Targeted radionuclide therapy (TRT) is an emerging pillar of precision medicine, with prostate-specific membrane antigen (PSMA)-targeted agents like 177LuPSMA-617 demonstrating notable clinical success. Achieving optimal therapeutic efficacy while minimizing toxicity requires precise tumor and organ dosimetry based on accurate time-activity curves (TACs) derived from molecular imaging. Glioblastoma (GBM), a highly treatment-resistant brain tumor with limited therapeutic possibilities, has shown PSMA expression, opening new avenues for TRT. Copper-67, a promising theranostic isotope producible in standard hospital-based cyclotrons, offers previously unavailable opportunities for such applications. In this study, we evaluated the feasibility of 67CuCu-rhPSMA-10.1 for TRT analyzed by SPECT and 68GaGa-rhPSMA-10.1 for PET-based imaging and predictive dosimetry in an orthotopic GBM mouse model. 67Cu was produced via a biomedical cyclotron, purified, and validated using gamma spectrometry and ICP-OES. 67CuCu-rhPSMA-10.1 and 68GaGa-rhPSMA-10.1 were synthesized with high radiochemical purity. GL261-luc2 GBM tumors were implanted in eight C57BL/6JRj mice. One hour PET and up to 72 h SPECT imaging were performed. PET pharmacokinetic modeling analyzed tumor uptake and whole-body biodistribution. Ex vivo gamma counting was applied to validate image-derived organ distribution. Tumor dosimetry was estimated using PET-derived TAC and validated by SPECT, with absorbed dose calculations performed via sphere- and voxel-based models (IDAC-dose 2.1 or Imalytics). Whole-body dosimetry was assessed using OLINDA 2.0. Immunohistochemical (IHC) staining against PSMA and CD31 was performed in human GBM tissue to validate the imaging findings. PET confirmed significantly higher tumor uptake of 68GaGa-rhPSMA-10.1 compared to healthy brain (SUVR 1.9 ± 0.5, 60 min). Pharmacokinetic modeling identified elevated tumor perfusion (K1 = 0.3 ± 0.07 mL/cm3/min) and volume of distribution (Vt = 0.26 ± 0.05 mL/cm3) relative to healthy brain. Predictive tumor dosimetry using 68GaGa-rhPSMA-10.1 PET data extrapolated to 67CuCu-rhPSMA-10.1 estimated a mean tumor dose of up to 31.1 mGy/MBq. Multi-time-point SPECT imaging confirmed tumor uptake of 67CuCu-rhPSMA-10.1, with an absorbed tumor dose of 29.1 mGy/MBq, resembling closely the predicted value. IHC staining confirmed expression of PSMA in human GBM tissue and its localization in vasculature. This study demonstrates the translational potential of 67CuCu-rhPSMA-10.1 as a targeted radionuclide therapy for PSMA-expressing GBM, supported by predictive PET-based dosimetry using 68GaGa-rhPSMA-10.1. Tumor dose estimates derived from PET closely matched those validated by SPECT imaging, indicating strong concordance between prediction and actual uptake. Additionally, IHC confirmed PSMA expression in human GBM vasculature, reinforcing the clinical relevance. These findings highlight the feasibility of integrating a cyclotron-produced 67Cu-based theranostic strategy for GBM, enabling personalized, image-guided dosimetry and paving the way for future preclinical efficacy studies and potential clinical translation.
Ekaney et al. (Tue,) studied this question.