Lutetium-177-PSMA-617 in Metastatic Castration-resistant Prostate Cancer: Limitations of the VISION Trial

Lu-PSMA was approved in the USA for patients with prostate-specific membrane antigen-positive metastatic castration-resistant prostate cancer already treated with androgen receptor pathway inhibition and taxane-based chemotherapy on the basis of results from VISION. Three limitations affected the control arm in VISION: choice of the standard of care was limited, some patients initially deemed ineligible for taxane later received it, and there was a high attrition rate. VISION is an example of the many challenges in modern oncology trials. The direct and indirect costs of Lu-PSMA also mean that this therapy is likely to be out of reach for many nations, deepening global inequities in health care access.