Selecting patients for receptor-targeted therapy.
Successful radioligand therapy begins with rigorous patient selection — combining disease characteristics, molecular imaging, and multidisciplinary review.
Four steps to identify candidates
Clinical assessment
Confirm diagnosis, disease burden, prior therapy lines, and performance status.
Pathology & biomarkers
Review receptor expression status where available (e.g. SSTR2 for NETs).
Molecular imaging
Companion PET imaging (e.g. 68Ga-DOTATATE) to confirm target expression in vivo.
MDT review
Discuss candidacy in a multidisciplinary tumor board with nuclear medicine present.
Companion molecular imaging
Receptor-targeted PET imaging serves as a non-invasive biomarker to visualize target expression and quantify disease burden across the whole body — critical information when considering radioligand therapy.
For SSTR2-expressing tumors such as gastroenteropancreatic neuroendocrine tumors (GEP-NETs), 68Ga-DOTATATE or 64Cu-DOTATATE PET is commonly used to assess receptor expression prior to therapy.
- ▸Is target expression sufficient on imaging across measurable lesions?
- ▸Are there discordant lesions (FDG-avid, receptor-negative)?
- ▸What is the patient's marrow, renal, and hepatic reserve?
- ▸What is the optimal sequencing relative to other available therapies?