March 22, 2022. Swiss drugmaker Novartis has released Pluvicto, “the first FDA-approved targeted radioligand therapy (RLT) for eligible patients with mCRPC that combines a targeting compound (ligand) with a therapeutic radioisotope (a radioactive particle). Pluvicto is expected to be available to physicians and patients within weeks.“
Pluvicto features a chelated Lutetium-177 ion (half-life 6.7 days) which is the source of the molecule’s radioactivity. Lutetium is the heaviest of the lanthanide elements and the name comes from the Latin Lutetia Parisiorum which was the predecessor to the city of Paris, France.
The drug has been approved in the US for the treatment of metastatic prostate cancer. Several things are notable about the Pluvicto molecule. The molecule contains a PSMA-specific peptidomimetic feature with an attached therapeutic radionuclide, where PSMA stands for Prostate Specific Membrane Antigen. Peptidomimetic refers to a small chain that resembles a stretch of protein forming amino acids. This peptidomimetic fragment, which interestingly contains a urea linker, is designed as the tumor targeting piece of the drug. Connected to it is a radioactive Lutetium-177 cation (below, upper right). The tumor targeting fragment binds to the cancer cell. While bound to the cell, the short-lived radioisotope undergoes two modes of decay. The Lu-177 emits a medium energy beta particle (Eβmax = 0.497 MeV) which is limited to a maximum of 2 millimeters of travel. This is the kill shot that will damage the attached target cell. The short path length of the beta ray in vivo limits the extent of surrounding damage by any given decay.
The other mode of decay is gamma emission by Lu-177. Gamma rays are much more penetrating than beta particles. They can be detected from the exterior allowing monitoring of dose and location of the drug. Even though gamma rays are more penetrating than beta rays, they produce many fewer ion pairs per centimeter as they traverse the tissue making them less effective in tissue destruction compared to alpha and beta particles. For instance alpha particles from therapeutic radionuclides like Radium-223 use to treat prostate cancer are much more destructive because they produce many ion pairs per centimeter. This is why getting alpha emitters like radon inside you is not a good thing.
A Google search of Pluvicto or Lutetium-177 will produce many good links of a technical and non-technical nature.
Pluvicto, PSMA-targeted radiotherapy (lutetium 177Lu vipivotide tetraxetan) for PSMA-positive prostate cancer 7.4 GBq (200 mCi) IV Q6W up to 6 doses
Novartis PluvictoTM (lutetium Lu 177 vipivotide tetraxetan)
