Gallium-68 pentixafor

68Ga-Pentixafor has been used in over 1,300 patients across more than 75 publications, mostly at academic centres (Memorial Sloan Kettering, Technical University of Munich, and others) under investigator INDs, with no serious adverse events reported to date. Its clearest oncology signal is in multiple myeloma, indolent lymphomas and myeloproliferative neoplasms, where CXCR4 overexpression on malignant plasma cells or lymphocytes gives high image contrast; a first proof-of-principle study in myeloproliferative neoplasms found bone-marrow SUVmean of 6.45 versus 4.44 in healthy controls.

In solid tumours the picture is more mixed: a retrospective series of 142 patients across 23 histologies found discernible CXCR4 uptake above blood pool in only 68% of scans, indicating that receptor expression is present but inconsistent outside the haematological setting. Beyond oncology, the tracer is also being explored for primary aldosteronism lateralisation and unstable atherosclerotic plaque, reflecting CXCR4's broader role in inflammation. It has not been submitted for marketing approval anywhere and remains supplied through academic radiopharmacies under IND/IMPD exemptions.