Dr. Patrick Veit-Haibach, deputy radiologist-in-chief and nuclear medicine physician at University Health Network, stands next to the door leading to an MRI machine at Toronto General Hospital in Toronto, on March 26.EDUARDO LIMA/The Globe and Mail
The last type of chemotherapy that David Easton tried in his five-year fight against prostate cancer left him living a life that was really no life at all.
The retired Ontario autoworker slept 20 hours a day. His little time awake was spent hunched on or over the toilet at his home in Ayton, a small community about two hours northwest of Toronto.
He and his wife, Ann Easton, decided in February of 2024 that he would stop chemotherapy, even though he had exhausted all other treatments and very much wanted to live.
Then, about a year later, Mr. Easton was presented with a new option: a radioactive drug delivered by IV that would target his cancer and spare his healthy cells, unlike chemotherapy. “The nurse said that chemo was like being hit with a sledgehammer,” Ms. Easton said, “and this stuff is like being tickled with a feather.”
The only catch was that the 73-year-old would have to limit time with his wife and grandchildren for a few days after the drug was injected into his bloodstream because he would be radioactive.
The radiopharmaceutical that Mr. Easton received at London Health Sciences Centre on March 20 is called Pluvicto, and it is part of a new class of treatments that proponents predict will soon be a fourth pillar of cancer care, alongside surgery, chemotherapy and traditional radiation.
“I like to reserve judgment, simply because otherwise we get our hopes really high, and I don’t want them all dashed,” said Katherine Zukotynski, a professor of radiology and nuclear medicine at McMaster University. “But I would say, truly, this is the tip of the iceberg.”
Clinical trials for Pluvicto found it increased survival by about half a year, but researchers hope it will extend life further if used earlier in the course of the disease. Promising trials are already under way globally testing radiopharmaceuticals for cancers of the breast, liver, lung, head and neck and brain, among others, said Patrick Veit-Haibach, a nuclear medicine physician and deputy radiologist-in-chief at the Joint Department of Medical Imaging that serves the University Health Network and several other hospitals in Toronto.
Dr. Veit-Haibach and his colleague Rebecca Wong, a radiation oncologist and clinician scientist at Princess Margaret Cancer Centre, part of UHN, will be co-leading the new Silber Family Theranostics Centre at Princess Margaret. It is scheduled to open in 2027.
Pluvicto belongs to a category often referred to as theranostics, a portmanteau of therapy and diagnostics. Pluvicto uses what are known as targeting molecules, which are injected into patients’ bloodstreams during cancer-detecting PET scans and then later during the cancer-killing treatment itself. The molecules are essentially a delivery system for medical isotopes.
In the case of Pluvicto, during the diagnostic workup, a particular isotope is fastened to a molecule aimed at prostate-specific membrane antigen (PSMA), a protein that is found on the exterior of many prostate cancer cells. If a PET scan lights up in a way that suggests a patient would be a good candidate for Pluvicto, the isotope is swapped out for Lutetium-177, another isotope that either kills the PSMA-positive cancer cells or stops them from multiplying.
Pluvicto is one of two modern radiopharmaceuticals to recently be approved for use in Canada. The first, called Lutathera, treats neuroendocrine cancer, a rare type that arises in neuroendocrine cells, which are similar to nerve cells but also make hormones. Some of the raw isotopes used to make the drugs come from Ontario’s Bruce nuclear power plant.
Ontario announced in January that it was the first province to publicly fund Pluvicto for a certain type of prostate cancer after the Swiss pharmaceutical giant Novartis hammered out a confidential pricing deal with the pan-Canadian Pharmaceutical Alliance (pCPA), the group that negotiates drug prices on behalf of the provincial, territorial and federal governments.
Nova Scotia, Alberta and Saskatchewan have since followed suit, and other jurisdictions are expected to join them. Every jurisdiction other than PEI and the territories already covers Lutathera for neuroendocrine cancer, according to Novartis, which makes both drugs.
London Health Sciences Centre was the first hospital in the country to deliver a publicly funded dose of Pluvicto in late December. UHN, meanwhile, has already treated more than 50 prostate cancer patients with the drug and 136 with Lutathera, the radiopharmaceutical for neuroendocrine cancer. Some received the drugs during clinical trials.
“If it already works so well in these two examples,” Dr. Wong said of prostate and neuroendocrine cancer, “and if you can combine it with other treatments, then we can potentially achieve what we can’t achieve right now. That’s why we’re so excited.”
Still, there are challenges and shortcomings associated with radiopharmaceuticals. One is cost, a common issue with cutting-edge cancer treatments.
The list price for Pluvicto is $27,000 a dose. Patients receive up to six doses, six weeks apart, for a total as high as $162,000. Lutathera is $35,000 a dose. Patients typically receive four doses.
As Rosa D’Acunti, head of communications and patient advocacy for Novartis Canada, pointed out in an e-mail, deals with the pCPA mean government drug plans are paying lower prices for both drugs, but how much lower isn’t publicly available.
When Canada’s Drug Agency, the organization that advises Ottawa and the provinces and territories on whether they should pay for new drugs, evaluated Pluvicto, it concluded that the price would have to be slashed by 92 per cent to be considered cost effective (or by 82 per cent if it were to achieve parity with a chemotherapy drug commonly given to men whose prostate cancer has progressed).
The other issue is that Pluvicto and Lutathera are not cures. Clinical trials for Pluvicto found it increased progression-free survival and overall survival by six to eight months, Dr. Veit-Haibach of UHN explained.
But Dr. Veit-Haibach, Dr. Wong and others working in theranostics say the meaningfulness of those extra months shouldn’t be underestimated.
“I hear it all the time. They say, ‘I just want more time with my family,’ ” said David Laidley, a molecular imaging and theranostics physician at London Health Sciences. It has been heartening and emotional to offer a new type of treatment to men with advanced prostate cancer who were preparing to die, he added.
Mr. Easton and his wife could hardly believe how much better he felt taking Pluvicto compared to chemotherapy. Doctors had warned him of dry mouth and pain in his back where the cancer had spread. “It was more of an ache than a pain,” Mr. Easton said. He didn’t even need Tylenol to control it.
Mr. Easton is hopeful the new treatment will give him more healthy days with his six grandchildren and his first great-grandchild, a girl born last month.
“We’ve got a chance now,” Ms. Easton said, speaking of herself and her husband as one. “For five years, we didn’t have a chance. We just kept going from one thing to the other. There was nothing left for us.”