Lutetium Lu 177 Vipivotide Tetraxetan — Drug Monograph

Brand names: Pluvicto

Drug class: Radiopharmaceutical

Mechanism of Action

PSMA-targeted radioligand therapy. A small molecule that binds prostate-specific membrane antigen (PSMA), a transmembrane protein highly expressed on prostate cancer cells, conjugated via a tetraxetan (DOTA) chelator to the beta-particle-emitting radionuclide lutetium-177. After binding PSMA and internalization, lutetium-177 delivers targeted beta radiation causing DNA damage and cell death in PSMA-expressing tumor cells and nearby cells.

FDA Indications

• PSMA-positive metastatic castration-resistant prostate cancer (mCRPC) — in patients previously treated with androgen receptor pathway inhibition and taxane-based chemotherapy (VISION)

Common Side Effects

• Fatigue
• Dry mouth (xerostomia)
• Nausea/vomiting
• Anemia
• Decreased appetite
• Constipation
• Thrombocytopenia

Clinical Pearl

Based on the VISION trial, Pluvicto extends overall survival in PSMA-positive mCRPC after progression on an ARPI and taxane chemotherapy. Confirm PSMA positivity with a companion PSMA-PET scan before treatment. Xerostomia results from PSMA expression in salivary glands; encourage hydration and frequent voiding to limit bladder dose.

Related Therapies & Mechanisms

• Radium-223 Dichloride (Xofigo) — Radiopharmaceutical · Prostate
• Lutetium Lu 177 dotatate (Lutathera) — Radiopharmaceutical
• Lutetium-177 DOTATATE (Lutathera) — Radiopharmaceutical
• Abiraterone Acetate (Zytiga) — Prostate