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.
Overview
Radioligand therapy is given at fixed activity despite wide variation in tumour and kidney dose, so this idea uses ultra-sensitive total-body PET with 44Sc- or 89Zr-labelled analogues to measure each patient's pharmacokinetics before treatment and tailor the therapeutic dose. Dosimetry-guided prescription of 177Lu-PSMA is expected to raise tumour absorbed dose and response without exceeding kidney and marrow limits. Personalised dosimetry is established in radioiodine and SIRT, and total-body scanners from United Imaging and Siemens Healthineers remove the imaging-time and dose barriers. The test is a randomised trial of dosimetry-guided versus fixed-dose Pluvicto in prostate cancer with PSA50 and rPFS endpoints. At early-clinical maturity it addresses the bottleneck Wrong doses.
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