Dr. Zachary Klaassen speaks with Dr. Steven Finkelstein and his patient, Paul Perry, about Paul’s experience receiving Pluvicto (lutetium Lu 177 vipivotide tetraxetan) following its expanded approval for metastatic hormone-sensitive prostate cancer (mHSPC). Paul shares what it was like to receive his first treatment, while Dr. Finkelstein explains how this PSMA-targeted radioligand therapy works and its expanded use earlier in the course of advanced prostate cancer. Together, they discuss what this new treatment option may mean for patients with mHSPC.
Dr. Zachary Klaassen:
Hello, my name is Zach Klaassen. I'm a urologic oncologist in Augusta, Georgia, and we are on Prostate Cancer Patient Voices with Dr. Steve Finkelstein and his patient, Paul. Dr. Finkelstein, after the approval of Pluvicto in the metastatic hormone sensitive prostate cancer setting, was able to treat Paul as the first patient in America after this indication. Thank you both for joining us on Prostate Cancer Patient Voices. Delighted to talk to you.
Dr. Steven Finkelstein:
Thank you so much for having us.
Paul Perry:
I'm glad to be here. I can do whatever I can do.
Dr. Zachary Klaassen:
That's perfect. Thank you both. Paul, before we get to your story, I just want to focus on Dr. Finkelstein just for a minute. The FDA approval came down on July 31st, 2026. Just briefly give our listeners a background of how we got to this point with Pluvicto.
Dr. Steven Finkelstein:
Well, I think it's important for patients to know that there's new, exciting treatments for prostate cancer, for men with advanced prostate cancer. And classically, we had medicines that we would give patients. Some affected our ability to knock down their hormone levels, androgen deprivation therapy, and other medicines that involved chemotherapy.
And then the exciting development was the creation of medicines that are called theragnostics. Theragnostics are medicines that are radiation agents that allow us to both image where the cancer might be, as seen behind me on this PET imaging, to be able to really see where the cancer has spread to, and then use an agent, a radiation agent to go specifically to those areas of disease, sparing normal tissue.
And so this specific agent, Pluvicto, was tested, as we do in many patients, tested in the men with the most advanced disease and done after most other therapies had already been given. And that was successful leading to its FDA approval. And like many things that have shown promise, we're able to test these agents now in an earlier and earlier subset. So this summer, we were very hopeful that this agent would be approved based on a clinical trial called PSMA Addition in the patient setting that my friend here is.
So he is in the setting of what was formerly known as metastatic hormone sensitive prostate cancer. What happens when you show up with prostate cancer, and then it is in him in a way, but he has not seen specific medicines that knock down his hormone levels. And so what could happen in a gentleman like you? In the past, you would just get medicines that may have been a man chemically castrate. But now with the FDA's approval, for the first time, this theragnostic approach is approved in a gentleman like my friend here who has hormone sensitive prostate cancer.
Dr. Zachary Klaassen:
That's a great background, Steve. Thank you. So Paul, just tell us a little bit your discussion with Dr. Pieczonka. This was approved on a Friday, you talked to him on a Sunday, and then discussing with Dr. Finkelstein. Just take us through that process after the approval.
Paul Perry:
That was a real, real short conversation. I was shocked that a doctor would call me on a Sunday to start with.
Dr. Zachary Klaassen:
Yeah, it's usually not good news, is it?
Paul Perry:
No. Well, he was all excited and he though that I was at the time a perfect patient for this process. And I was a little reluctant, I guess, mentally. What is this? What's new? It's a little scary. I'd been and had prostate cancer for years, and it migrated into something that I didn't expect. So what it was is that I agreed to do it. And as soon as I said, yes, these guys had me in the room and were ready to go. And it was way back in, I was telling you before, way back in 2015 when I was first diagnosed with prostate cancer with Dr. Madison, and he couldn't do surgery because I had blood clots and the position he was going to put my legs in, he couldn't do any of that. And I went for years, happy, joyous and free.
And all of a sudden, they thought or my wife thought I was having a stroke. So I went to Cross Hospital and right away they run me through a CAT scan and everything. I wasn't having a stroke. Then they did a whole bunch of tests and that's what they found. They did a bone scan and this showed up, and I had my... What do I want to say? When I was in the hospital, I lost too much weight. I went down to 177 and it drives me crazy because I only got up at 186 now. I'm working on it.
Dr. Zachary Klaassen:
That's good.
Paul Perry:
I just got to eat more. And there's some side effects with all this that I don't enjoy. The night sweats I don't enjoy. But what I really don't like is the fatigue in my legs. I've been used to going to the gym four days a week and I haven't been in a long time, but I hope to go back this week.
Dr. Zachary Klaassen:
Good.
Paul Perry:
The fatigue and the night sweats, and that's probably the biggest thing that's going on with me. But I'm hoping these guys are all right. They got all the answers, and at the end of this process, they look at me and say that it's non-detectable. That's what I'm looking for. Cancer, to my mind, never goes away. It stays there forever somewhere. Maybe dormant, but in any case, that's what my goal is. The doctor walks in and says, "We can't find it." That will be really nice.
Dr. Zachary Klaassen:
Tell us about that day on Tuesday when you had the first injection. How did the injection go? How do you feel now?
Paul Perry:
That was just a little bit scary.
Dr. Zachary Klaassen:
Yeah, I bet.
Paul Perry:
They told me what it was going to be like and they told me what they were going to do. Then they marched me down to this room, which is all set up for all this. I'm looking, oh my God. The next thing I know, I got some nurse putting an IV in me, and then the next thing I know, this guy walks in with his tube and he puts it down, he's hooking it all up to me and all this stuff. I go, "Oh Jesus." Then doc here, he gets all dressed up on his paraphernalia. I'm going, "I'm the only one that's not protected."
