2020a). Similar results have also been observed with 64-Cu-labeled RGD ligands in

patients with gliomas (glioblastoma multiforme) (Zhang et al. 2020).

7.4

Radiomolecular Therapy

The introduction of radioiodine (¹³¹I) for the treatment of Graves’ disease in the early

1940s by Saul Hertz was a revolution in patients with hyperthyroidism. ¹³¹I now forms

the standard of care in most patients with hyperthyroidism or differentiated thyroid

cancer. ¹²³I, ¹³¹I formed one of the earliest theranostic pairs (Seidlin et al. 1949).

Nuclear medicine theranostics in most cases involves the use of a common molecule

that can be tagged with a radionuclide for SPECT/PET imaging and a therapeutic

radionuclide for treatment. Examples of such theranostic pairs include

68Ga-

DOTATATE for PET/CT imaging of NENs and ¹⁷⁷Lu-DOTATATE for PRRT,

68Ga-PSMA for PET/CT imaging of prostate cancer and 225Ac or 177Lu-PSMA for

RLT, ¹²³I-mIBG for SPECT imaging of neuroblastomas, and ¹³¹I-mIBG for therapy.

The advantage of such theranostic pairs is the ability to visualize the disease prior to its

treatment (Alzahrani et al. 2012).

Fig. 7.2 MIP PET image of 57-year-old female patient with breast carcinoma, 45 min post

i.v. injection of 3–5 mCi⁶⁸Ga-DOTA-RGD2. (a) Abnormal tracer uptake was seen in right hemi-

thorax which on CT and fused PET/CT transaxial images (b) and (c) localized to a moderately tracer

avid (SUVmax 8.5) lesion in the upper outer quadrant of right breast

7

Precision Radiomolecular Oncology: Challenging the Classical Statistical. . .

101