Remarkable Response to 177Lu-PSMA and 177Lu-DOTA-IBA Cocktail Therapy in a Patient With Dual Primary Malignancies

A patient with metastatic atypical right lung carcinoid underwent 68 Ga-FAP2286 and 68 Ga-DOTATATE PET/CT scans to assess eligibility for radionuclide therapy, which revealed insufficient coverage of all lesions by either tracer. The imaging also identified a prostate mass with markedly elevated PSA level; biopsy confirmed prostate adenocarcinoma with neuroendocrine differentiation. Subsequent 68 Ga-PSMA PET/CT demonstrated high uptake in all lesions. Guided by these multimodal imaging, the patient received combined 177 Lu-PSMA and 177 Lu-DOTA-IBA therapy. Notably, he achieved near-complete remission of both primary malignancies and all metastases after one cycle of cocktail therapy and one cycle of 177 Lu-DOTA-IBA therapy.