OnCo
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Total-body PET for personalised radioligand dosing

Ultra-sensitive whole-body scanners can measure exactly where a radioactive drug goes at tiny tracer doses, allowing each patient's therapeutic dose to be tailored.

Radioligand therapy is given at fixed activity despite 10-fold variation in tumour and kidney dose. Total-body PET with 44Sc- or 89Zr-labelled analogues can quantify pharmacokinetics before treatment.

Confidence
30%55%likelyOnCo editors (initial estimate), 2026-09-07 · Dosimetry-guided dosing is plausible; a randomised outcome benefit is a higher bar.
Hypothesis
Dosimetry-guided activity prescription for 177Lu-PSMA increases tumour absorbed dose and response without exceeding kidney and marrow limits, compared with fixed 7.4 GBq.
Rationale
Established in radioiodine and SIRT; total-body PET removes the imaging-time and dose barriers to pre-therapy dosimetry.
What would test it
Randomised dosimetry-guided vs fixed-dose Pluvicto trial with PSA50 and rPFS endpoints.
Maturity
early clinical

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