Data dictionary

{
  "id": "prostate",
  "kind": "indication",
  "name": "Prostate cancer",
  "tldr": "Prostate cancer is the home of theranostics: PSMA PET finds it, PSMA radioligands treat it. Hormonal therapy remains the foundation, with PARP and AKT inhibi...",
  "summary": "Prostate cancer is the most common cancer in men in most high-income countries and a spectrum: most PSA-detected disease is indolent and safely watched (Prot...",
  "asOf": "2026-09-06",
  "wikipedia": "https://en.wikipedia.org/wiki/Prostate_cancer",
  "links": [
    {
      "label": "Wikipedia",
      "url": "https://en.wikipedia.org/wiki/Prostate_cancer"
    }
  ],
  "tags": [
    "gu",
    "spike"
  ],
  "related": [
    "radiopharma-roadmap",
    "psma-pet-to-rlt",
    "beta-then-alpha"
  ],
  "technologies": [
    "psma-pet",
    "radioligand-therapy",
    "targeted-alpha-therapy"
  ],
  "targets": [
    "psma",
    "parp",
    "b7h3"
  ],
  "drugs": [
    "samarium-153-lexidronam"
  ],
  "companies": [
    "futurechem",
    "novartis",
    "bayer"
  ],
  "institutions": [
    "royal-marsden",
    "peter-mac",
    "ucla-jonsson"
  ],
  "pathways": [
    "prostate-cancer-signalling"
  ],
  "terms": [
    "biochemical-recurrence",
    "psa50",
    "theranostics"
  ],
  "trials": [
    "nct06855277",
    "nct06780670",
    "mcrpc"
  ],
  "group": "genitourinary",
  "burden": "~1.5 million new cases per year worldwide; lifetime risk ~1 in 8 men in high-income countries; median age at diagnosis 67; most PSA-detected disease is indol...",
  "subtypes": [
    "Localised: low / favourable-intermediate / unfavourable-intermediate / high risk (NCCN)",
    "Non-metastatic castration-resistant (nmCRPC)",
    "Metastatic hormone-sensitive (mHSPC; FDA 2026 term 'androgen pathway modulation-naive or -sensitive'), de novo vs recurrent, high vs low volume (CHAARTED)"
  ],
  "biomarkers": [
    "PSA",
    "Gleason / Grade Group",
    "PSMA PET"
  ],
  "standardOfCare": [
    {
      "setting": "Localised",
      "approach": "Active surveillance, prostatectomy, or radiation ± ADT (duration guided by risk/ArteraAI).",
      "refs": [],
      "guideline": {
        "version": "NCCN Guidelines: Prostate Cancer",
        "url": "https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459"
      }
    },
    {
      "setting": "Metastatic hormone-sensitive",
      "approach": "ADT + ARPI ± docetaxel; PSMA PET staging; capivasertib if PTEN-deficient.",
      "refs": [
        "psma-pet"
      ],
      "guideline": {
        "version": "NCCN Guidelines: Prostate Cancer",
        "url": "https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459"
      }
    },
    {
      "setting": "Castration-resistant",
      "approach": "ARPI switch, PARP inhibitor combinations (HRR+), 177Lu-PSMA-617, docetaxel/cabazitaxel, radium-223.",
      "refs": [
        "pluvicto",
        "olaparib",
        "vision"
      ],
      "guideline": {
        "version": "NCCN Guidelines: Prostate Cancer",
        "url": "https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459"
      }
    }
  ],
  "stateOfArt": [
    "Theranostic pairing of PSMA PET and Pluvicto.",
    "Genotype-directed doublets.",
    "AI pathology guiding ADT duration."
  ],
  "history": [
    {
      "year": 1941,
      "title": "Huggins: castration controls prostate cancer",
      "refs": []
    },
    {
      "year": 1941,
      "title": "Huggins shows castration controls metastatic prostate cancer",
      "note": "Nobel Prize 1966; the first hormonal therapy of any cancer.",
      "refs": []
    },
    {
      "year": 1966,
      "title": "Gleason grading system published",
      "refs": []
    }
  ],
  "pipeline": [
    "ac225-psma",
    "aaa817",
    "jnj-87189401"
  ],
  "openProblems": [
    "Overdiagnosis vs. underdiagnosis in screening.",
    "Neuroendocrine transformation.",
    "Ac-225 supply."
  ],
  "prognosis": {
    "text": "In the United States, 98.2% of men diagnosed with prostate cancer in 2016-2022 were alive five years later, relative to men of the same age without the disea...",
    "sources": [
      {
        "label": "SEER Cancer Stat Facts: Prostate Cancer",
        "url": "https://seer.cancer.gov/statfacts/html/prost.html"
      }
    ]
  }
}

{
  "id": "lu-177",
  "kind": "isotope",
  "name": "Lutetium-177",
  "aka": [
    "177Lu",
    "Lu-177"
  ],
  "tldr": "A radioactive metal that gives off short-range radiation. Attached to a molecule that sticks to a tumour, it irradiates the tumour from the inside while spar...",
  "summary": "Lutetium-177 is the workhorse therapeutic radionuclide of the theranostic era, carried by DOTATATE (Lutathera, neuroendocrine tumours) and PSMA-617 (Pluvicto...",
  "status": "approved",
  "asOf": "2026-09-22",
  "links": [
    {
      "label": "Challenges and future options for the production of lutetium-177 (EJNMMI Radiopharm Chem, 2021)",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8241800/"
    },
    {
      "label": "FDA label: Pluvicto (lutetium Lu 177 vipivotide tetraxetan)",
      "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/215833s000lbl.pdf"
    },
    {
      "label": "OECD-NEA: Current trends in the supply and utilisation of medical radioisotopes (2025)",
      "url": "https://www.oecd-nea.org/upload/docs/application/pdf/2025-10/7743_medical_radioisotopes_supply_rev.pdf"
    }
  ],
  "tags": [
    "therapy",
    "beta emitter"
  ],
  "related": [
    "pluvicto",
    "lutathera",
    "prrt"
  ],
  "symbol": "177Lu",
  "element": "Lutetium",
  "massNumber": 177,
  "halfLife": "6.65 days",
  "emissions": [
    "β− 497 keV maximum (mean 134 keV)",
    "γ 113 keV (6.2%)",
    "γ 208 keV (10.4%)"
  ],
  "emissionClass": "beta-minus",
  "use": "therapy",
  "tissueRange": "Up to about 2 mm, mean roughly 0.5-0.7 mm",
  "production": "Reactor. Non-carrier-added via 176Yb(n,γ)177Yb, which beta-decays to 177Lu; or carrier-added via direct 176Lu(n,γ)177Lu (co-produces long-lived 177mLu).",
  "supply": "tight",
  "supplyNote": "Demand rose sharply after Pluvicto's approval. Reactor neutron-flux capacity and the scarcity of enriched 176Yb (historically mostly from Russian calutrons) ...",
  "chelators": [
    "DOTA",
    "DOTAGA"
  ],
  "pairedWith": [
    "ga-68"
  ],
  "since": 2018
}

