# Clinical outcomes of lutetium-177–PSMA-617 in a racially diverse cohort of patients with metastatic castration-resistant prostate cancer

## TL;DR

This study examines how well lutetium-177–PSMA-617 treats prostate cancer in a racially diverse group, finding similar or better outcomes for Black patients.

## Contribution

The study provides real-world evidence of 177Lu-PSMA-617 efficacy in Black patients, addressing underrepresentation in prior trials.

## Key findings

- Black patients had comparable or better survival and PSA response rates compared to non-Black patients.
- Black patients had significantly higher odds of achieving a 50% PSA reduction.
- Results highlight the need for better racial representation in future clinical trials.

## Abstract

Lutetium-177 (177Lu)–PSMA-617 is a beta-emitting radioligand approved for treatment of metastatic castration-resistant prostate cancer (mCRPC), despite the underrepresentation of Black patients in pivotal trials. We analyzed outcomes of 177Lu-PSMA-617 in a racially diverse cohort.

Retrospective analysis of patients with mCRPC treated with 177Lu-PSMA-617 was conducted at the Emory Winship Cancer Institute. Primary outcomes assessed were progression-free survival (PFS), overall survival (OS), and prostate-specific antigen (PSA) reduction ≥50% (PSA50). Cox proportional hazard models were used for univariate and multivariate OS and PFS, and logistic regression was used for PSA50 analysis.

Among 163 patients treated with 177Lu–PSMA-617, 97 (59.5%) self-identified as White or other racial groups and 66 (40.5%) self-identified as Black. On univariate analysis, Black patients had comparable OS, PFS, and PSA50 responses to non-Black patients, with a trend toward improved outcomes (OS HR: 0.82, P = .446; PFS HR 0.92, P = .655; PSA50 OR = 1.79, P = .088). Multivariate analysis demonstrated a non-significant prolonged PFS and reduction in mortality risk for Black patients (PFS HR: 0.65, P = .106; OS: HR 0.59, HR P-value .081). The odds of a PSA50 response were 2.45 times higher for Black patients (OR = 2.45, P = .027).

In our racially diverse cohort of patients with mCRPC, Black patients had PFS and OS comparable to non-Black patients, although wide confidence intervals limit definitive conclusions. Black patients had a significantly greater odds of achieving a PSA50 response. Our findings suggest efficacy of 177Lu-PSMA-617 among Black patients in real-world settings and underscore the importance of improved representation in prospective studies.