177Lu-FAPI-2286 Radioligand Therapy in Refractory Scalp Melanoma.

Elahifard, Haniye; Samadi, Mohammad Hadi; Bari, Alireza; Soltani, Ehsan; Kamali, Hassan; Aghaee, Atena · Clin Nucl Med · 2026

case_report · Level V

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Abstract

A 66-year-old man with inoperable malignant scalp melanoma, refractory to immunotherapy, underwent 99mTc-HYNIC-TOC SPECT/CT for evaluating the possibility of radioligand therapy with 177Lu-DOTATATE, which demonstrated no tracer uptake in scalp lesions, precluding 177Lu-DOTATATE therapy. Subsequent disease progression prompted 99mTc-FAPI-46 SPECT/CT, which showed intense tracer uptake in lesions and prompted radioligand therapy with 177Lu-FAPI-2286. After 4 cycles of treatment, all lesions showed regression and he was referred for tumor resection. This case illustrates the clinical utility of FAPI-based theranostic and shows 99mTc-FAPI SPECT/CT can directly inform targeted radioligand therapy using 177Lu-FAPI, thereby expanding therapeutic options in melanoma management.