The nuclear medicine and theranostics program at Novant Health Cancer Institute offers an integrated approach to diagnosing and treating prostate cancer patients who are eligible for Pluvicto therapy.

The radiopharmaceutical, approved by the Food and Drug Administration in 2022, targets and helps slow metastatic cancer. However, the only candidates for it are prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) patients who have undergone chemotherapy.

"Pluvicto is not a cancer cure and is not for everyone," said Novant Health oncologist Tim Collins, MD.

Patients undergoing the intravenous therapy at Novant Health Cancer Institute are reporting immediate pain relief. Among them is Tony Williamson, who in 2020 was diagnosed with stage 4 prostate cancer. He underwent external beam radiation therapy, hormone therapy and chemotherapy, but those proved ineffective and intensely painful, given Williamson's advanced cancer.

He was looking for another solution to ease the pain, and that opportunity came last year when Collins referred Williamson for treatment.

"After the first dose of Pluvicto, I couldn't believe it," Williamson said. "The next day I literally sat up in bed, got up and walked to the bathroom. I was still hurting some, but I was able to fight through it."

Collins identifies eligible patients and refers them to nuclear medicine physician Gbenga Shogbesan, MD, the program's medical director of molecular imaging and theranostics. Since October 2023, Shogbesan has administered Pluvicto to Williamson, who is Novant Health Forsyth Medical Center's first patient to receive the therapy.

The therapy is administered in six doses, six weeks apart, and releases radiation to kill PSMA on cancer cells. From diagnosis to referral to treatment, the Cancer Institute's approach to integrated care puts patients at ease throughout the 30-week process.

Radiation oncologists, palliative care physicians and urologists all play a role in treating symptoms related to metastatic prostate cancer, said oncologist Logan Rhea, DO.

“Years ago, there were not many good treatment options in patients with prostate cancer who had worsening of their disease despite treatment with chemotherapy,” Rhea said. “Now, with targeted therapies such as Pluvicto, patients are living longer and more comfortably. It will be exciting to see what impact this may have as we learn more from ongoing clinical trials.”

Referring providers should be aware of specific patient eligibility.

Pluvicto is effective only in men who have received chemotherapy for PSMA-positive mCRPC. Patients who could benefit from Pluvicto treatment include:

  • Those whose external beam radiation therapy was ineffective because the cancer had metastasized.
  • Those whose hormone therapy was inadequate to starve cancer cells of testosterone.
  • Those whose chemotherapy resulted in side effects, including constant, debilitating pain.
  • Risk versus reward

    Treatment options are limited once cancer spreads beyond the prostate, but for eligible patients, Pluvicto is capable of slowing metastasis and offering a quality-of-life other option do not.

    "For somebody who has been through all those treatments, this represents an entirely new category of treatment," Collins said. "Pluvicto is now an option when other standard therapies have failed."

    Plus, there's no need to wait for the end of treatment to experience a better quality of life. Williamson's PSA levels dropped considerably following the first dose, Shogbesan said.

    "When he came back after his first dose, he was a different man," Shogbesan added. "He was in high spirits, and that has been the reaction of most of our patients. I tell them that this medication is not going to cure the cancer, but it will reduce their pain and symptoms."

    Pluvicto's side effects include tiredness, weight loss and a risk from radiation exposure. Research is underway to determine whether the drug can become the standard of care for eligible prostate cancer patients.

    A developing nuclear medicine and theranostics program

    Shogbesan joined the Cancer Institute medical staff in August 2023 from Emory University in Georgia, where he completed a residency in nuclear medicine and a fellowship in imaging and theranostics. Prior to that, he studied internal medicine and radiology in his native Nigeria.

    "My passion was to get this to people in community health centers like Forsyth Medical Center, evaluate patients together with the oncologist and be closer to the patient," Shogbesan said.

    As the nuclear medicine and theranostics program expands, referring clinicians should feel confident in the centralized services at Novant Health Cancer Institute.

    What Pluvicto success looks like

    Success does not mean a cure. After a single dose, patients report significant changes in their ability to manage pain.

    Lower PSA levels with each dose indicate effectiveness in slowing the cancer.

    "Pluvicto offers the possibility of one more effective therapy. We're excited because we're seeing very good results with patients who are tolerating it well and are responding to it."

    - Tim Collins, MD, Novant Health Cancer Institute medical oncologist

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