RT Journal Article SR Electronic T1 Real-World Comparison of Cabazitaxel Versus 177Lu-PSMA Radiopharmaceutical Therapy in Metastatic Castration-Resistant Prostate Cancer JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 61 OP 66 DO 10.2967/jnumed.124.268807 VO 66 IS 1 A1 Wenzel, Mike A1 Koll, Florestan A1 Hoeh, Benedikt A1 Humke, Clara A1 Siech, Carolin A1 Mader, Nicolai A1 Sabet, Amir A1 Groener, Daniel A1 Steuber, Thomas A1 Graefen, Markus A1 Maurer, Tobias A1 Brandts, Christian A1 Banek, Severine A1 Chun, Felix K.H. A1 Mandel, Philipp YR 2025 UL http://jnm.snmjournals.org/content/66/1/61.abstract AB 177Lu-vipivotide tetraxetan prostate-specific membrane antigen (177Lu-PSMA) therapy is under current scientific investigation and aims to become established in the treatment of metastatic castration-resistant prostate cancer (mCRPC). However, real-world evidence in treatment comparison is scant. Methods: We relied on the FRAMCAP database and compared cabazitaxel versus 177Lu-PSMA therapy in mCRPC patients regarding progression-free survival (PFS) and overall survival (OS). Sensitivity analyses addressed second- to fourth-line mCRPC treatment to approximate current phase III patient selection criteria. Results: Of 373 patients, 14% received cabazitaxel, 65% received 177Lu-PSMA, and 21% received both. Patients undergoing 177Lu-PSMA therapy were significantly older than cabazitaxel patients (median, 72 y vs. 66 y; P < 0.01), and a higher proportion had an Eastern Cooperative Oncology Group score of 2 or more (12% vs. 5.0%, P = 0.1). Rates of a prostate-specific antigen decline of at least 50% were 32% versus 0% for 177Lu-PSMA versus cabazitaxel. In outcome analyses, significant superior median PFS was observed for 177Lu-PSMA versus cabazitaxel (13.4 mo vs. 7.1 mo, P < 0.001), even after multivariable adjustment (hazard ratio, 0.38; P < 0.001). Regarding OS, rates also significantly differed, with median OS of 14.7 mo versus 16.5 mo versus 29.6 mo for cabazitaxel versus 177Lu-PSMA versus both treatments (P < 0.01). In sensitivity analyses of second- to fourth-line mCRPC treatment, PFS rates and median OS rates for cabazitaxel versus 177Lu-PSMA versus both therapies qualitatively remained the same as for the entire cohort. Conclusion: In a real-world setting, 177Lu-PSMA provides significantly better PFS and qualitatively better OS rates than does cabazitaxel chemotherapy and should therefore be considered a valuable treatment option for advanced mCRPC patients according to the European Medicines Agency approval.