ideasIdea
CAIX theranostics: 89Zr-girentuximab PET and 177Lu/225Ac-girentuximab therapy
Almost every clear-cell kidney cancer carries the CAIX protein. Image it with one radioactive antibody, then treat with the same antibody carrying a therapeutic isotope.
ZIRCON validated CAIX PET for diagnosis; STARLITE-1/2 test 177Lu-girentuximab with nivolumab or cabozantinib in advanced RCC. CAIX expression is near-universal and stable in clear-cell disease because it is a direct consequence of VHL loss.
Hypothesis
177Lu- or 225Ac-girentuximab produces objective responses in ≥25% of heavily pretreated clear-cell RCC patients selected by CAIX PET, and synergises with PD-1 blockade.
Rationale
Stable antigen, theranostic pairing proven in prostate cancer (PSMA), and radiation-induced immunogenic cell death in an immunotherapy-responsive tumour.
What would test it
Randomised phase 2 of 177Lu-girentuximab + nivolumab vs nivolumab after IO-TKI progression, PET-selected.
Maturity
early clinical