{
  "id": "f-molecular-imaging",
  "kind": "section",
  "name": "Molecular imaging",
  "tldr": "Molecular imaging uses a small radioactive tracer injected into the body and a PET or SPECT camera to show where a specific protein sits on a tumour, so doct...",
  "summary": "Molecular imaging is the diagnostic half of theranostics: a radiolabelled ligand binds a target expressed on tumour cells (PSMA, SSTR2, FAP, HER2, CAIX, TROP...",
  "asOf": "2026-09-22",
  "links": [
    {
      "label": "EANM/SNMMI: PSMA PET/CT procedure guideline 2.0 (Eur J Nucl Med Mol Imaging, 2023)",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10027805/"
    },
    {
      "label": "proPSMA trial (Hofman et al., Lancet 2020)",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/"
    },
    {
      "label": "PMC: Future opportunities and nuances with PSMA PET (2026 review, incl. 2026 NCCN guidance)",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13141699/"
    }
  ],
  "related": [
    "f-radioligand-therapy",
    "f-dosimetry",
    "ga-68"
  ],
  "indications": [
    "prostate",
    "prostate-bcr",
    "prostate-high-risk"
  ],
  "technologies": [
    "psma-pet",
    "sstr-pet",
    "fdg-pet"
  ],
  "drugs": [
    "ga68-psma-11",
    "pylarify",
    "flotufolastat"
  ],
  "companies": [
    "telix",
    "lantheus",
    "curium"
  ],
  "terms": [
    "suv",
    "theranostics"
  ],
  "trials": [
    "propsma"
  ],
  "notes": [
    "PSMA-negative or discordant disease on biopsy is not resolved by better tracers alone; it is a biology problem, not a chemistry one.",
    "Quantitative reporting frameworks (PROMISE/miTNM, E-PSMA) exist but adoption across sites is uneven, which limits cross-trial comparability.",
    "Reimbursement for newer PET agents (e.g. flotufolastat, PSMA-1007) trails clinical guideline endorsement in several countries."
  ],
  "order": 1
}

{
  "id": "radioligand-therapy",
  "kind": "technology",
  "name": "Radioligand therapy (beta emitters)",
  "tldr": "A drug that finds tumour cells and carries a radioactive atom that irradiates them from inside the body.",
  "summary": "177Lu-DOTATATE (Lutathera, 2018) in neuroendocrine tumours and 177Lu-PSMA-617 (Pluvicto, 2022; pre-chemotherapy label 2025; 2026 label expansion) in prostate...",
  "status": "approved",
  "asOf": "2026-09-04",
  "wikipedia": "https://en.wikipedia.org/wiki/Radioligand_therapy",
  "links": [
    {
      "label": "Wikipedia",
      "url": "https://en.wikipedia.org/wiki/Radioligand_therapy"
    }
  ],
  "related": [
    "lu-177"
  ],
  "indications": [
    "prostate",
    "neuroendocrine"
  ],
  "technologies": [
    "psma-pet",
    "spect",
    "targeted-alpha-therapy"
  ],
  "targets": [
    "psma",
    "sstr2",
    "fap"
  ],
  "drugs": [
    "pluvicto",
    "lutathera"
  ],
  "companies": [
    "clarity-pharmaceuticals",
    "abdera-therapeutics",
    "alpha-9-oncology"
  ],
  "journals": [
    "cancer-biotherapy-and-radiopharmaceuticals"
  ],
  "dependsOn": [
    "therapy-isotope-supply-chain",
    "radiopharmacy-network",
    "medical-cyclotrons-synthesis-modules"
  ],
  "principle": "177Lu emits beta particles with ~2 mm range and gamma photons for SPECT imaging; the ligand determines biodistribution.",
  "strengths": [
    "Systemic, whole-body targeting of microscopic disease",
    "Crossfire kills antigen-negative neighbours",
    "Imaging companion selects patients"
  ],
  "limitations": [
    "Marrow and kidney dose",
    "Isotope logistics (6.7-day half-life)",
    "Not curative alone"
  ],
  "since": 2018
}

{
  "id": "psma",
  "kind": "target",
  "name": "PSMA",
  "tldr": "A protein on prostate cancer cells that lets doctors both see the cancer on a PET scan and hit it with a radioactive drug.",
  "summary": "Prostate-specific membrane antigen is the archetypal theranostic target. PSMA PET (Pylarify, Illuccix, Locametz, Pylarify TruVu) is standard for staging; 177...",
  "asOf": "2026-09-04",
  "wikipedia": "https://en.wikipedia.org/wiki/Glutamate_carboxypeptidase_II",
  "links": [
    {
      "label": "Wikipedia",
      "url": "https://en.wikipedia.org/wiki/Glutamate_carboxypeptidase_II"
    }
  ],
  "tags": [
    "theranostic",
    "pet-target"
  ],
  "related": [
    "lu-177",
    "ac-225"
  ],
  "indications": [
    "prostate"
  ],
  "drugs": [
    "aaa817",
    "jnj-87189401",
    "hrs-4357"
  ],
  "companies": [
    "artbio",
    "convergent-therapeutics",
    "point-biopharma"
  ],
  "pathways": [
    "prostate-cancer-signalling"
  ],
  "trials": [
    "nct07567521",
    "nct06383052",
    "nct05381103"
  ],
  "symbol": "FOLH1",
  "hgnc": "HGNC:3788",
  "ensembl": "ENSG00000086205",
  "uniprot": "Q04609",
  "entrez": "2346",
  "biology": "PSMA is a type II transmembrane glutamate carboxypeptidase; expression increases with grade and castration resistance. Also expressed in tumour neovasculatur...",
  "whereFound": [
    "Prostate cancer (>90%)",
    "Neovasculature of RCC, glioma, others"
  ],
  "targetClass": "surface-antigen",
  "prevalence": [
    {
      "indicationId": "prostate",
      "pct": ">90",
      "measure": "PSMA PET positivity, metastatic disease",
      "source": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12796145/",
      "note": "~10% PSMA-negative or low"
    },
    {
      "indicationId": "rcc",
      "pct": "60-80",
      "measure": "Neovascular PSMA expression",
      "source": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12796145/",
      "note": "Clear-cell; imaging studies"
    }
  ]
}

