Nuclear medicine theranostics comes of age.

Abstract

Personalised medicine is widely discussed, but only intermittently implemented. The use of theranostics by whole body molecular imaging modalities (eg, 68Ga-prostate-specific membrane antigen [PSMA]-PET/CT or 68Ga-DOTATATE-PET/CT) allows assessment of druggable target expression as well as target accessibility of all lesions, defining patient populations that most likely benefit from radioligand therapy with their therapeutic counterparts 177Lu-PSMA and 177Lu-DOTATATE, respectively. Molecular imaging-based theranostics exclude patients from being exposed to a priori futile therapy. In the NETTER-1 trial 1 Strosberg J El-Haddad G Wolin E et al. Phase 3 trial of 177Lu-dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017; 376: 125-135 Crossref PubMed Scopus (1354) Google Scholar 177Lu-DOTATATE proved efficacious in rare neuroendocrine tumours, whereas the VISION trial 2 Sartor O de Bono J Chi KN et al. Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med. 2021; 385: 1091-1103 Crossref PubMed Scopus (170) Google Scholar studied a far more common cancer—prostate cancer, which is the second most common cause of cancer death in men—and showed 177Lu-PSMA was efficacious in this setting. Now that a significant benefit of 177Lu-PSMA has been shown in patients with advanced PSMA-positive metastatic castration-resistant prostate cancer, with a median overall survival of 15·3 months versus 11·3 months for standard care (HR 0·62; 95% CI 0·52–0·74; p<0·001), 2 Sartor O de Bono J Chi KN et al. Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med. 2021; 385: 1091-1103 Crossref PubMed Scopus (170) Google Scholar the tone of the discussions around treatment has changed, with some advocating the disruption of the molecular imaging theranostic concept by discarding 68Ga-PSMA-PET/CT for patient selection. Correction to Lancet Oncol 2021; 22: 1497–98Herrmann K, Krause BJ, Hadaschik B, et al. Nuclear medicine theranostics comes of age. Lancet Oncol 2021; 22: 1497–98—In this Comment, the spelling of author Bernd Joachim Krause's surname was incorrectly spelt as “Kraus” and has been corrected to “Krause”. This correction has been made to the online version as of Nov 29, 2021. Full-Text PDF