The role of nuclear medicine and molecular imaging in guiding the path to precision oncology

Nuclear medicine and molecular imaging have fundamentally transformed precision oncology by enabling non-invasive, quantitative visualization of disease-specific targets. This review systematically summarizes recent clinical advances in radiolabeled molecular probes targeting key biomarkers, including immune checkpoints (PD-L1, LAG-3, TIGIT), tumor-associated antigens (HER2, Trop2, DLL3, B7-H3), and signaling kinases (EGFR, KRAS). These imaging agents facilitate improved patient stratification, real-time treatment monitoring, and response assessment across multiple cancer types, while also helping to overcome challenges such as tumor heterogeneity and therapy resistance. Emerging clinical evidence supports the role of immuno-PET with novel tracers, including nanobodies, peptides, and engineered proteins, in predicting and evaluating responses to immunotherapy, antibody-drug conjugates, and tyrosine kinase inhibitors. Despite promising results, limitations including suboptimal pharmacokinetics and small cohort sizes remain. Future efforts should focus on probe optimization, standardization of imaging protocols, and validation in large-scale trials to fully realize the potential of molecular imaging in guiding personalized cancer therapy.