{
  "id": "lutathera",
  "kind": "drug",
  "name": "Lutetium-177 dotatate",
  "tldr": "Lutetium-177 dotatate was the first modern radioligand therapy (2018), for neuroendocrine tumours, and is now used in first line.",
  "summary": "Lutetium-177 dotatate is a radioligand therapy: the somatostatin analogue DOTATATE binds SSTR2 on neuroendocrine tumour cells and carries the beta emitter 17...",
  "status": "approved",
  "asOf": "2026-10-04",
  "wikipedia": "https://en.wikipedia.org/wiki/Lutetium_(177Lu)_oxodotreotide",
  "links": [
    {
      "label": "FDA label (DailyMed)",
      "url": "https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Lutetium-177%20dotatate"
    },
    {
      "label": "Drugs@FDA: ANDA 217060, Bravnetsa (Lantheus), tentative approval",
      "url": "https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=217060"
    },
    {
      "label": "FDA tentative approval letter, ANDA 217060 (21 Sep 2026)",
      "url": "https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2026/217060Orig1s000TAltr.pdf"
    }
  ],
  "related": [
    "lu-177"
  ],
  "indications": [
    "neuroendocrine",
    "small-intestinal-net",
    "pancreatic-net"
  ],
  "technologies": [
    "radioligand-therapy"
  ],
  "targets": [
    "sstr2"
  ],
  "companies": [
    "novartis"
  ],
  "terms": [
    "prrt-term"
  ],
  "trials": [
    "netter-1",
    "nct04711135",
    "nct05142696"
  ],
  "brand": "Lutathera",
  "code": "177Lu-DOTATATE",
  "modality": "Radioligand therapy (beta)",
  "mechanism": "SSTR2 agonist peptide with 177Lu.",
  "approvals": [
    {
      "region": "US",
      "year": 2018,
      "indication": "SSTR+ GEP-NETs"
    },
    {
      "region": "US",
      "year": 2024,
      "indication": "Paediatric ≥12 years; first-line (NETTER-2 label)"
    },
    {
      "region": "EU",
      "year": 2017,
      "indication": "First approval globally (Sep 2017)"
    }
  ],
  "mechanismSteps": [
    "Radioligand circulates and binds Somatostatin receptor 2 on tumour cells",
    "Ligand is internalised or retained at the membrane",
    "Beta emissions deposit energy within a short range"
  ],
  "dosing": {
    "route": "IV infusion",
    "schedule": "7.4 GBq (200 mCi) every 8 weeks for 4 doses, with amino acid infusion starting 30 minutes before and continuing ≥3 hours",
    "modifications": "Hold for grade ≥3 haematologic toxicity or renal toxicity; discontinue after 16-week delay",
    "monitoring": "Blood counts, creatinine, LFTs before each dose; long-term MDS/AML surveillance",
    "source": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=72d1a024-00b7-418a-b36e-b2cb48f2ab55"
  },
  "toxicity": [
    {
      "event": "Lymphopenia",
      "grade3PlusPct": 44,
      "source": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=72d1a024-00b7-418a-b36e-b2cb48f2ab55",
      "note": "NETTER-1; grade 3-4 rates"
    },
    {
      "event": "GGT increased",
      "grade3PlusPct": 20,
      "source": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=72d1a024-00b7-418a-b36e-b2cb48f2ab55",
      "note": "NETTER-1; grade 3-4 rates"
    },
    {
      "event": "Vomiting",
      "grade3PlusPct": 7,
      "source": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=72d1a024-00b7-418a-b36e-b2cb48f2ab55",
      "note": "NETTER-1; grade 3-4 rates"
    }
  ],
  "access": [
    {
      "country": "US",
      "listPrice": "~$47,500 per dose (launch price 2018)",
      "reimbursement": "Medicare Part B (physician-administered); commercial plans per formulary",
      "source": "https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files",
      "asOf": "2026-09-06"
    },
    {
      "country": "UK",
      "reimbursement": "NICE: recommended for unresectable/metastatic GEP-NETs (TA539)",
      "source": "https://www.nice.org.uk/guidance/published?ngt=Technology%20appraisal%20guidance",
      "asOf": "2026-09-06"
    }
  ],
  "regulatoryEvents": [
    {
      "date": "2017-09-26",
      "type": "approval",
      "region": "EU",
      "note": "EMA approval: first modern PRRT",
      "source": "https://www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancer-hematologic-malignancies-approval-notifications"
    },
    {
      "date": "2018-01-26",
      "type": "approval",
      "region": "US",
      "note": "SSTR+ gastroenteropancreatic NETs (NETTER-1)",
      "source": "https://www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancer-hematologic-malignancies-approval-notifications"
    },
    {
      "date": "2024-04-23",
      "type": "approval",
      "region": "US",
      "note": "Paediatric patients ≥12 years",
      "source": "https://www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancer-hematologic-malignancies-approval-notifications"
    }
  ]
}

{
  "id": "novartis",
  "kind": "company",
  "name": "Novartis",
  "aka": [
    "Endocyte"
  ],
  "tldr": "The company that made radioligand therapy a business, with Pluvicto and Lutathera, and the maker of Kisqali and Gleevec.",
  "summary": "Novartis, based in Basel and listed as NOVN.SW, is the company that made radioligand therapy a business with Pluvicto and Lutathera, and the maker of Kisqali...",
  "asOf": "2026-09-04",
  "wikipedia": "https://en.wikipedia.org/wiki/Novartis",
  "links": [
    {
      "label": "Official website",
      "url": "https://www.novartis.com"
    }
  ],
  "related": [
    "lu-177",
    "ac-225"
  ],
  "drugs": [
    "pluvicto",
    "lutathera",
    "ac225-psma"
  ],
  "companies": [
    "mariana-oncology"
  ],
  "trials": [
    "netter-1",
    "nct05939414",
    "nct04711135"
  ],
  "hq": "Basel",
  "country": "CH",
  "companyType": "pharma",
  "website": "https://www.novartis.com",
  "ticker": "NOVN.SW"
}

