Neue Ansätze in der Nuklearmedizinischen Diagnostik und Therapie

Durch den Erfolg der gegen Somatostatinrezeptoren (SSTR)- und das Prostata-spezifische Membranantigen (PSMA)-gerichteten Radioliganden hat die Nuklearmedizin in den letzten Jahren eine außergewöhnliche Dynamik erfahren. Aktuell wird eine Vielzahl neuer Radiopharmazeutika für theranostische Konzepte entwickelt; wobei das Fibroblasten-aktivierende Protein (FAP) das größte klinische Interesse in den letzten Jahren geweckt hat. Jenseits der FAP-Inhibitoren sind noch weitere Radiopharmazeutika erfolgreich in die Klinik überführt worden. In diesem kurzen Überblick werden wir uns auf fünf Ansätze bzw. Zielstrukturen konzentrieren, die die große Vielfalt der nuklearmedizinischen Theranostik widerspiegeln: den C-X-C-motif Chemokin-Rezeptor 4, die Carboanhydrase IX, Glypican-3, Östrogenrezeptoren und Antagonisten für SSTR 2.

Kernaussagen

• Potential theranostischer Konzepte: Mit dem Einsatz von Radiopharmazeutika, wie SSTR- und PSMA-Liganden, hat die Nuklearmedizin in den letzten Jahren neue zielgerichtete Therapien ermöglicht. Aktuell besteht ein großes Interesse an neuen zielgerichteten Radioliganden, die die Forschung in der Theranostik vorantreiben.

• Die Carboanhydrase IX (CAIX) als Hypoxiemarker: Die CAIX wird unter hypoxischen Bedingungen verstärkt exprimiert und stellt u.a. eine wichtige Zielstruktur in klarzelligen Nierenzellkarzinomen dar. Verschiedene Antikörper- und small molecule-basierte Radiopharmazeutika wurden hier bereits in der Diagnostik und Therapie evaluiert.

• C-X-C motif Chemokin-Rezeptor 4 (CXCR4) als neuer Tracer in der Hämatoonkologie: CXCR4 wird physiologischerweise von vielen Immunzellen exprimiert. [⁶⁸Ga]Ga-Pentixafor und [¹⁷⁷Lu]Lu/[90Y]Y-Pentixather haben daher vor allem in hämatologischen Neoplasien, wie dem multiplen Myelom, vielversprechende Ergebnisse gezeigt.

• Glypican-3 als Zielstruktur bei hepoatozellullären Karzinomen: Glypican-3 wird überwiegend von hepatozellulären Karzinomen überexprimiert und weist im gesunden oder zirrhotischen Leberparenchym nahezu keine Expression auf. Erste Studien haben vielversprechende Ergebnisse hinsichtlich sehr guter Tumordetektionsraten mit hohen Tumor-zu-Hintergrund-Kontrasten ergeben.

• Somatostatinrezeptor-Antagonisten (SSTR-Antagonisten): Während die SSTR-Agonisten DOTATOC/DOTATATE in der klinischen Routine etabliert sind, wurde für SSTR-Antagonisten eine höhere Bindungskapazität im Vergleich zu Agonisten nachgewiesen. Das Potential der SSTR-Antagonisten für die Diagnostik und Therapie in verschiedenen (primär neuroendokrinen) Tumorerkrankungen wird aktuell in Studien untersucht.

• Östrogenrezeptor (ER)-Bildgebung: Die [¹⁸F]FES-PET/CT ist in den USA bereits zugelassen und erlaubt eine in vivo-Darstellung der ER-Expression von Tumorzellen. Dies kann Therapieentscheidungen in der Behandlung des Mammakarzinoms unterstützen.

Schlüsselwörter

Theranostics - PET/CT - Somatostatinrezeptor-Antagonisten - Carboanhydrase IX - C-X-C motif Chemokin-Rezeptor 4 - Glypican-3 - Östrogenrezeptor

Keywords

theranostics - carbonic anhydrase IX - somatostatin receptor antagonists - C-X-C motif chemokine receptor 4 - glypican-3 - estrogen receptor - PET/CT

Publication History

Article published online:
02 September 2025

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