A theranostic radionuclide — the low-energy gamma emissions allow SPECT imaging to confirm target localization and dosimetry, while the beta emissions deliver therapeutic cytotoxic dose at short range (~0.5–2 mm in tissue).
Lu-177 DOTATATE (Lutathera) — PRRT:
- Approved for somatostatin receptor-positive gastroenteropancreatic NETs (GEP-NETs)
- Patient must have DOTATATE-avid disease on Ga-68 DOTATATE PET prior to therapy
- 4 cycles of 200 mCi every 8 weeks
- NETTER-1 trial: significantly improved PFS vs high-dose octreotide LAR
- Kidneys are dose-limiting organ (renal tubular uptake) — renal protection with amino acid infusion (lysine/arginine) required
Lu-177 vipivotide tetraxetan (Pluvicto) — PSMA-targeted therapy:
- Approved for metastatic castration-resistant prostate cancer (mCRPC) after prior ARPI and taxane
- Patient must have PSMA-avid disease on PSMA PET (Ga-68 PSMA-11 or F-18 piflufolastat)
- VISION trial: significant improvement in radiographic PFS and OS vs standard of care
- Salivary glands, kidneys, and lacrimal glands are dose-limiting (PSMA-expressing normal tissues)
Lu-177 is the foundation of the rapidly expanding theranostics platform in nuclear medicine.