{
  "id": "snmmi",
  "kind": "institution",
  "name": "Society of Nuclear Medicine and Molecular Imaging",
  "aka": [
    "SNMMI",
    "Society of Nuclear Medicine"
  ],
  "tldr": "The Society of Nuclear Medicine and Molecular Imaging represents US nuclear medicine and publishes the Journal of Nuclear Medicine; its annual meeting is whe...",
  "summary": "Founded in 1954 as the Society of Nuclear Medicine, SNMMI represents physicians, technologists and scientists in nuclear medicine and molecular imaging and p...",
  "asOf": "2026-09-09",
  "links": [
    {
      "label": "SNMMI",
      "url": "https://www.snmmi.org"
    }
  ],
  "related": [
    "src-snmmi"
  ],
  "technologies": [
    "pet",
    "pet-ct",
    "psma-pet"
  ],
  "drugs": [
    "pluvicto",
    "lutathera",
    "pylarify"
  ],
  "institutions": [
    "eanm"
  ],
  "terms": [
    "theranostics",
    "dosimetry",
    "suv"
  ],
  "people": [
    "virginia-pappas"
  ],
  "city": "Reston, VA",
  "country": "US",
  "lat": 38.958,
  "lng": -77.357,
  "institutionType": "consortium",
  "website": "https://www.snmmi.org",
  "programs": [
    "SNMMI Annual Meeting",
    "Journal of Nuclear Medicine",
    "Clinical Trials Network"
  ]
}

{
  "id": "prostate-cancer-signalling",
  "kind": "pathway",
  "name": "Prostate cancer (KEGG map)",
  "aka": [
    "KEGG hsa05215",
    "Prostate cancer"
  ],
  "tldr": "KEGG's prostate cancer map centres on the androgen receptor, the hormone switch that prostate cells depend on, plus loss of PTEN and NKX3.1 that lets PI3K/AK...",
  "summary": "The KEGG prostate cancer map (hsa05215) draws the androgen receptor (AR) as the central node. Testosterone is converted by SRD5A2 to dihydrotestosterone, whi...",
  "asOf": "2026-09-10",
  "links": [
    {
      "label": "KEGG map hsa05215",
      "url": "https://www.kegg.jp/pathway/hsa05215"
    },
    {
      "label": "Review: Emerging mechanisms of resistance to AR inhibitors in prostate cancer",
      "url": "https://doi.org/10.1038/nrc4016"
    }
  ],
  "related": [
    "lu-177"
  ],
  "indications": [
    "prostate"
  ],
  "targets": [
    "psma"
  ],
  "drugs": [
    "enzalutamide",
    "abiraterone",
    "pluvicto"
  ],
  "pathways": [
    "lineage-plasticity-neuroendocrine"
  ],
  "analogy": "The androgen receptor is an engine that runs on testosterone. Cutting the fuel (androgen deprivation) works until the tumour fits a bigger tank (AR amplifica...",
  "nodes": [
    {
      "id": "androgen",
      "label": "Testosterone to DHT (SRD5A2)",
      "x": 20,
      "y": 6
    },
    {
      "id": "ar",
      "label": "Androgen receptor (amplified, mutated)",
      "x": 20,
      "y": 30
    },
    {
      "id": "coact",
      "label": "Co-activators (CBP/p300, NCOA)",
      "x": 50,
      "y": 20
    }
  ],
  "edges": [
    {
      "from": "androgen",
      "to": "ar",
      "type": "activates"
    },
    {
      "from": "coact",
      "to": "ar",
      "type": "activates"
    },
    {
      "from": "ar",
      "to": "argenes",
      "type": "activates"
    }
  ],
  "interventions": [
    "Androgen deprivation (GnRH agonists or antagonists) combined with an AR pathway inhibitor: enzalutamide, apalutamide, darolutamide or abiraterone (CYP17 inhi...",
    "AKT inhibitor capivasertib plus abiraterone for PTEN-deficient metastatic castration-resistant prostate cancer",
    "PSMA radioligand therapy (lutetium-177 vipivotide tetraxetan, Pluvicto) for PSMA-positive disease after AR pathway inhibitors"
  ]
}

{
  "id": "theranostics",
  "kind": "term",
  "name": "Theranostics",
  "aka": [
    "theranostic"
  ],
  "tldr": "Using the same targeting molecule for a diagnostic scan and a therapy, so you treat exactly what you can see.",
  "summary": "Theranostics uses the same targeting molecule for a diagnostic scan and for therapy, so clinicians treat exactly what they can see. The established pairs are...",
  "asOf": "2026-09-04",
  "wikipedia": "https://en.wikipedia.org/wiki/Theranostics",
  "links": [
    {
      "label": "Wikipedia",
      "url": "https://en.wikipedia.org/wiki/Theranostics"
    }
  ],
  "related": [
    "f-18",
    "ga-68",
    "i-123"
  ],
  "technologies": [
    "radioligand-therapy",
    "psma-pet",
    "targeted-alpha-therapy"
  ],
  "category": "Treatment jargon"
}

{
  "id": "vision",
  "kind": "trial",
  "name": "VISION",
  "tldr": "VISION was the trial that established radioligand therapy in prostate cancer.",
  "summary": "VISION, trial NCT03511664 sponsored by Novartis and published in the New England Journal of Medicine in 2021, was the trial that established radioligand ther...",
  "status": "positive",
  "asOf": "2026-09-04",
  "links": [
    {
      "label": "ClinicalTrials.gov NCT03511664",
      "url": "https://clinicaltrials.gov/study/NCT03511664"
    }
  ],
  "related": [
    "lu-177"
  ],
  "indications": [
    "prostate",
    "prostate-mcrpc"
  ],
  "technologies": [
    "radioligand-therapy",
    "psma-pet"
  ],
  "targets": [
    "psma"
  ],
  "drugs": [
    "pluvicto"
  ],
  "people": [
    "oliver-sartor",
    "ken-herrmann",
    "michael-morris"
  ],
  "nct": "NCT03511664",
  "phase": "3",
  "setting": "PSMA+ metastatic castration-resistant prostate cancer after ARPI and taxane: 177Lu-PSMA-617 + SOC vs SOC",
  "sponsor": "Novartis",
  "result": "OS HR 0.62.",
  "yearReported": 2021,
  "enrolled": 861,
  "enrolledBasis": "registry",
  "outcomes": [
    {
      "endpoint": "Overall survival",
      "primary": true,
      "unit": "months",
      "arms": [
        {
          "name": "177Lu-PSMA-617 + standard care",
          "n": 551,
          "value": 15.3
        },
        {
          "name": "Standard care",
          "n": 280,
          "value": 11.3
        }
      ],
      "hr": 0.62,
      "ci": [
        0.52,
        0.74
      ],
      "p": "<0.001",
      "source": "https://www.nejm.org/doi/full/10.1056/NEJMoa2107322"
    },
    {
      "endpoint": "Radiographic progression-free survival",
      "primary": true,
      "unit": "months",
      "arms": [
        {
          "name": "177Lu-PSMA-617 + standard care",
          "value": 8.7
        },
        {
          "name": "Standard care",
          "value": 3.4
        }
      ],
      "hr": 0.4,
      "ci": [
        0.29,
        0.57
      ],
      "p": "<0.001",
      "source": "https://www.nejm.org/doi/full/10.1056/NEJMoa2107322"
    }
  ],
  "replication": "Consistent with TheraP (phase 2, 177Lu-PSMA-617 vs cabazitaxel: higher PSA response, similar OS) and with PSMAfore in an earlier line."
}

