A 52-year-old woman with metastatic pancreatic adenocarcinoma underwent imaging with 18 F-FDG PET/CT and 68 Ga-FAPI-46 PET/CT, which demonstrated malignancy recurrence in the surgical bed with multiple metastatic lesions, more extensive on 68 Ga-FAPI-46 PET/CT. The patient was a candidate for therapy with 177 Lu-FAPI-46 due to high uptake of lesions in 68 Ga-FAPI-46 images and no other available therapeutic option. Posttreatment 177 Lu-FAPI-46 scans showed rather rapid washout of the radiopharmaceutical from tumoral lesions. This case report suggests that, although 68 Ga-FAPI-46 is a promising agent for tumor imaging, 177 Lu-FAPI-46 may not be an optimal compound for theranostic applications.

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Prostate-specific membrane antigen (PSMA) is a transmembrane protein that is highly expressed on the surface of prostate cancer (PC) cells, making it an excellent radiotracer for both therapeutic and diagnostic purposes. In this prospective study, we investigated the efficacy and toxicity of 177 Lutetium (Lu)-PSMA in metastatic castration-resistant PC (mCRPC) patients for the establishment and approval of this therapy in Iran. Fourteen mCRPC patients (mean age 70.57 ± 7.3 years) were treated with a single dose of 177 Lu-PSMA. Complete blood count, liver function tests (aspartate aminotransferase and alanine aminotransferase), alkaline phosphatase levels, renal function tests (urea and creatinine), and prostate-specific antigen (PSA) levels were obtained for the patients at baseline and every 2 weeks. A majority of the patients (11 patients, 64.2%) experienced a decline in their PSA levels; in 5 (45.4%) of these patients, the PSA levels declined > 50%.The severity of pain decreased in 8 (57.1%) patients, and performance status was improved in 5 (45.4%) patients. The treatment was well tolerated, and no severe hematological or nonhematological side effects were observed. Our findings show that 177 Lu-PSMA had a high efficacy and a low toxicity in an Iranian population and is a promising treatment option for PC patients.