Radiopharmaceutical Theranostics: Emerging Treatments for Prostate Cancer

Radiopharm Theranostics Limited hosted a special call with Chief Medical Officer Dimitris Voliotis and CEO Riccardo Canevari. The call featured a presentation by Hans David Ulmert on prostate cancer treatment landscape and emerging treatments, including radiotherapy and targeted approaches. The company aims to address the unmet medical need for new treatments in prostate cancer patients who have received PSMA targeting treatments.

Prostate cancer (PCa) remains a significant global health concern, with varying incidence and clinical courses across different ethnic groups. The advent of prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) has transformed the treatment landscape for advanced PCa. However, the effectiveness and safety of this therapy in Asian populations remain underrepresented in clinical trials and literature.

PSMA-targeted RLT, such as lutetium-177–labeled PSMA ligands, has shown promising results in predominantly Western populations. The pivotal VISION trial demonstrated significant survival benefits with [177Lu]Lu-PSMA-617 in men with heavily pre-treated metastatic castration-resistant PCa (mCRPC) [11]. Despite these encouraging results, Asian patients were sparsely represented in these trials, with only 2.4% of the VISION population consisting of Asian patients [11].

Clinical data on PSMA-targeted RLT in Asian populations are limited, with most evidence coming from small retrospective series. A systematic literature review identified only a handful of studies reporting on PSMA-targeted RLT outcomes specifically in Asian patients [13]. A recent single-institution study from Singapore found that [177Lu]Lu-PSMA-I&T was both effective and well-tolerated in Asian mCRPC patients, with outcomes mostly similar to their global counterparts [14].

Prospective data from China and India further support the efficacy and safety of PSMA-targeted RLT in Asian patients. In a Chinese study, 62.5% of patients achieved a PSA decline consistent with partial response, with hematologic toxicity predominantly grade 1–2 [15]. In an Indian cohort, over half of the patients achieved symptomatic or biochemical responses, with an imaging response rate of 43% and a median OS of 12 months [16].

While these studies suggest that PSMA-targeted RLT may provide consistent therapeutic value across diverse Asian populations, the current evidence is largely based on small, retrospective cohorts. Therefore, it remains uncertain whether subtle ethnic or biological differences may influence treatment outcomes or side effects in Asian patients.

To optimize PSMA-targeted RLT in Asian contexts, the development of region-specific radiopharmaceuticals, clinical trials, and systematic real-world data collection is essential. Personalized approaches informed by ethnic-specific disease biology and clinical experience will be crucial for effectively bridging the current knowledge gaps in PSMA-targeted RLT for Asian prostate cancer patients.

References:

[1] SpringerLink. (2025). Abstract: Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) is transforming the treatment landscape for prostate cancer. Retrieved from [https://link.springer.com/article/10.1007/s13139-025-00946-w](https://link.springer.com/article/10.1007/s13139-025-00946-w)