{
  "id": "beta-then-alpha",
  "kind": "pairing",
  "name": "Beta radioligand → alpha radioligand",
  "tldr": "After lutetium therapy stops working, an actinium version of the same drug can still produce responses.",
  "summary": "This sequence pairing follows Radioligand therapy (beta emitters) with Targeted alpha therapy using the same targeting molecule: after lutetium stops working...",
  "asOf": "2026-09-04",
  "links": [
    {
      "label": "ClinicalTrials.gov NCT06402331: AlphaBreak (FPI-2265) & AcTION (225Ac-PSMA-617)",
      "url": "https://clinicaltrials.gov/study/NCT06402331"
    }
  ],
  "related": [
    "lu-177",
    "ac-225"
  ],
  "indications": [
    "prostate",
    "neuroendocrine"
  ],
  "drugs": [
    "pluvicto",
    "ac225-psma",
    "lutathera"
  ],
  "terms": [
    "alpha-vs-beta"
  ],
  "a": "radioligand-therapy",
  "b": "targeted-alpha-therapy",
  "rationale": "Alpha particles cause oxygen-independent clustered DNA damage that beta-resistant, hypoxic, or small-volume disease cannot repair.",
  "evidence": "Retrospective and phase 1/2; phase 3 pending.",
  "pairingType": "sequence"
}

{
  "id": "alpha-therapy-roadmap",
  "kind": "roadmap",
  "name": "Alpha-emitter roadmap: radium-223 → 225Ac-PSMA-617 → a phase 3 pipeline",
  "tldr": "Alpha particles carry much more energy over a much shorter distance than the beta particles used in Lutathera and Pluvicto, so they can be more powerful agai...",
  "summary": "Alpha-particle therapy began clinically with radium-223 dichloride, approved by the FDA on 15 May 2013 for bone metastases in prostate cancer after the ALSYM...",
  "asOf": "2026-09-22",
  "links": [
    {
      "label": "FDA: Alsympca (radium-223 dichloride) approval, May 2013",
      "url": "https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203971Orig1s000TOC.cfm"
    },
    {
      "label": "Kratochwil et al., 225Ac-PSMA-617 for PSMA-targeted alpha-radiation therapy (J Nucl Med 2016)",
      "url": "https://pubmed.ncbi.nlm.nih.gov/27390158/"
    },
    {
      "label": "RayzeBio/ClinicalTrials.gov: ACTION-1 (NCT05477576)",
      "url": "https://clinicaltrials.gov/study/NCT05477576"
    }
  ],
  "related": [
    "lu-177",
    "ac-225",
    "ra-223"
  ],
  "technologies": [
    "targeted-alpha-therapy",
    "actinium-225-supply",
    "radioligand-therapy"
  ],
  "drugs": [
    "radium-223",
    "ryz101",
    "fpi-2265"
  ],
  "companies": [
    "rayzebio",
    "fusion-pharma",
    "novartis"
  ],
  "trials": [
    "alsympca",
    "action-1",
    "alphabreak"
  ],
  "people": [
    "clemens-kratochwil",
    "uwe-haberkorn"
  ],
  "keyPapers": [
    "paper-alsympca-radium-223-nejm-2013"
  ],
  "steps": [
    {
      "era": "2013",
      "title": "Radium-223: the first alpha emitter approved",
      "description": "The FDA approves radium-223 dichloride on 15 May 2013 for symptomatic bone metastases in castration-resistant prostate cancer, based on the ALSYMPCA trial (m...",
      "refs": [
        "radium-223",
        "alsympca",
        "paper-alsympca-radium-223-nejm-2013"
      ],
      "status": "historic"
    },
    {
      "era": "2014-2017",
      "title": "First-in-human targeted alpha therapy: 225Ac-PSMA-617",
      "description": "Clinical investigation of 225Ac-PSMA-617 begins in 2014 at Heidelberg University Hospital with the Joint Research Centre Karlsruhe. Kratochwil et al. report ...",
      "refs": [
        "clemens-kratochwil",
        "uwe-haberkorn"
      ],
      "status": "historic"
    },
    {
      "era": "2018-2023",
      "title": "Sponsor-run alpha programmes multiply",
      "description": "Compassionate-use experience is followed by company-sponsored trials repeating the beta-to-alpha substitution across targets and companies: RYZ101 (225Ac-DOT...",
      "refs": [
        "action-1",
        "alphabreak",
        "alphamedix-02"
      ],
      "status": "historic"
    }
  ],
  "watch": [
    {
      "item": "ACTION-1 (RYZ101, RayzeBio/BMS) phase 3 primary completion",
      "expected": "Primary Completion (Estimated): 2026-12",
      "source": "https://clinicaltrials.gov/study/NCT05477576",
      "refs": [
        "action-1",
        "rayzebio"
      ]
    },
    {
      "item": "AlphaBreak (FPI-2265, Fusion Pharmaceuticals) phase 2 primary completion",
      "expected": "Estimated Completion: July 23, 2026",
      "source": "https://www.ancora.ai/en/detailsradiopharm/NCT06402331",
      "refs": [
        "alphabreak",
        "fusion-pharma"
      ]
    },
    {
      "item": "AAA817 (Novartis, PSMAcTION, NCT06780670) phase 3 primary completion",
      "expected": "Primary completion date: Jun 27, 2028 (Anticipated)",
      "source": "https://www.allclinicaltrials.com/study/NCT06780670",
      "refs": [
        "novartis"
      ]
    }
  ]
}

