Radioligand therapies (RLTs) have received prominent attention from major pharmaceutical companies in treating prostate cancer. Bayer’s Xofigo (radium-223 dichloride) demonstrated the proof-of-concept with its FDA approval for castration-resistant prostate cancer (CRPC). Interest in RLTs has since peaked, with Novartis acquiring developer Advanced Accelerator Applications and the highly effective Pluvicto (lutetium [177Lu] vipivotide tetraxetan), targeting prostate-specific membrane antigen (PSMA). Against this backdrop, radiopharmaceuticals for prostate cancer are expected to go nuclear, recording $6.3 billion in sales by 2030, according to GlobalData.
GlobalData analyst consensus forecast predicts the global revenue of Pluvicto to rise from $980 million in 2023 to $4.3 billion by 2030, far outshining Xofigo. Pluvicto is indicated for metastatic CRPC (mCRPC) patients previously treated with ADT and taxane chemotherapy.
Thomas Wales, MSc, Oncology and Hematology Analyst at GlobalData, comments, “Clinical appraisal of Pluvicto in the Phase III VISION trial successfully showed Pluvicto improving imaging-based progression-free survival (PFS) when compared to standard-care treatments such as Astellas Pharma’s highly popular Xtandi (enzalutamide). The results showed that the median PFS more than doubled with Pluvicto (8.7 vs. 3.4 months).
“Similar improvements were seen with overall survival (OS), with patients receiving Pluvicto having a median four-month increase in OS compared to standard-care options. In a landscape where prostate cancer recurrence and androgen deprivation therapies (ADT) resistance are commonplace, Pluvicto has made a clear impact in the mCRPC treatment paradigm.”
Eli Lilly currently recruiting patients for its Phase III trial seeking expanded access to lutetium (177Lu) zadavotide guraxetan. GlobalData’s analyst consensus forecast predicts that lutetium (177Lu) zadavotide guraxetan will achieve global sales of $1.65 billion by 2030. Despite this, clinical approval seems far off for Eli Lilly’s RLT, leaving no real threats to Pluvicto’s market share until the end of the decade.
Following its acquisition of Fusion Pharmaceuticals, AstraZeneca has taken responsibility of FPI-2265-202, which has its Phase II/III trial in PSMA-positive mCRPC patients slated for primary completion in 2026. Despite its forecasted sales performance paling in comparison to Pluvicto by 2030, the use of alpha-emitting actinium-225 could prove to be the future of RLTs in this therapeutic landscape.
Wales concludes, “Novartis has recently filed for a label expansion, which would enable physicians to prescribe Pluvicto for patients with mCRPC not yet treated with taxane-based chemotherapies. The Phase III PSMAfore study has shown promise that PSMA-targeting RLTs can be highly effective and improve long-term survival. It is expected that Pluvicto will be at the forefront of the drug class in terms of market dominance until the turn of the decade when alternate radiation-emitting ligands can make their mark.”
Edits made by EP News Bureau