Novartis (SWX: NOVN) reported new data from the Phase III PSMAddition trial showing that lutetium (177Lu) vipivotide tetraxetan (Pluvicto) reduced the risk of PSA progression by 58% in PSMA-positive metastatic hormone-sensitive prostate cancer, extending the radioligand therapy’s clinical evidence into an earlier and larger patient population where no PSMA-targeted agent is currently approved.
PSMAddition is a randomized Phase III trial evaluating Pluvicto combined with standard of care — an androgen receptor pathway inhibitor (ARPI) plus androgen deprivation therapy (ADT) — against standard of care alone in patients with PSMA-positive metastatic hormone-sensitive prostate cancer treatment. The data, presented as a rapid oral presentation at the American Urological Association Annual Meeting 2026, represent the trial’s second interim analysis.
Key results: PSA progression risk reduction and depth of response
The primary finding from this interim analysis was a hazard ratio of 0.42 (95% CI: 0.30–0.59), corresponding to a 58% lower risk of PSA progression in patients receiving Pluvicto plus standard of care compared to those on standard of care alone. The depth of PSA response data reinforces the direction of the primary finding. At week 12, 47.6% of patients in the Pluvicto combination arm achieved a PSA nadir below 0.2 ng/mL, compared with 37.7% on standard of care alone. By week 48, that gap widened: 87.4% versus 74.9%. More than 98% of patients in both arms showed some degree of PSA decline, but the proportion reaching the deeper threshold was consistently higher with the addition of Pluvicto across all measured timepoints.
On safety, Grade ≥3 adverse events occurred in 50.7% of patients in the Pluvicto combination arm versus 43.0% on standard of care alone. The most commonly reported all-grade adverse events included dry mouth, fatigue, nausea, hot flush, and anemia — a profile consistent with what was observed in the earlier PSMAfore and VISION trials in metastatic castration-resistant prostate cancer (mCRPC).
Pluvicto’s research context
Pluvicto is a PSMA-targeted radioligand therapy delivering lutetium-177 directly to prostate cancer cells. The rationale for testing this mechanism in the hormone-sensitive setting rests on the hypothesis that targeting PSMA-expressing disease before castration resistance develops may delay or prevent the transition to mCRPC — a state associated with a median survival of less than two years and limited treatment options. The drug was first approved by the US FDA in 2022 for PSMA-positive mCRPC following androgen receptor pathway inhibitor (ARPI) therapy and taxane-based chemotherapy, and in 2025 gained an expanded indication for ARPI-treated patients considered appropriate to delay chemotherapy
The PSMAddition results build on earlier radiographic progression-free survival data from the same trial, which Novartis has previously cited as the basis for its regulatory submissions. The company has filed supplemental new drug applications in the US, China, and Japan, with first decisions expected in the second half of 2026.
The mHSPC treatment landscape is currently defined by oral androgen receptor signaling inhibitors combined with ADT. Astellas and Pfizer’s Xtandi (enzalutamide), Johnson & Johnson’s Erleada (apalutamide), and Johnson & Johnson’s Zytiga (abiraterone acetate) are all approved in this setting, as is Bayer’s Nubeqa (darolutamide) in combination with docetaxel and ADT for high-volume disease. Most recently, Johnson & Johnson’s Akeega (niraparib plus abiraterone acetate) received US FDA approval in December 2025 for BRCA2-mutated metastatic castration-sensitive prostate cancer.
None of these approved agents are PSMA-targeted. If Pluvicto receives approval in mHSPC, it would be the first PSMA-directed therapy cleared for use in the hormone-sensitive setting — a mechanistic distinction that the ARSIs and cytotoxic doublets cannot replicate. Cross-trial comparisons are limited by differences in patient populations, trial design, and endpoints, and the PSMAddition PSA data are from an interim analysis rather than a final readout. Whether the PSA progression benefit translates into overall survival improvement remains to be established.
Bayer’s Xofigo (radium-223 dichloride), an alpha-emitting radiopharmaceutical approved for mCRPC with symptomatic bone metastases, operates through a different mechanism and lacks PSMA targeting, limiting its comparability to lutetium (177Lu) vipivotide tetraxetan.
Novartis has positioned this PSA data readout alongside the previously reported rPFS findings to support its regulatory case across three major markets. The company’s sNDA filings in the US, China, and Japan place Pluvicto on track for potential label expansion decisions in H2 2026, which would mark the first approval of a PSMA-targeted radioligand therapy in metastatic hormone-sensitive prostate cancer.
This article was generated with AI assistance and reviewed and edited by the AllSci editorial team Explore more at AllSci News: https://allsci.com/news/
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