{
  "id": "idea-net-dosimetry-prrt",
  "kind": "idea",
  "name": "Dosimetry-personalised PRRT instead of four fixed cycles",
  "tldr": "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 cy...",
  "summary": "The idea is to personalise peptide receptor radionuclide therapy with lutetium-177 dotatate or 177Lu-edotreotide by measuring the radiation each patient's tu...",
  "asOf": "2026-09-07",
  "links": [
    {
      "label": "ClinicalTrials.gov NCT03049189: COMPETE",
      "url": "https://clinicaltrials.gov/study/NCT03049189"
    }
  ],
  "related": [
    "lu-177"
  ],
  "indications": [
    "neuroendocrine"
  ],
  "technologies": [
    "prrt",
    "spect"
  ],
  "drugs": [
    "lutathera",
    "itm-11"
  ],
  "terms": [
    "dosimetry"
  ],
  "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.",
  "test": "Randomised phase 2 of individualised vs fixed activity with ORR and PFS endpoints.",
  "maturity": "early-clinical"
}

{
  "id": "prostate-cancer-foundation",
  "kind": "collection",
  "name": "Prostate Cancer Foundation (PCF)",
  "tldr": "Michael Milken's prostate cancer foundation, which funded the science behind abiraterone, enzalutamide and PSMA therapy and runs a precision-oncology network...",
  "summary": "Founded 1993 (as CaP CURE). PCF-funded research contributed to abiraterone, enzalutamide, radium-223, PSMA imaging and radioligands, and germline testing gui...",
  "asOf": "2026-09-08",
  "links": [
    {
      "label": "PCF",
      "url": "https://www.pcf.org/"
    },
    {
      "label": "ZERO Prostate Cancer",
      "url": "https://zerocancer.org/"
    },
    {
      "label": "Movember",
      "url": "https://us.movember.com/"
    }
  ],
  "tags": [
    "gap-fill",
    "patient-org"
  ],
  "related": [
    "prostate",
    "psma",
    "psma-pet"
  ],
  "url": "https://www.pcf.org/",
  "holds": "The largest philanthropic funder of prostate cancer research (>$1 billion), Challenge Awards and Young Investigator programme, the PCF-VA Precision Oncology ...",
  "license": "Copyright PCF",
  "maintainer": "PCF"
}

{
  "id": "ken-herrmann",
  "kind": "person",
  "name": "Ken Herrmann",
  "tldr": "Nuclear medicine leader who co-led VISION and runs one of the world's largest theranostics programmes.",
  "summary": "Ken Herrmann was a lead investigator of VISION and of the German multicentre 177Lu-PSMA-617 registry, and leads the Essen theranostics centre that has treate...",
  "asOf": "2026-09-10",
  "links": [
    {
      "label": "PubMed",
      "url": "https://pubmed.ncbi.nlm.nih.gov/?term=Herrmann%20K%5BAuthor%5D%20theranostics%20PSMA"
    }
  ],
  "tags": [
    "radioligand",
    "nuclear-medicine",
    "germany"
  ],
  "related": [
    "lu-177"
  ],
  "indications": [
    "prostate",
    "neuroendocrine"
  ],
  "technologies": [
    "radioligand-therapy",
    "psma-pet",
    "fapi-pet"
  ],
  "targets": [
    "psma",
    "fap"
  ],
  "drugs": [
    "pluvicto",
    "lutathera"
  ],
  "institutions": [
    "essen-wtz",
    "eanm"
  ],
  "trials": [
    "vision"
  ],
  "keyPapers": [
    "paper-vision-nejm-2021"
  ],
  "role": "Chair of Nuclear Medicine, University Hospital Essen",
  "institutionId": "essen-wtz",
  "specialisms": [
    "Theranostics",
    "PSMA radioligand therapy",
    "Nuclear medicine"
  ],
  "profiles": [
    {
      "label": "PubMed",
      "url": "https://pubmed.ncbi.nlm.nih.gov/?term=Herrmann%20K%5BAuthor%5D%20theranostics%20PSMA"
    }
  ],
  "papers": [
    {
      "title": "Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer (VISION)",
      "journal": "NEJM",
      "year": 2021,
      "doi": "10.1056/NEJMoa2107322"
    },
    {
      "title": "Radiotheranostics: a roadmap for future development",
      "journal": "Lancet Oncology",
      "year": 2020,
      "doi": "10.1016/S1470-2045(19)30821-6"
    }
  ],
  "orcid": "0000-0002-9662-7259"
}

{
  "id": "b-manufacturing-cell-therapy",
  "kind": "bottleneck",
  "name": "Manufacturing cost and time for living and radioactive medicines",
  "tldr": "Cell therapies take weeks to make for one patient and cost hundreds of thousands of dollars. Isotopes run short.",
  "summary": "Autologous CAR-T, TIL and TCR-T are one-batch-per-patient manufacturing: leukapheresis, shipping, transduction, expansion, release testing and return take se...",
  "asOf": "2026-09-08",
  "links": [
    {
      "label": "Hernandez, Prasad & Gellad, Total costs of chimeric antigen receptor T-cell immunotherapy (JAMA Oncology 2018)",
      "url": "https://doi.org/10.1001/jamaoncol.2018.0977"
    },
    {
      "label": "Maude et al., Tisagenlecleucel in children and young adults with B-cell lymphoblastic leukemia (ELIANA, NEJM 2018)",
      "url": "https://doi.org/10.1056/NEJMoa1709866"
    },
    {
      "label": "US Department of Energy Isotope Program",
      "url": "https://www.isotopes.gov/"
    }
  ],
  "related": [
    "radiopharma-roadmap",
    "idea-reg-legacy-radium-recovery-ac225",
    "idea-reg-ac225-accelerator-pharmacopoeia"
  ],
  "indications": [
    "dlbcl",
    "prostate",
    "neuroendocrine"
  ],
  "technologies": [
    "radioligand-therapy",
    "targeted-alpha-therapy"
  ],
  "drugs": [
    "pluvicto",
    "lutathera",
    "ac225-psma"
  ],
  "companies": [
    "novartis",
    "terrapower-isotopes",
    "orano-med"
  ],
  "terms": [
    "alpha-vs-beta",
    "dosimetry",
    "theranostics"
  ],
  "trials": [
    "vision"
  ],
  "stage": "regulation-manufacturing",
  "severity": "major",
  "metrics": [
    {
      "label": "Estimated total cost of CAR-T therapy including list price and management of adverse events (2018 US analysis)",
      "value": "Up to ~US$500,000 per patient",
      "source": "Hernandez, Prasad & Gellad, JAMA Oncology 2018",
      "url": "https://doi.org/10.1001/jamaoncol.2018.0977"
    },
    {
      "label": "Patients in ELIANA for whom tisagenlecleucel could not be manufactured",
      "value": "7 of 92 enrolled",
      "source": "Maude et al., NEJM 2018",
      "url": "https://doi.org/10.1056/NEJMoa1709866"
    },
    {
      "label": "Historic global actinium-225 supply from thorium-229 stockpiles",
      "value": "~63 GBq (1.7 Ci) per year",
      "source": "Robertson et al., Current Radiopharmaceuticals 2018",
      "url": "https://doi.org/10.2174/1874471011666180416161908"
    }
  ],
  "causes": [
    "Autologous products are bespoke batches with no economies of scale.",
    "Viral vector and GMP capacity are limited and expensive.",
    "Actinium-225 has historically come only from decay of legacy thorium-229 held by a few government laboratories."
  ],
  "currentEfforts": [
    "Umoja, Interius and Orna are developing in vivo CAR-T that programmes T cells inside the patient, removing manufacturing entirely.",
    "Allogene, Caribou, Sana and Fate build off-the-shelf allogeneic CAR-T and CAR-NK products from healthy donor or iPSC sources.",
    "Novartis' T-Charge and point-of-care manufacturing programmes at academic centres cut vein-to-vein time to days."
  ],
  "successLooksLike": "A CAR-T or equivalent cell therapy is available within a week of decision at a cost comparable to a course of biologic therapy, the majority of eligible pati..."
}

