- Design
- Randomised phase 2 trial, extended follow-up
- Population
- 92 men with PSMA PET-detected oligorecurrent hormone-sensitive prostate cancer
- Primary outcome
- Progression-free survival
- Effect
- Median 17.6 vs 7.4 months; HR 0.38 (95% CI 0.23-0.61)
LUNAR randomised 92 men with oligorecurrent hormone-sensitive prostate cancer and one to five PSMA PET-detected lesions to SBRT alone or two cycles of 177Lu-PSMA (177Lu-PNT2002) followed by SBRT. This report adds follow-up to a median of 31.9 months.
Progression-free survival — new lesions on PSMA PET, starting hormone therapy or death — was 17.6 months with radioligand plus SBRT against 7.4 months with SBRT alone (HR 0.38, 95% CI 0.23-0.61). Hormone therapy-free survival also improved (HR 0.57, 0.34-0.95). Exploratory endpoints, including castration-resistant disease-free survival, pointed the same way with wide intervals. No new safety signals were seen.
This is a phase 2 trial with a PSMA PET-based endpoint that is sensitive to small recurrences. Overall survival has not been shown.
For now, the combination is a trial question rather than standard care.
- Median PFS was 17.6 vs 7.4 months with 177Lu-PSMA before SBRT.
- Time to starting hormone therapy was also longer.
- Exploratory endpoints were favourable but had wide intervals.
- This is phase 2 evidence; overall survival benefit is not shown.
- Consider referral to trials for men with PSMA-detected oligorecurrence.
Why it matters
It suggests systemic radioligand treatment might change the course of oligorecurrence rather than just delaying the next scan finding.
Don't overread it
A phase 2 trial with a PET-based progression endpoint has not shown longer survival.
The statistics, in plain English
A hazard ratio of 0.38 means a substantially lower rate of progression. With 92 patients the estimate is reasonably clear for PFS, but exploratory intervals crossing 1 are hypothesis-generating only.
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