ideasIdea
Dosimetry-personalised PRRT instead of four fixed cycles
Measure the radiation each patient's tumour and kidneys actually absorb and adjust the number and size of doses, instead of giving everyone four identical cycles.
Fixed 7.4 GBq × 4 leaves many patients under-dosed relative to kidney and marrow limits; retrospective dosimetry shows tumour absorbed dose correlates with response. Prospective trials (e.g., P-PRRT in Canada) test individualised activity.
Hypothesis
Dosimetry-guided PRRT increases cumulative tumour dose and response rate without exceeding renal/marrow limits, versus fixed dosing.
Rationale
Wide inter-patient variation in uptake; SPECT/CT after each cycle makes dosimetry feasible.
What would test it
Randomised phase 2 of individualised vs fixed activity with ORR and PFS endpoints.
Maturity
early clinical