First-in-Human 212Pb-PSMA–Targeted α-Therapy SPECT/CT Imaging in a Patient with Metastatic Castration-Resistant Prostate Cancer

First-in-Human ²¹²Pb-PSMA–Targeted α-Therapy SPECT/CT Imaging in a Patient with Metastatic Castration-Resistant Prostate Cancer

There is significant interest in the development of ²¹²Pb-PSMA–based targeted α-therapy for patients with metastatic castration-resistant prostate cancer. A previous phantom study has shown that ²¹²Pb SPECT is feasible by imaging the 238.6 keV and 75 to 91 keV γ-emissions produced after the β-decay of ²¹²Pb to its α-emitting progeny.

Here we present—to the best of our knowledge—the first human ²¹²Pb SPECT/CT images published to date. They were acquired after administration of 60 MBq of ²¹²Pb-ADVC001 to a 73-y-old man with metastatic castration-resistant prostate cancer. This study was approved by the local institutional review board. Imaging was at 1.5, 5, 20, and 28 h after infusion. Two simultaneous triple-energy window acquisitions (78 keV ± 20% with 20% scatter [31% abundance] and 239 keV ± 10% with 10% scatter [43% abundance] were obtained using a Siemens Intevo Bold (high-energy collimators at 30 s per view for 120 views per rotation at 2 bed positions with noncircular orbits; total time, 60 min). Each energy window was reconstructed independently, and the resulting images were summed with removal of Compton-based orbit artifacts.