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While this issue offers many good choices, Kuyumcu and colleagues’ small pilot study “Safety of Fibroblast Activation Protein–Targeted Radionuclide Therapy by a Low-Dose Dosimetric Approach Using 177Lu-FAPI04​” offers evidence for the potential use of radioligand FAPI for the novel treatment of multiple different cancers. Radiation-absorbed doses to normal organs and tumor tissue using low-dose 177Lu-FAPI04 dosimetry regarding the safety and theranostic potential of fibroblast activation protein–targeted radionuclide therapy was performed in 4 participants with advanced-stage metastatic cancer 
177Lu-FAPI04 dosimetry of normal organs and tumors was performed with sequential whole-body and 3D SPECT/CT and blood sampling. Mean absorbed doses per MBq were 0.25 ± 0.16 mGy (range, 0.11–0.47 mGy), 0.11 ± 0.08 mGy (range, 0.06–0.22 mGy), and 0.04 ± 0.002 mGy (range, 0.04–0.046 mGy) for kidneys, liver, and bone marrow, respectively. 
The respective maximum estimated amount of radioactivity to reach radiation-absorbed dose limits were 120.9 ± 68.6 GBq, 47.5 ± 2.8 GBq, 397.8 ± 217.1 GBq, and 52.4 ± 15.3 GBq for kidneys, bone marrow, liver, and total body. The mean absorbed dose per MBq was 0.62 ± 0.55 mGy for bone metastases, 0.38 ± 0.22 mGy for metastatic lymph nodes, 0.33 ± 0.21 mGy for liver metastases, and 0.37 ± 0.29 for metastatic soft tissue. The maximum tumor absorbed dose was 1.67 mGy/MBq for bone, 0.6 mGy/MBq for lymph node, 0.62 mGy/MBq for liver, and 1 mGy/MBq for soft tissue.
The investigators concluded that the mean absorbed dose to organs at risk with 177Lu-FAPI04 is reasonably low, allowing for the administration of  a higher doses. Hopefully, we will soon be able to treat a variety of refractory FAPI avid cancers with 177Lu-FAPI04 or similar agents.

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