# Radiohybrid theranostics (rhPSMA)

Source: https://onco.cc/technologies/radiohybrid-theranostics/  
OnCo record `radiohybrid-theranostics` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A radiohybrid molecule has two places to attach a radioactive atom. The same molecule can carry fluorine-18 for a PET scan or a metal such as lutetium-177 for treatment, so the scan shows exactly where the treatment version will go.

## Summary

Radiohybrid ligands were introduced by Wurzer, Wester and colleagues at the Technical University of Munich (Journal of Nuclear Medicine 2020). Each molecule carries both a silicon-fluoride acceptor, labelled with fluorine-18 by isotopic exchange, and a metal chelator, so one scaffold can be made as an 18F PET tracer, a 68Ga PET tracer or a therapeutic radiometal conjugate with the same chemistry. Their rhPSMA inhibitors showed targeting equal to or better than the established 18F PSMA tracers in preclinical studies, with labelling completed in under 20 minutes at laboratory scale.

The first approved product is flotufolastat F-18 (rhPSMA-7.3, Posluma), a PSMA PET agent approved in the United States in 2023. On the treatment side, lutetium-177 rhPSMA-10.1 is in clinical trials in metastatic prostate cancer, developed by Blue Earth Therapeutics, which Bracco set up for radiohybrid therapy.

## Fields

- Kind: Technology
- Status: approved
- Last checked: 2026-11-03
- Also known as: radiohybrid ligands; radiohybrid PSMA; rhPSMA; radiohybrid radiopharmaceuticals
- Principle: A targeting ligand carries a silicon-fluoride acceptor for 18F labelling and a chelator for a radiometal; the radiolabel sits on one site while the other is filled with the stable isotope or metal, so diagnostic and therapeutic versions are chemically identical.
- Since: 2023
- Strengths: Imaging and therapy agents share one chemistry; Simple 18F labelling by isotopic exchange; Low urinary excretion with the approved PSMA tracer
- Limitations: Only one approved product, a diagnostic; Therapeutic versions still in trials; Head-to-head comparisons with other PSMA agents are limited

## Sources

- Wurzer et al. 2020, Journal of Nuclear Medicine: radiohybrid ligands, a novel tracer concept exemplified by 18F- or 68Ga-labelled rhPSMA inhibitors: https://doi.org/10.2967/jnumed.119.234922

## Connected records

- cancers: [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Imaging](https://onco.cc/fronts/imaging/), [Radiopharmaceuticals & Theranostics](https://onco.cc/fronts/radiopharma/)
- technologies: [PSMA PET](https://onco.cc/technologies/psma-pet/), [Radioligand therapy (beta emitters)](https://onco.cc/technologies/radioligand-therapy/)
- targets: [PSMA](https://onco.cc/targets/psma/)
- drugs: [Flotufolastat F-18](https://onco.cc/drugs/flotufolastat/)
- companies: [Blue Earth Diagnostics (Bracco)](https://onco.cc/companies/blue-earth-diagnostics/), [Blue Earth Therapeutics](https://onco.cc/companies/blue-earth-therapeutics/)
- institutions: [TUM Klinikum rechts der Isar / CCC München](https://onco.cc/institutions/tum-munich/)
- trials: [Anti-tumour Activity of (177Lu) rhPSMA-10.1 Injection](https://onco.cc/trials/nct05413850/)
- key papers: [First Safety and Efficacy Data with the Radiohybrid 177 Lu-rhPSMA-10.1 for the Treatment of Metastatic Prostate Cancer](https://onco.cc/key-papers/paper-nct05413850-j-nucl-med-2024/)

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