Targeted Radionuclide Therapy in Diffuse Intrinsic Brainstem Gliomas: Exploring Options Beyond the Finish Line

Area of Science:

• Oncology
• Nuclear Medicine
• Pediatric Neuro-oncology

Background:

• Diffuse intrinsic brainstem gliomas (DIPG) are aggressive pediatric brain tumors, predominantly occurring in the pons.
• DIPG has a poor prognosis, with limited treatment options and high-grade, infiltrative characteristics.

Purpose of the Study:

• To investigate the potential of radiotheranostics in treating a pediatric patient with diffuse intrinsic brainstem glioma (DIPG) exhibiting residual disease.
• To evaluate the efficacy and safety of targeted radionuclide therapy in a challenging pediatric neuro-oncology case.

Main Methods:

• A 12-year-old girl with DIPG received standard radiotherapy and temozolomide, followed by gallium-68 (68Ga) prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scan.
• The patient subsequently underwent targeted radionuclide therapy with lutetium-177 (Lu-177) PSMA-617 and actinium-225 (Ac-225) PSMA-617.

Main Results:

• 68Ga PSMA PET/CT demonstrated significant tracer accumulation in the pontine tumor mass, indicating PSMA expression.
• The patient received multiple cycles of Lu-177 PSMA-617 and Ac-225 PSMA-617 therapy, with outcomes to be detailed.

Conclusions:

• Radiotheranostics targeting PSMA show potential as a novel therapeutic strategy for pediatric DIPG with residual disease.
• This case highlights the feasibility of using PSMA-targeted radioligand therapy in pediatric neuro-oncology, warranting further investigation.