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ESMO 2025 | Challenges in identifying patients suited for PSMA-targeted therapies in HSPC

Scott Tagawa, MD, MS, FACP, Weill Cornell Medical Center, New York, NY, comments on the challenges of interpreting the results of combination therapies for hormone-sensitive prostate cancer in the earlier setting, where the impact of each individual treatment on the tumor is unclear. Prof. Tagawa highlights the need for a multivariate model that incorporates clinical, imaging, and genomic criteria to better understand the therapeutic index and improve treatment outcomes. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.

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Transcript

So we don’t know. So, you know, in the later setting, PSMA imaging generally will stand out. There’s a number of clinical criteria that look to stand out to improve, at least improve the therapeutic index. We do not know if those all apply to the earlier setting. This was a true combination therapy with active therapies. One, number one, might influence a target, but number two, might influence different tumors...

So we don’t know. So, you know, in the later setting, PSMA imaging generally will stand out. There’s a number of clinical criteria that look to stand out to improve, at least improve the therapeutic index. We do not know if those all apply to the earlier setting. This was a true combination therapy with active therapies. One, number one, might influence a target, but number two, might influence different tumors. So if there happened to be a PSMA negative or low tumor, well, that tumor may well respond to ADT and or ARPI. So it’s a little bit more difficult to tell in the setting of combination therapy. And we haven’t fully incorporated a true kind of a multivariate model. There is the VISION model that includes clinical criteria as well as imaging criteria. It doesn’t include genomics, for instance. So I think that’s what we want to do. And now that we have, depending on how you look at it, four different triplets in this setting, I think we really need to rely on a combination of clinical criteria plus molecular criteria.

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