{
  "id": "opp-fap-pancreatic-staging",
  "kind": "opportunity",
  "name": "FAP imaging to stop futile pancreatic surgery",
  "aka": [
    "FAPI PET in PDAC"
  ],
  "tldr": "Four in ten pancreatic cancer patients whose scans say the tumour can be removed turn out, once opened up, to have disease that cannot be removed. A scan tha...",
  "summary": "The number that defines this opportunity comes from a Cochrane review: the median pre-test probability of unresectable disease after CT was 41.4%, meaning 41...",
  "asOf": "2026-09-23",
  "links": [
    {
      "label": "Cochrane review: unresectable disease found at laparotomy after CT",
      "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.cd009323.pub3/full"
    },
    {
      "label": "18F-FAPI-04 against FDG in 62 patients, J Nucl Med 2024",
      "url": "https://jnm.snmjournals.org/content/jnumed/65/2/206.full.pdf"
    },
    {
      "label": "NCT05262855: [68Ga]FAPI-46 phase 2 in pancreatic cancer",
      "url": "https://clinicaltrials.gov/study/NCT05262855"
    }
  ],
  "tags": [
    "unmet need first",
    "pancreas",
    "surgical selection"
  ],
  "related": [
    "ga-68",
    "f-18",
    "lu-177"
  ],
  "indications": [
    "pancreatic-cancer"
  ],
  "technologies": [
    "fapi-pet",
    "pet-ct",
    "fdg-pet"
  ],
  "targets": [
    "fap"
  ],
  "drugs": [
    "ga-68-fapi-46",
    "fap-2286"
  ],
  "lens": "unmet-need-first",
  "unmetNeed": "No validated test tells a pancreatic tumour board, before operating, whether a CT-resectable tumour hides peritoneal or small liver metastases, and 41.4% of ...",
  "useCase": "A hepatobiliary surgeon and tumour board would scan every patient considered for resection or for neoadjuvant therapy, and would cancel or defer surgery on t...",
  "hypothesis": "FAP-directed PET before pancreatic resection will identify CT-occult peritoneal and hepatic metastases often enough to reduce the non-curative laparotomy rat...",
  "rationale": "Pancreatic ductal adenocarcinoma is defined by its fibroblast-rich stroma, which is why a tracer aimed at fibroblast activation protein has repeatedly outper...",
  "test": "A prospective study in patients deemed resectable on CT, imaging all of them with a FAP tracer, with a pre-specified rule for when a FAPI-positive extra-panc...",
  "maturity": "being-tested-at-scale",
  "verdict": "standalone-and-companion",
  "mostAdvanced": "[68Ga]FAPI-46 from SOFIE: a completed prospective multicentre phase 2 in resectable or borderline resectable pancreatic ductal adenocarcinoma, 63 patients, w...",
  "dueDiligence": [
    {
      "domain": "target-biology",
      "state": "strong",
      "why": "Pancreatic ductal adenocarcinoma is stroma-rich and fibroblast activation protein is expressed in the tumour stroma rather than the tumour cells, which is wh...",
      "source": "Wang et al., J Nucl Med 2024",
      "url": "https://jnm.snmjournals.org/content/jnumed/65/2/206.full.pdf",
      "weighted": true
    },
    {
      "domain": "clinical-evidence",
      "state": "strong",
      "why": "A completed prospective multicentre phase 2 of 63 patients with histopathology truth standard, a 62-patient prospective head-to-head against FDG, a 20-patien...",
      "source": "NCT05262855 and Hu et al. meta-analysis",
      "url": "https://clinicaltrials.gov/study/NCT05262855",
      "weighted": true
    },
    {
      "domain": "diagnostic-performance",
      "state": "strong",
      "why": "Pooled sensitivity 0.99 (0.97 to 1.00) for FAPI against 0.84 (0.70 to 0.92) for FDG with comparable specificity across 322 patients; stage upgraded in 14 of ...",
      "source": "PDAC-specific meta-analysis, Academic Radiology 2025",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12890629/",
      "weighted": true
    }
  ],
  "flags": [
    {
      "category": "technical",
      "flag": "green",
      "why": "Works with both gallium-68 and fluorine-18 constructs, same-day imaging, and repeatedly reproduced across independent centres."
    },
    {
      "category": "unmet-need",
      "flag": "green",
      "why": "A 41.4% futile-laparotomy rate after CT staging is a large, quantified, guideline-recognised failure of current imaging."
    },
    {
      "category": "ip",
      "flag": "red",
      "why": "The FAPI chemical space is crowded with FAPI-04, FAPI-46, FAPI-74, FAP-2286 and numerous derivatives across multiple sponsors and academic groups."
    }
  ],
  "competition": [
    {
      "name": "SOFIE Biosciences",
      "what": "[68Ga]FAPI-46 phase 2 in resectable and borderline resectable pancreatic ductal adenocarcinoma, 63 patients, completed, histopathology truth standard.",
      "stage": "phase 2 complete",
      "url": "https://clinicaltrials.gov/study/NCT05262855"
    },
    {
      "name": "Novartis",
      "what": "177Lu-FAP-2286 in LuMIERE, phase 1/2, 222 planned; phase 1 had 27 patients including 9 with pancreatic cancer, with one partial response and nine stable.",
      "stage": "phase 1/2",
      "url": "https://clinicaltrials.gov/study/NCT04939610"
    },
    {
      "name": "Chinese and Korean academic groups",
      "what": "18F-FAPI-04 in 62 patients prospectively against FDG, and [18F]AlF-FAPI-74 in 20 potentially resectable patients.",
      "stage": "published prospective studies",
      "url": "https://jnm.snmjournals.org/content/jnumed/65/2/206.full.pdf"
    }
  ],
  "differentiation": "The comparators are CT, which leaves a 41.4% futile-laparotomy rate, and staging laparoscopy, which is itself an operation. CA 19-9 is neither sensitive nor ...",
  "metrics": [
    {
      "label": "CT-resectable patients found unresectable at laparotomy",
      "value": "41.4% median pre-test probability",
      "source": "Cochrane review, Allen et al. 2016",
      "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.cd009323.pub3/full"
    },
    {
      "label": "Pooled sensitivity of FAPI against FDG in pancreatic ductal adenocarcinoma",
      "value": "0.99 against 0.84 across 7 studies and 322 patients",
      "source": "Hu et al., Academic Radiology 2025, via review",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12890629/"
    },
    {
      "label": "Patients whose TNM stage was upgraded by 18F-FAPI-04 against FDG",
      "value": "14 of 62",
      "source": "Wang et al., J Nucl Med 2024",
      "url": "https://jnm.snmjournals.org/content/jnumed/65/2/206.full.pdf"
    }
  ],
  "risks": [
    "FAP is expressed in wound healing, pancreatitis and other fibrotic conditions, so specificity in a chronically inflamed pancreas is the obvious failure mode ...",
    "Detection superiority does not automatically translate into fewer futile operations; a surgeon will not cancel an operation on an unbiopsied peritoneal signa...",
    "The therapeutic side of FAP is going badly, with one terminated trial and mostly progression in compassionate use, so a theranostic pitch would be weak."
  ],
  "watch": [
    "Publication of the SOFIE phase 2 results and whether any follow-on trial adopts avoided laparotomy as an endpoint.",
    "Specificity data in chronic pancreatitis and post-treatment fibrosis, which is where this agent will either hold up or fail.",
    "Whether FAP-directed therapy recovers after FRONTIER, which determines if a companion use ever exists."
  ]
}

