We have seen (see this link) that Pluvicto works better than Jevtana in men who are metastatic and castration-resistant (mCRPC) and who have already used docetaxel and failed one advanced hormonal therapy (abiraterone or enzalutamide). But would there still be an advantage in mCRPC men who have not yet had any chemo?
Satapathy et al. sought to answer this question. They randomized 40 men to either docetaxel or Pluvicto who were chemo naive, and mCRPC.
After a follow-up of 33 months they found that both groups survived for 15 months, based on the therapy they were intended to get. When they looked at the therapy they actually got, there was still no statistically significant difference (19 months for Pluvicto vs 15 months for docetaxel).
This was a very small Phase II trial, so it is possible that there would have been a significant difference in a larger trial. However, while there are trials that randomize mCRPC patients to 177LuPSMA or 2nd line hormonal (see this link), I am not aware of any exploring the sequencing of docetaxel or Pluvicto in chemo-naive mCRPC patients.