When we talk about precision medicine, I think most of what we’ve gotten used to – but not all – has to do with the genomic changes associated with cancer. But phenotypic changes like PSMA expression – that’s not something you can detect with gene rearrangement. It’s really about protein expression. I also think this area has a bright future. I envision many, many more theranostics in the future.