1. 177 Lu-Dota-NOCate & 177 Lu-Dota-Gastrin in Metastatic Medullary Thyroid Cancer Clinic of Endocrinology, Inst. of Nuclear Medicine, University Hospital, Basel, CH For Questions contact: Beat Müller, happymiller@bigfoot.comhappymiller@bigfoot.com Martin A. Walter, m.a.walter@gmx.netm.a.walter@gmx.net

2. Medullary Thyroid Cancer Treatment Options: -Surgery (first line) -To date no effective systemic treatment option -Radiation Therapy is not well defined -Treatment options with different Radiopeptides are currently evaluated

3. Aim To assess the value of 177 Lu-Dota-NOCate and 177 Lu-Dota-Gastrin in Imaging and Treatment of Metastatic Medullary Thyroid Cancer Ethically Approved (EKBB)

4. Radiopeptides Target Somatostatin/ CCK2-Receptor Ligand Somatostatin/ Gastrin-Analogs Signal 177 Lu

5. „Magic Bullet“ Approach ApplicationDistributionAccumulation Tumor Metastases

6. Affinity Profile (Dota-NOC-ATE)

7. Receptor Profile (MTC) EB Forssell-Aronsson. J Nucl Med 2000;41:636–642

8. Pilot-Patient (Dota-NOC-ATE) Specific Tumor Uptake (LN-metastesis) p9581 ♂, 63y Metastised MTC

9. Patients Patients with progressive MTC Exclusion criteria: Karnofsky Performance Status < 50% Refusion of a 1-year contraception Pregnancy Breast-feeding Age<18

10. Diagnostic Scintigraphy Scintigraphy + Dosimetry (first compound, outpatient, 2d) Scintigraphy + Dosimetry (second compound, outpatient, 2d) 2 weeks later Significant Accumulation + Favorable Biodistribution → Treatment

11. Treatment Inpatient 3 Days Day 1: Injection of Radiopeptide + Amino Acid Infusion (Kidney Protection) Day 2: Imaging Day 3: Release of Patient