{
  "id": "paper-vision-nejm-2021",
  "kind": "paper",
  "name": "VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer",
  "tldr": "A radioactive drug that homes to the PSMA protein on prostate cancer cells helped men with heavily pretreated metastatic prostate cancer live about four mont...",
  "summary": "Open-label phase 3 trial of 831 men with PSMA-PET-positive metastatic castration-resistant prostate cancer previously treated with at least one androgen-rece...",
  "asOf": "2026-09-08",
  "links": [
    {
      "label": "NEJM 2021",
      "url": "https://doi.org/10.1056/NEJMoa2107322"
    },
    {
      "label": "ClinicalTrials.gov NCT03511664",
      "url": "https://clinicaltrials.gov/study/NCT03511664"
    }
  ],
  "related": [
    "psma-pet-to-rlt",
    "lu-177"
  ],
  "indications": [
    "prostate"
  ],
  "technologies": [
    "radioligand-therapy",
    "psma-pet",
    "pet-ct"
  ],
  "targets": [
    "psma"
  ],
  "drugs": [
    "pluvicto"
  ],
  "companies": [
    "novartis"
  ],
  "terms": [
    "theranostics",
    "alpha-vs-beta",
    "dosimetry"
  ],
  "trials": [
    "vision",
    "psmafore"
  ],
  "people": [
    "karim-fizazi",
    "michael-morris"
  ],
  "journals": [
    "nejm"
  ],
  "journal": "New England Journal of Medicine",
  "year": 2021,
  "doi": "10.1056/NEJMoa2107322",
  "authors": "Sartor O, de Bono J, Chi KN, et al.",
  "paperType": "rct",
  "findings": [
    "Median overall survival 15.3 vs 11.3 months; HR 0.62 (95% CI 0.52-0.74).",
    "Median radiographic PFS 8.7 vs 3.4 months; HR 0.40 (99.2% CI 0.29-0.57).",
    "PSA decline of 50% or more in 46% vs 7%; objective response in measurable disease 30% vs 2%."
  ],
  "whatItMeans": "Men with metastatic castration-resistant prostate cancer that has progressed after hormonal therapy and chemotherapy, and whose tumours show PSMA on a PET sc...",
  "caveats": [
    "Standard care in the control arm excluded chemotherapy, radium-223 and other active drugs, and about 56% of control patients withdrew early, weakening the co...",
    "Open-label; the OS benefit is nonetheless robust to sensitivity analyses.",
    "Requires nuclear medicine infrastructure, isotope supply and PSMA PET access, which are unequally distributed."
  ],
  "changedPractice": true,
  "participants": 831
}

{
  "id": "journal-of-nuclear-medicine",
  "kind": "journal",
  "name": "Journal of Nuclear Medicine",
  "aka": [
    "JNM",
    "J Nucl Med"
  ],
  "tldr": "The Journal of Nuclear Medicine is the SNMMI's journal and the core venue for PET tracers and radioligand therapy: PSMA and somatostatin imaging, lutetium an...",
  "summary": "The Journal of Nuclear Medicine appears monthly and publishes first-in-human tracer studies, PSMA PET diagnostic accuracy trials, radioligand-therapy dosimet...",
  "asOf": "2026-09-09",
  "links": [
    {
      "label": "SNMMI",
      "url": "https://www.snmmi.org"
    }
  ],
  "related": [
    "src-snmmi",
    "lu-177",
    "ac-225"
  ],
  "technologies": [
    "radioligand-therapy"
  ],
  "publisher": "Society of Nuclear Medicine and Molecular Imaging",
  "url": "https://jnm.snmjournals.org",
  "issn": "0161-5505",
  "scope": "nuclear medicine",
  "access": "hybrid",
  "founded": 1960,
  "matchNames": [
    "Journal of Nuclear Medicine",
    "JNM",
    "J Nucl Med"
  ],
  "society": "Society of Nuclear Medicine and Molecular Imaging"
}