Recent advances in theranostics and oncology PET: emerging radionuclides and targets
Tadashi Watabe, Kenji Hirata, Mami Iima, Masahiro Yanagawa, Tsukasa Saida, Akihiko Sakata, Satoru Ide, Maya Honda, Ryo Kurokawa, Kentaro Nishioka, Mariko Kawamura, Rintaro Ito, Koji Takumi, Seitaro Oda, Shunsuke Sugawara, Keitaro Sofue, Daiju Ueda, Shinji Naganawa
Abstract
Abstract Theranostics, a novel integrated approach that combines cancer diagnosis and therapy by switching the radionuclide, has attracted growing attention. Various oncology PET probes other than FDG have been developed for the highly sensitive and precise detection of many types of cancer with the advancements in PET scanners, supporting the innovative development in theranostics. In therapeutic applications, radioligand therapy targeting somatostatin receptors (SSTR) and prostate-specific membrane antigen (PSMA) has already demonstrated significant clinical benefits. Terbium-161 ( 161 Tb) has emerged as a new beta and Auger electron emitter, showing greater therapeutic efficacy compared to 177 Lu. Alpha emitters, such as astatine ( 211 At), are currently being evaluated in investigator-initiated clinical trials, with preliminary efficacy data reported for [ 211 At]NaAt in patients with radioiodine-refractory thyroid cancer. Novel pan-tumor targeting agents, such as TROP-2, Nectin-4, LAT1, GPC-1, and EphA2, are also under development, and clinical translation of radioligand therapy is anticipated. These innovations in theranostics are expected to further broaden the scope of precision medicine in oncology.