Xiao Wei: Yeah, thank you for having me, Neeraj. It's great to be here.
Neeraj Agarwal: So you have done a lot of work, especially from the Precision database regarding the therapies which are received, their relative efficacy, their overall profile, how patients are doing after lutetium therapy has been administered. It's such a new therapy that really none of the drugs currently approved are approved based on patients who had received Pluvicto or Lutetium-177. Personally, I like to know how these patients are doing with other standard approved therapy after lutetium. And when I saw the data, let's hear from the horse's mouth.
Xiao Wei: Well, thank you. Yeah, so that's exactly why we asked this question, is phase-three clinical trials are great, but it doesn't have... First, it doesn't follow outcomes of subsequent therapies after the investigational agent. And second, it's not representative of the large US population. It tends to be less diverse, younger patients, less underrepresented patients. So we utilize the Precision database, which is a large-scale US database that represents thousands of practices across the country, ranging from community sites, academic sites, urology practices, and oncology practices. It's developed by Novartis and it's growing. So this is just the beginning of the evidence generation, but it's really meant to capture patient experience and outcomes across the US. So to focus on our abstract, we asked the question of how do patients do with therapies after Pluvicto? And to do this, we selected patients who received at least one cycle of Pluvicto between March of 2022 when it was initially approved in the VISION population to June of 2025, so middle of last year. That's about 2,000 patients overall.
Neeraj Agarwal: That's a lot. Large number of patients post-lutetium. None of the phase-three trials had these numbers.
Xiao Wei: Exactly. Exactly.
Neeraj Agarwal: Yeah.
Xiao Wei: And so far we have about 440 patients, 442 to be exact, who had evidence of a subsequent therapy after Pluvicto. So first we asked what are the patients receiving? And second is what are the outcomes of those therapies? The vast majority of patients, over 80% of the patients are getting either a taxane or another ARPI in this cohort of, again, over 400 patients. And what we saw in terms of response was that the PSA-50 response to a taxane after Pluvicto was about 40%, and this is a large VISION population post-ARPI, post-taxane. And what was kind of surprising to us was that the PSA-50 response for ARPI was actually higher in this cohort of about 50%. But I think the patient selection is critical here. I think the patients who are appropriate for ARPI after Pluvicto are going to be different from those who are appropriate for taxane after Pluvicto.
Neeraj Agarwal: And I'm sure those clinicians, very experienced clinicians, are making decisions to pick docetaxel versus ARPI according to disease characteristics, according to the pace of progression, according to volume of disease and patient's eligibility for chemotherapy versus ARPI. But it's still very heartening to see that docetaxel and ARPI both continue to have activity after lutetium. Is that a correct statement?
Xiao Wei: Yes. In the patients who received it, we are seeing meaningful responses.
Neeraj Agarwal: That's a great point. In patients who receive these therapies. There are many patients who do not receive any therapy after each line of therapy in prostate cancer, in mCRPC. And there are some patients who have great response to lutetium and they may not need any therapy right away.
Xiao Wei: Exactly. Yeah.
Neeraj Agarwal: So any idea number of cycles of docetaxel these patients are receiving?
Xiao Wei: Median is about four cycles in our cohort. And I will say that median follow-up is relatively short, about half a year. So we also reported RPFS and OS data, but I think those will mature as the database grows.
Neeraj Agarwal: Absolutely. They need to mature, half a year follow-up is not enough. But I think based on what you have shown so far in the ASCO GU 2026 meeting, that patients continue to be eligible for post-lutetium therapy and they are receiving them and they are experiencing meaningful responses.
Xiao Wei: Yeah. And I think the data will grow each year. And with that, we'll have longer follow-up for survival outcomes. We'll be able to look at other therapies, not just taxane and ARPI. So yeah, stay tuned.
Neeraj Agarwal: Well, thank you for sharing your results, Xiao. And we are really looking forward to a more updated analysis next year.
Xiao Wei: Yeah. Thank you. This was fun.