Chemokine receptor-4-targeted imaging with [68Ga]Ga-Pentixafor PET: unveiling its diagnostic and prognostic potential across cancers: a systematic review

This systematic review aimed to synthesize published data on the application of gallium-68 pentixafor PET/computed tomography ([68Ga]Ga-Pentixafor PET/CT) or PET/MRI (PET/MRI) in patients diagnosed with various lymphomas and solid malignancies. A comprehensive literature search was conducted across Cochrane, Ovid PubMed/MEDLINE, and Embase databases for articles indexed up to July 2023. Thirty-seven studies or subsets within studies met the inclusion criteria for analysis. Key findings indicate that lymphomas, including those with low [18F]FDG avidity such as lymphoplasmacytic lymphoma, chronic lymphocytic leukemia, marginal zone lymphoma (MZL), and central nervous system lymphoma, demonstrate [68Ga]Ga-Pentixafor avidity. Among lymphomas, mantle cell lymphoma and MZL showed particularly high uptake. [68Ga]Ga-Pentixafor PET/CT or PET/MRI demonstrated utility for staging and treatment response assessment in several solid tumors, including lung cancer [small-cell lung cancer, large cell neuroendocrine carcinoma of the lung (LCNEC), nonsmall cell lung cancer (adenocarcinoma (AC), squamous cell carcinoma (SCC))], glioblastoma multiform, vestibular schwannoma, desmoplastic small round cell tumor, esophageal cancer, and aldosterone-producing adenoma. The review suggests that [68Ga]Ga-Pentixafor PET holds promise for personalized diagnosis and therapy, potentially offering advantages over [18F]FDG PET in certain malignant conditions. Despite limitations such as study heterogeneity and varying patient numbers per tumor type, [68Ga]Ga-Pentixafor PET is a potentially valuable imaging modality for staging and response evaluation, particularly in nonsolid malignancies like lymphomas. Further research is needed to fully clarify its role in solid tumors.