A roundtable discussion, moderated by Michael Morris, MD, discussed the current landscape of radioligand therapy in prostate cancer, including recent trial highlights presented at ESMO 2023. Dr. Morris was joined by Tanya Dorff, MD; Evan Yu, MD; and Rana McKay, MD.
In the next segment of the roundtable series, the panel discuss patient interest in receiving radioligand therapy in the context of cost and access challenges.
Dr. Morris: The agency, just as you were saying, wants to see the longer-term toxicity and the off-treatment toxicity and we’re waiting for more survival data. But in the interim, what do you tell patients who want it [radioligand therapy]? Because patients are now asking all of us for it. What’s your advice to those patients? Does your institution give it off-label, or do you recommend those patients go overseas to get it if they can, if they have those resources? How do you deal with that?
Dr. Dorff: We are not likely to offer it off-label. We have other things we can do. We have clinical trials in this space. If patients really are not ready for chemotherapy, we do NGS [next-generation sequencing] hoping to find something we can use, but we’re not necessarily going to promote going to another country. First of all, not every person can afford that.
Dr. Morris: Absolutely.
Dr. Dorff: It’s quite expensive. Because we can still use this after chemotherapy, and chemotherapy remains a valid tool in this disease.
Dr. Morris: How about yourselves, Evan, Rana?
Dr. Yu: Yeah, very similar to what Tanya’s doing. We have a lot of clinical trials, and we have some clinical trials with other radioligand therapies. Those are patients are usually that are very interested in this come in asking for it, are very attracted to the fact that we have other trials in this arena. With that being said and done, I think that I’m enthusiastic about the data. I’m hopeful about the data because it’s always good to have more options, life-prolonging options, for our patients, but not quite doing off-label therapy at this point in time. I think it’s more ideal to enroll on other clinical trials that are ongoing.
Dr. Morris: Yeah, Rana, the same?
Dr. McKay: Same, yeah. I think very select individuals who truly cannot even get 1 dose of docetaxel, underlying cardiovascular disease, and things like that where I can count the number of times on my hands. We’ve basically had a tumor board and all decided yeah, we would treat that individual prior to chemotherapy. I tend to make sure that we’re on-label.
Dr. Morris: This is always a very frustrating time. We had this with PREVAIL and with COUGAR-AA-302 as well. You have the data, you know that the drug will be of benefit, and you’re waiting for something to happen to allow the label to be extended so that patients can access it. They know the data as well, and they know that there’s a regulatory hurdle now, and it’s always hard in this period where the data are out there, but the regulatory framework is not in place and the reimbursement is not there.