Abstract
Background: Breast cancer is the most common malignancy in women, with high morbidity
and mortality. Molecular alterations in breast cancer involve the expression or upregulation of various
molecular targets that can be used for diagnostic nuclear medicine imaging and radiopharmaceutical
treatment. Theragnostics is based on the binding of radionuclides to molecular targets. These radionuclides
can induce a cytotoxic effect on the specific tumor cell (target) or its vicinity, thus allowing a
personalized approach to patients with effective treatment and comparably small side effects.
Aim: This review aims to describe the most promising molecular targets currently under investigation
for theragnostics and precision oncology in breast cancer.
Methods: A comprehensive literature search of studies on theragnostics in breast cancer was performed
in the PubMed, PMC, Scopus, Google Scholar, Embase, Web of Science, and Cochrane library
databases, between 2010 and 2022, using the following terms: breast neoplasm*, breast, breast cancer*,
theragnostic*, theranostic*, radioligand therap*, RLT, MET, FLT, FMISO, FES, estradiol,
trastuzumab, PD-L1, PSMA, FAPI, FACBC, fluciclovine, FAZA, GRPR, DOTATOC, DOTATATE,
CXC4, endoglin, gastrin, mucin1, and syndecan1.
Results: Fifty-three studies were included in the systematic review and summarized in six clinical
sections: 1) human epidermal growth factor receptor 2 (HER2); 2) somatostatin receptors (SSTRS); 3)
prostate-specific membrane antigen radiotracers (PSMA); 4) fibroblast activation protein-α targeted
radiotracers; 5) gastrin-releasing peptide receptor-targeted radiotracers; 6) other radiotracers for
theragnostics.
Conclusion: The theragnostic approach will progressively allow better patient selection, and improve
the prediction of response and toxicity, avoiding unnecessary and costly treatment.
Keywords:
Theragnostic, breast cancer, radioligand therapy, precision medicine, [177Lu]Lu-trastuzumab, PRRT, PSMA, FAPi.
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Virginia Liberini
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