[ 68 Ga]Ga-NECT-224 PET/CT Shows Increasing Nectin-4 Expression in Progressive Urothelial Carcinoma Under ADC-Therapy With Enfortumab-Vedotin.

Hoberück, Sebastian; Banek, Severine; Krönke, Tobias; Pretze, Marc; Brandt, Florian; Kopka, Klaus; Trommer, Johanna; Thomas, Christian et al. · Clin Nucl Med · 2026

case_report · Level V

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Abstract

A 64-year-old man with metachronous metastatic urothelial carcinoma originating from the right renal pelvis underwent nectin-4-targeted [ 68 Ga]Ga-NECT-224 PET/CT prior to initiation of nectin-4-targeted antibody-drug conjugate (ADC) therapy with enfortumab-vedotin (PADCEV), in combination with pembrolizumab. A CT follow-up after 3 months of ADC therapy showed a progressive adrenal metastasis. Subsequent [ 68 Ga]Ga-NECT-224 PET/CT restaging revealed multiple new lesions with intense nectin-4 expression. This case illustrates the potential of [ 68 Ga]Ga-NECT-224 PET/CT to visualize heterogeneous nectin-4 expression, its potential in therapy guidance, and highlights the need for theranostic strategies in patients retaining target expression despite cytotoxic therapy resistance.

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