Emerging theragnostic radionuclide applications for hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is a major global health problem. Theragnostic is a term that refers to the integration of diagnostic and therapeutic modalities into a single system for personalized medicine. Theragnostic care in HCC involves the use of imaging techniques to diagnose the cancer and assess its characteristics, such as size, location, and extent of spread. Theragnostics involves the use of molecular and genetic tests to identify specific biomarkers that can help guide treatment decisions and, post-treatment, assess the dosimetry and localization of the treatment, thus guiding future treatment. This can be done through either positron emission tomography (PET) scanning or single photon emission tomography (SPECT) using radiolabeled tracers that target specific molecules expressed by HCC cells or radioembolization. This technique can help identify the location and extent of the cancer, as well as provide information on the tumor's metabolic activity and blood supply. In summary, theragnostics is an emerging field that holds promise for improving the diagnosis and treatment of HCC. By combining diagnostic and therapeutic modalities into a single system, theragnostics can help guide personalized treatment decisions and improve patient outcomes.

Keywords: fibroblast activation protein inhibitors; hepatocellular carcinoma; lipiodol; microspheres; prostate specific membrane antigen; radioembolization; theragnostics; transarterial radionuclide therapy.

Figure 1

Staging and treatment based on the BCLC system. PST-performance status; CP-Child Pugh CIS-Carcinoma in situ HCC-hepatocellular carcinoma. Image adapted from Int J Mol Sci. (2019) 20:1465. doi: 10.3390/ijms20061465 licensed under Creative Commons Attribution 4.0 International.

Figure 2

18-year-old female with a 2-year history of HCC. The patient had a hepatectomy and subsequent recurrence, which was not responding to conventional therapy. (A) Ga-68 PSMA scan demonstrating uptake in the liver and lung lesions. (B) Lu-177 PSMA post-therapy image, demonstrating congruent uptake in these lesions.

Figure 3

Tracer retention in the liver lesions is seen at 19 h and 48 h following ¹⁷⁷Lu PSMA administration in patient shown in Figure 2. (A) (anterior) and (B) (posterior) are taken 19 hours post Lu-177 PSMA administration. Images (C) (anterior) and (D) (posterior) are taken at 48 h post Lu-177 PSMA administration.