The clinical applications of 68Ga-Pentixafor/177Lu/213Bi-Pentixather as a

“theranostics pair” for the diagnosis and treatment of CXCR4 expressing cancers

are emerging. CXCR4-based theranostics which had not been investigated in routine

clinical practice till now (except few preliminary proof of concept studies), therefore,

may be a potential game changer both in the diagnosis and treatment of CXCR4

overexpressing solid tumors and hematological malignancies especially with failure

of conventional therapies. A pilot study in GBM patients using ⁶⁸Ga-Pentixafor

PET/CT for quantitative imaging of CXCR4 expression (Fig. 7.5) demonstrated that

68Ga-Pentixafor PET imaging in GBM (known to have high CXCR4 expression) is

viewed to open up new theranostics applications (with beta and alpha radionuclides)

for long-term survival benefits. However, the diagnostic utility of this tracer needs to

be validated in large-scale prospective studies through multicenter trials.

Precision radiomolecular oncology is the future of evidence-based, personalized

medicine and a step toward the optimal management of cancer. Through nuclear

medicine, we can achieve the combined target of early and accurate assessment of

malignant involvement as well as optimal and efficacious therapy with minimal and

manageable adverse events.

Fig. 7.4

68Ga-Pentixafor PET/CT in a patient with adenocarcinoma right lung (a) MIP image

showing tracer uptake in bilateral thoracic region, (b) trans-axial fused PET/CT image showing

tracer avid soft tissue mass (SUVmax ¼ 12.20) in the lower lobe of the right lung and (c) is the

corresponding CT image demonstrating the primary lung mass

7

Precision Radiomolecular Oncology: Challenging the Classical Statistical. . .

105