And they put it in my arm. And when they put in my arm, what I felt was just a little bit of something. I didn't feel really anything and I didn't feel any sickness afterwards. I had to stay away from my wife for three days, but that was okay. So it wasn't bad. The next one would be easier. I'd just walk in, sit down, shoot me up, and I'll leave.
Dr. Zachary Klaassen:
You know what to expect on the next one.
Paul Perry:
Yes, I know what to expect on the next one.
Dr. Zachary Klaassen:
That's right.
Dr. Steven Finkelstein:
Do you remember what we talked about after the dose?
Paul Perry:
No.
Dr. Steven Finkelstein:
Three feet-
Paul Perry:
Oh yeah. The three feet thing, the walking [inaudible 00:07:53]-
Dr. Steven Finkelstein:
Three foot, three days, right?
Paul Perry:
All that stuff.
Dr. Steven Finkelstein:
So when we think about that, the distance we are to this camera right here is about the distance that we can do with respect to patients. So it's really remarkable that you were able to drive home with your wife, you were able to, for three days, give a little bit of distance, but still be able to talk and see her and-
Paul Perry:
Yeah. On the way home, she felt like she was Miss Daisy because [inaudible 00:08:28]-
Dr. Zachary Klaassen:
Steve, what would your message be to patients like Paul who are considering Pluvicto in this new setting?
Paul Perry:
Well, my feelings to any guy I would talk to, that if he didn't do something like this or try something like this, he's nuts. There's not a lot of options out there anymore today. We're getting more options as you guys develop more stuff. And like I told you earlier before, if I could tell every man who was 25 years old or older and asked him what his PSA was from his primary doctor, he looked at me and said it's blah, blah, blah, blah, that would be wonderful.
But we need to... It's like, what was my PSA the other day? 0.33. And at one time, way back when it was almost nine. But my message is that, why not? What are you scared of? This stuff is probably going to save my life. I'm 85 years old. My wife wants me to live to 95. The doctors have promised me maybe 90. So we're hoping for the best and I think it's going to come. I really do.
Dr. Zachary Klaassen:
That's a great message.
Paul Perry:
My message is why not?
Dr. Zachary Klaassen:
It's a great message. Steve or Paul, any other final thoughts for our patients and the listeners before we wrap up?
Dr. Steven Finkelstein:
So I think it's really remarkable to have such a wonderful patient be able to help men out there who are trying to, and their loved ones, to weigh their options. I think what Pluvicto brings is a new innovative approach that lets a gentleman like my friend here be able to come into the clinic, get something where a IV injected medicine is given over a minute, and then you were able to go home under your own power and leave. Go home, be with your wife, although at a little bit of distance for a couple days, and then go back to resuming your normal daily life. And we're going to do this six times, which you only get to see me every six weeks or so. Although, it's nice to see him today here.
Really, it's remarkable to see folks come in under their own power, leave under their own power, living their best life because we have these medicines available to patients. And so I encourage men to get educated about what exists out there. Radiation oncologists obviously are the ones who are very interested and excited about this new robust approach, but it's also, it's a team sport.
So when we found out about the FDA approval, the first thing I did is I called my multidisciplinary partner, Dr. Christopher Pieczonka, who's a urologist, and we talked about you on a Friday. And Chris said, "I'm going to call you and make sure you know what it is that you need to know so you can make good decisions." And like I said, you told me once, and I thought this was so appropriate, is that you believe in science.
Paul Perry:
Yes.
Dr. Steven Finkelstein:
Not everybody does, you said, but you believe in science because we put in the work to try to figure things out as physicians. And so why don't you tell men what you think about that.
Paul Perry:
Well, it's like as we look at life, and you guys are doing things and looking at things and testing things and developing things that are way beyond us. What we have today, this medicine, probably a year from now it'll be something else. It could be different. But the thing is, if we have this opportunity to have this medicine, why wouldn't a person want to take it? Why wouldn't you just lay out your arm and say, "Give it to me." It didn't hurt, was none of that. That three feet thing is no big deal. Three days, get to do some things afterwards. But other than that, it's not.
What I'm hoping for, like I said before, is that the medicine will do exactly what you guys are thinking it will do. I'm pretty sure it will. And at the end, it'd be non-detectable. So guys, when they go out and they go to their primary doctors once a year, a PSA test should be done and they should know their numbers. And that's how we prevent this. Like me, I had my numbers, I knew my numbers, and I was willing to do this, and I think it's great. I really do.
Dr. Steven Finkelstein:
So I will tell you that sitting here with you today, it reminds me as a physician why we put in all the long hours, why we put in all the work to be able to help nice folks like yourself. My own father had prostate cancer and he was treated with radiation and cured. Not everyone is so lucky. And so our ability to be able to create new and exciting things to help nice folks like yourself, it reminds me about for every time I'm away from my family and for every time that we're here trying to help nice folks like yourself, it makes it so happy to me to see you helping so many men out there. So thank you from the sincerest bottom of my heart for all of what you're doing to help men out there and their loved ones.
Paul Perry:
If I could do this once a month, I would do it.
Dr. Zachary Klaassen:
That's awesome.
Paul Perry:
If I could get online and talk to guys, I'd love to do that just to say, "Guys, come on. Get with it. Join."
Dr. Zachary Klaassen:
Well, listen, thank you both. Steve, always at the forefront of this. We appreciate you setting this up. Paul, sincere thanks on behalf of the-
Paul Perry:
You're welcome.
Dr. Zachary Klaassen:
... patients out there. The patients are going to get more out of this than anybody on this video. So thank you both so much for your time and joining us on Prostate Cancer Patient Voices.
Paul Perry:
You're welcome.
Dr. Steven Finkelstein:
Thank you so much for having us.
This conversation with produced with the generous support of Novartis