Combination Therapy With 177Lu-FAPI-2286 and Tyrosine Kinase Inhibitor: A Novel Approach for Treating Metastatic Medullary Thyroid Carcinoma

A 48-year-old man diagnosed with symptomatic metastatic medullary thyroid carcinoma (MTC) presented with dyspnea and a right neck mass which was identified as a metastatic lymph node. Despite initial treatments with sorafenib and chemotherapy, his condition continued to worsen. Evaluation using 99m Tc-FAPI-46 scintigraphy showed favorable uptake in both primary tumor and its metastases, leading to enrollment in a clinical trial for a combination therapy involving sorafenib and 177 Lu-FAPI-2286. After four cycles of this treatment, the patient experienced significant improvement in symptoms, along with notable reductions in serum calcitonin and carcinoembryonic antigen (CEA) levels. This case underscores the potential effectiveness of 177 Lu-FAPI-2286 in managing advanced MTC when conventional therapies prove ineffective.