# Docetaxel (taxane chemotherapy) then 177Lu-PSMA-617

Source: https://nuclide.cc/pairings/docetaxel-then-lu177-psma/  
Nuclide record `docetaxel-then-lu177-psma` (Pairing). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

In the trial that got 177Lu-PSMA-617 (Pluvicto) approved, everyone had already been treated with a taxane chemotherapy drug like docetaxel and with a hormone pill first. That is the treatment order the approval is based on, though a newer trial is now testing whether Pluvicto can be used earlier, before chemotherapy.

## Summary

The pivotal VISION trial (NCT03511664; Sartor et al., NEJM 2021) that supported FDA and EMA approval of 177Lu-PSMA-617 (Pluvicto) enrolled adults with metastatic castration-resistant prostate cancer who had already progressed on at least one androgen-receptor pathway inhibitor (for example abiraterone or enzalutamide) and on one or two prior taxane-based chemotherapy regimens, typically docetaxel. Patients also had to have PSMA-positive disease on centrally read 68Ga-PSMA-11 PET-CT, with no qualifying PSMA-negative lesions. 177Lu-PSMA-617 (7.4 GBq every 6 weeks, up to 6 cycles) plus protocol-permitted standard care was compared with standard care alone; median overall survival was 15.3 months versus 11.3 months (hazard ratio 0.62, 95% CI 0.52-0.74, p<0.001).

Because prior taxane exposure was a trial entry requirement rather than a randomised comparison of sequencing strategies, VISION establishes an evidence-based treatment order — androgen-receptor pathway inhibitor, then taxane chemotherapy (commonly docetaxel), then 177Lu-PSMA-617 — rather than proving that giving the radioligand therapy after docetaxel is better than giving it before. Retrospective subgroup analyses of VISION found that survival benefit from 177Lu-PSMA-617 was preserved regardless of whether patients had received one or two prior taxane regimens, and regardless of the number of prior androgen-receptor pathway inhibitors.

This sequencing question is now being tested directly: the phase 3 PSMAfore trial (NCT04689828) enrolled taxane-naive patients progressing after one androgen-receptor pathway inhibitor and randomised them to 177Lu-PSMA-617 or to switching to a different androgen-receptor pathway inhibitor, explicitly to establish whether radioligand therapy can move earlier in the treatment sequence, ahead of chemotherapy, rather than only being used after it.

## Fields

- Kind: Pairing
- Last checked: 2026-09-22
- Tags: prostate cancer; treatment sequencing; radioligand therapy
- Pairs: Docetaxel + Lutetium-177 vipivotide tetraxetan
- Type: sequence
- Rationale: The approval of 177Lu-PSMA-617 rests on a trial population defined by prior treatment order (hormone therapy, then taxane chemotherapy, then radioligand therapy), so this is the evidence-based sequence rather than a proven optimal one.
- Evidence: VISION (n=831) required progression after at least one androgen-receptor pathway inhibitor and one or two taxane regimens (typically docetaxel) before enrolment; median overall survival with added 177Lu-PSMA-617 was 15.3 vs 11.3 months (HR 0.62, p<0.001) (Sartor et al., NEJM 2021). PSMAfore (NCT04689828) is testing whether the radioligand therapy can instead be used before taxane chemotherapy.

## Sources

- Sartor et al., VISION primary results, N Engl J Med 2021 (full text): https://www.nejm.org/doi/full/10.1056/NEJMoa2107322
- JNM commentary on VISION eligibility criteria (prior taxane and ARPI requirements): https://jnm.snmjournals.org/content/63/6/823
- PSMAfore design (taxane-naive, ARPI-progressed population), ASCO 2022: https://ascopubs.org/doi/10.1200/JCO.2022.40.6_suppl.TPS211

## Connected records

- indications: [Metastatic castration-resistant prostate cancer](https://nuclide.cc/indications/prostate-mcrpc/)
- trials: [PSMAfore](https://nuclide.cc/trials/psmafore/), [VISION](https://nuclide.cc/trials/vision/)
- key papers: [VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer](https://nuclide.cc/key-papers/paper-vision-nejm-2021/)
- people: [A. Oliver Sartor](https://nuclide.cc/people/oliver-sartor/), [Michael J. Morris](https://nuclide.cc/people/michael-morris/)
- isotopes: [Gallium-68](https://nuclide.cc/isotopes/ga-68/), [Lutetium-177](https://nuclide.cc/isotopes/lu-177/)
- drugs: [Docetaxel](https://nuclide.cc/drugs/docetaxel/), [Lutetium-177 vipivotide tetraxetan](https://nuclide.cc/drugs/pluvicto/)

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