177Lu-PSMA vs. cabazitaxel in patients with castration-resistant prostate cancer: Real-world efficacy and safety data from the ARON-3 study
(2025) European Journal of Cancer — Vol. 229, p. 115789 (2025)
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- Authors
Groener, Daniel 
Ürün, Yüksel
- Abstract
- Background: Radioligand therapy with [ 177 Lu]Lutetium-177-PSMA-617 (177 Lu-PSMA) was recently introduced in clinical practice in the US, Latin America and in most European countries for progressive, metastatic castration-resistant prostate cancer (mCRPC). However, multicenter real-world data on cancer-control outcomes are scant. Methods: Real-word data from the ARON-3 collaboration in progressive mCRPC patients treated with 177 Lu-PSMA vs. cabazitaxel were collected. A retrospective analysis was performed, including overall survival (OS), progression free survival (PFS), time to treatment failure (TTF) and PSA50/90 rates. Results: Data from 285 (50.1 %) patients receiving 177 Lu-PSMA vs. 283 (49.9 %) cabazitaxel after one or two lines of ARPI and Docetaxel were analyzed. PSA50 and PSA90 rates were higher, and TTF and OS were significantly longer in 177 Lu-PSMA patients, even after multivariable adjustment (p ≤ 0.01). This effect held true for most subgroups such as age < 70 and ≥ 70 years, ECOG 0-1, distant lymph nodes and one vs. two lines of prior ARPI. Incidence of grade 3-4 adverse events were comparable between both treatments (37 % vs. 43 % for 177 Lu-PSMA vs. cabazitaxel cohort p = 0.5) but differed according to the type of adverse events. Sensitivity analyses with cross-over adjustment showed similar effects. Conclusions: Analyzing the currently largest real-world cohort comparing 177 Lu-PSMA vs. cabazitaxel, we provided robust information of 177 Lu-PSMA being at least equally effective or possibly even superior to cabazitaxel regarding cancer-control outcomes with reasonable side effects.
- Affiliations
Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany Department of Urology University Hospital Hamburg-Eppendorf, Hamburg, Germany Martini-Klinik Prostate Cancer Center Macerata Hospital, AST, Macerata 62100, Italy Nuclear Medicine Unit Ankara University Medical Faculty, Ankara, Turkey Medical Oncology Mexico City, Mexico Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Koç University Hospital, Istanbul, Turkey Department of Medical Oncology University Hospital Bonn (UKB), Bonn, Germany Department of Urology Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia Clinical Oncology NHS Foundation Trust, London, UK Royal Marsden NHS Foundation Trust Santa Maria delle Grazie Hospital, Napoli, Pozzuoli ASL NA2 NORD, Italy Oncology Operative Unit Markey Cancer Center, University of Kentucky, Lexington, KY, USA Division of Medical Oncology, Department of Internal Medicine University of Foggia, Policlinico Riuniti, Foggia, Italy Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences Buenos Aires, Argentina Instituto de Oncologia Angel H. Roffo IRCCS European Institute of Oncology, Milan, Italy Division of Cancer Prevention and Genetics Institutd’ Investigaci´ o Biom` edica Sant Pau, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain Department of Medical Oncology University Hospital Münster, Münster, Germany; West German Cancer Center, Münster, Germany Department of Urology University of Florence, Viale Pieraccini 6, Florence 50139, Italy Department of Health Sciences, Section of Clinical Pharmacology and Oncology Ochsner Medical Center, New Orleans, LA, USA Department of Internal Medicine, Hematology/Oncology Livorno Hospital, Azienda Toscana Nord Ovest, Livorno 57124, Italy Medical Oncology Unit Universidad El Bosque, Bogota, Colombia Internal Medicine Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy Medical Oncology Tawam Hospital, Al Ain, United Arab Emirates Medical Oncology IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy Medical Oncology Hospital Universitario Ram´ on y Cajal, Madrid, Spain Medical Oncology Department Newcastle University, Newcastle upon Tyne, UK Translational and Clinical Research Institute, Centre for Cancer Hospital Sírio-Libanes, Sao Paulo, Brazil Department of Medical Oncology Cincinnati, OH, USA Cincinnati Cancer Advisors LACOG, Porto Alegre, Brazil Latin American Cooperative Oncology Group Brasília, DF, Brazil Hospital Sírio-Libanes Sao Paulo, SP, Brazil Hospital Israelita Albert Einstein University of Bologna, Bologna, Italy Department of Medical and Surgical Sciences (DIMEC) Clinic for Radiology and Nuclear Medicine, Frankfurt am Main, Germany Goethe University Frankfurt, University Hospital, Department of Nuclear Medicine Macerata Hospital, Macerata, Italy Medical Oncology Unit
Citations
Mandel, P., Groener, D., Follacchio, G., Ürün, Y., Bourlon, M., Sabet, A., Grünwald, F., Tural, D., Büttner, T., Kopp, R., Taha, T., Chun, F., Facchini, G., Myint, Z., Seront, E., Conteduca, V., Quiroga, M., Aurilio, G., Palacios, G., & Bögemann, M. (2025). 177Lu-PSMA vs. cabazitaxel in patients with castration-resistant prostate cancer: Real-world efficacy and safety data from the ARON-3 study. European Journal of Cancer, 229, 115789. https://doi.org/10.1016/j.ejca.2025.115789 (Original work published 2025)