Theranostic Approach in Liver Cancer: an Emerging Paradigm to Optimize Personalized Medicine

Purpose This review aims to focus an update of the state-of-the-art theranostics approach in liver cancer using 1311, 32P, 90Y, 166Ho, and 186/188Re microspheres as well as some receptors including fibroblast activation protein (FAP), prostate-specific membrane antigen (PSMA), chemokine C-X-C motif receptor 4 (CXCR4), and somatostatin receptors (STR). Methods A literature search was performed using the PubMed/MEDLINE and Clinical Trials.gov database and "liver", "theranostics", "transarterial radioembolization (TARE)", "prostate-specific membrane antigen (PSMA)", "fibroblast activation protein (FAP)", "hepatocellular carcinoma", "32P", "90Y", "166Ho", "131I" and "somatostatin receptor (STR)" as keywords. Both, preclinical and clinical studies were included in this review. The search was restricted to the English language. Result After exclusion of letters, editorials, comments and duplicates publications, remaining articles were included in this review. Conclusion There is growing evidence for applicability of theranostic approach in these patients to enhance early identification, patient evaluation, targeted treatment, restaging, follow-up, and palliation of symptoms or slow down tumor progression. However, this field requires multidisciplinary expertise and collaboration. The increased access to tracers, training multidisciplinary teams, using novel trial designs, and establishing initiatives to share and re-analyze data from clinical imaging studies can encourage the use of molecular nuclear imaging in both clinical research and practical. It is also well recognized that dosimetric recommendations should be considered to compare promising new theranostic agents and clarify the better or similar performance of these methods in hepatocellular carcinoma. [GRAPHICS] .