OnCo
pairingsPairing

PSMA PET → PSMA radioligand therapy

The scan shows whether the target is there; the treatment uses the same address. Only patients whose tumours light up are treated.

VISION and PSMAfore required PSMA PET positivity; SUV predicts response. The archetype of theranostics, now being copied for FAP, TROP2, HER2, CAIX.

PSMA PET→ selectsRadioligand therapy (beta emitters)diagnostic → therapeutic
Rationale
Identical ligand chemistry means imaging biodistribution predicts therapeutic biodistribution; also enables dosimetry.
Evidence
Embedded in phase 3 design and labels.

Key papers

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rctNew England Journal of Medicine 2021changed practice
VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer

Men with metastatic castration-resistant prostate cancer that has progressed after hormonal therapy and chemotherapy, and whose tumours show PSMA on a PET scan, can now receive lutetium-PSMA, which extends life, controls pain and is usually better tolerated than further chemotherapy. It has established a new treatment class in which a scan decides who gets the matching radioactive drug, and it is now being tested earlier in the disease (PSMAfore, PSMAddition).

Connected

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cancers

1
Prostate cancer

technologies

2
PSMA PETRadioligand therapy (beta emitters)

targets

1
PSMA

drugs

2
ApprovedRadioligand therapy (beta)
Lutetium-177 vipivotide tetraxetan · Pluvicto
ApprovedPET imaging agent
Piflufolastat F-18 / Pylarify TruVu · Pylarify

terms

1
Theranostics

ideas

2
Qualify PSMA PET tumour volume as a validated imaging biomarkerTROP2 PET to choose and sequence TROP2 ADCs

key papers

1
VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer