Trivehexin
A gallium-68 tracer for the 'cancer integrin', and an unexpected finder of overactive parathyroid glands
Trivehexin is three small ring-shaped peptides joined on a central cage that holds gallium-68. It binds integrin αvβ6, a receptor that healthy tissue carries little of but many carcinomas display. On PET it shows pancreatic, head and neck and lung cancers, and it has turned out to light up overactive parathyroid glands too. First used in people in 2022, it is a research tracer and not approved.
Used in human trials: 84–185 MBq, Single injection, Intravenous (Study: kit-like labelling, head and neck and pancreatic cancer) Details ↓
Recommended Dosing
Used in human trials
No manufacturer dose exists for this use: these are amounts given in published trials, not recommendations.
What is it?
Integrins are receptors that anchor cells to their surroundings. One of them, αvβ6, is scarce in healthy adult tissue but appears on epithelial cells when they are wounded, scarred or turning cancerous, which is why it is sometimes called the cancer integrin. Pancreatic, head and neck, lung and many other carcinomas carry it, often in large amounts. A tracer for it could show these cancers on PET without the uptake in inflamed tissue that complicates FDG, the sugar tracer most cancer PET scans use.
Trivehexin was made by taking a cyclic peptide of nine amino acids, c[YRGDLAYp(NMe)K], optimised to bind αvβ6 rather than its relatives, and attaching three copies to TRAP, a small cage-like chelator that holds gallium-68. Three copies on one molecule gave very tight binding, with an IC50 of 0.047 nM, and kept selectivity over related integrins. In mice it gathered in αvβ6-positive tumours and little else apart from the kidneys and bladder, through which it leaves. The first human scans, published in 2022, showed high uptake in metastatic pancreatic cancer and head and neck cancer, small liver metastases, and no uptake in inflammation around a tumour.
The tracer is simple to make. Later papers reported kit-like and fully automated labelling with over 99% purity, the automated method meeting European Pharmacopoeia standards, so a hospital radiopharmacy can prepare it shortly before a scan. In 44 patients with pancreatic cancer, nearly all primaries and many liver, nodal and peritoneal metastases stood out from the background, with the best contrast about 45 minutes after injection.
Lymph nodes are where it may help most. FDG lights up nodes that are merely inflamed, a common source of false positives. In 58 people with non-small cell lung cancer, trivehexin was as sensitive as FDG for nodal spread and far more specific (93.8% against 62.5%), was much better at finding brain metastases, and changed the treatment plan in about a quarter. A small study across several cancers and case reports in breast cancer and cholangiocarcinoma made the same point. Uptake in some normal or benign tissue, such as the pituitary gland, is a pitfall to know about.
The parathyroid finding was a surprise. Overactive parathyroid glands cause high calcium, and surgeons need to know which gland to remove; sestamibi scans miss a good share. A 2024 study reported that trivehexin found 16 of 17 overactive glands in 13 patients, against 10 for sestamibi, and later studies of 44 and 38 patients found detection rates of about 82% to 92% of patients, again well above sestamibi and ultrasound.
Trivehexin is not approved by FDA or the EMA. Many reports are single cases, and none of the studies read compared it with surgery in a large blinded trial. ClinicalTrials.gov lists one recruiting study of αvβ6 PET in malignant tumours.
Mechanism of Action
Trivehexin carries gallium-68 to integrin αvβ6, a receptor that is rare in healthy adult tissue but common on carcinomas and remodelling epithelium, so a PET scan shows where it collects.
Integrin αvβ6
Each of its three cyclic nonapeptides binds αvβ6; together they gave an IC50 of 0.047 nM with high selectivity over related integrins.
TRAP chelator
A small cage-like chelator holds gallium-68 and links the three peptides; labelling takes about 12 minutes and suits kits.
Specific for cancer, not inflammation
Inflammation around a tumour and benign inflamed nodes stayed dark in several studies, unlike on FDG.
Kidney clearance
Apart from tumours, the kidneys and bladder take up most of it, as it leaves in the urine.
Published Research
Studies whose titles name trivehexin, read from their PubMed abstracts on October 29, 2026. All used gallium-68 trivehexin. Many recent reports are single cases; the cards below favour the series, with a few cases that show a point.
Development and first human scans
Trimerising the αvβ6-selective peptide on TRAP gave an IC50 of 0.047 nM with selectivity factors of 131, 57 and 468 over αvβ8, αvβ3 and α5β1. Uptake in mouse tumours was target-specific. In people, metastatic pancreatic cancer and head and neck cancers showed SUVmax of 10 to 13, small pancreatic metastases were visible, and inflammation beside a tumour was not.
Pancreatic cancer, 44 patients
PET/CT detected 40 pancreatic cancers (median SUVmax 12.6), 39 liver, 21 lymph-node and 17 peritoneal metastases. Primary tumours took up more than liver or nodal metastases, and tumour-to-background contrast was best at 45 minutes.
Lung cancer staging, 58 patients
In a prospective study, both trivehexin and FDG found every primary tumour. For nodal metastasis, per station, sensitivity was 80.0% against 72.0%, specificity 93.8% against 62.5% and accuracy 91.2% against 64.2%; for brain metastases sensitivity was 92.3% against 38.5%. The result changed treatment in 14 patients, and uptake tracked integrin β6 staining.
Lymph nodes in various cancers
In 15 patients with colorectal, breast, pancreatic, lung, bladder, thyroid or endometrial cancer, both tracers took up in every primary; FDG was positive in all nodes, trivehexin only in metastatic ones, giving positive predictive values of 100% against 26.3%.
Primary hyperparathyroidism, first report
In 13 patients (three with MEN-1), trivehexin found 16 of 17 confirmed hyperfunctioning parathyroid lesions (94.1%) against 10 for sestamibi (58.8%), and found lesions in two of three patients whose fluorocholine PET was negative.
Hyperparathyroidism, 44 patients at two centres
Trivehexin found 37 foci in 36 of 44 patients (81.8%), against 45.5% for ultrasound and 47.7% for sestamibi, and showed a focus in 18 of 23 sestamibi-negative patients; against a composite reference it had 97.3% sensitivity and 100% positive predictive value.
Hyperparathyroidism, 38 patients
Trivehexin localised hyperfunctioning tissue in 35 of 38 patients (92%) against 28 (74%) for sestamibi, and 49 of 50 lesions (98%) against 29 (58%), including 18 lesions that sestamibi missed or left equivocal. Imaging at about 40 minutes was enough; contrast plateaued after about 25 minutes.
Parathyroid adenomas, 28 patients
In a prospective proof-of-concept study, trivehexin was positive in 78.6% of patients and sestamibi in 60.7%, with moderate agreement between them; many sestamibi-negative patients had a positive trivehexin focus.
Kit-like labelling and biodistribution
Heating 30 to 50 µg of precursor with gallium-68 for 12 minutes gave 85% to 88% yield and 99% purity, stable for 6 hours, sterile and pyrogen-free. Patients with head and neck or pancreatic cancer received 84 to 185 MBq; tumours showed intense uptake and 60 minutes was the best imaging time.
Automated production
A fully automated synthesis gave over 99% radiochemical purity, with pH 3.6 and 30 µg of precursor chosen as optimal; every quality test met European Pharmacopoeia requirements, and imaging of healthy volunteers supported routine clinical use.
Case: small breast cancer foci
In a 49-year-old woman with breast cancer, both FDG and trivehexin showed the main mass, but trivehexin also showed three tiny additional foci that FDG missed.
Case: breast cancer nodes
Trivehexin showed more uptake than FDG in the primary tumour and the internal mammary and armpit nodes, but none in FDG-positive mediastinal and hilar nodes; a biopsy of one of those nodes was benign.
Case: cholangiocarcinoma staging
In intrahepatic cholangiocarcinoma, the liver tumour took up all three tracers; metastatic neck nodes were seen on trivehexin and FAPI but not FDG, while FAPI also showed abdominal nodes.
Case: normal pituitary uptake
Focal trivehexin uptake in a pituitary gland with no abnormality on CT or MRI is reported as a pitfall, since αvβ6 is mainly expected in regenerating or cancerous epithelium.
Review
A 2025 review of its chemistry and first clinical uses: the trimer improved affinity and selectivity up to 18-fold over earlier single-peptide tracers, labelling reaches over 95% purity, and early results in head and neck and pancreatic cancer, pulmonary fibrosis and hyperparathyroidism look promising.
Dosing Data
Trivehexin has no approved label. These are activities given in a published human study, a single injection of a radioactive tracer before PET.
Educational information, not medical advice. Each dose above is tagged with its source: an approved label, a published human study, animal data, or amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
What a Buyer Needs to Know
What is sold, how it is mixed, stored and taken, and what is known about its safety, quality and legal status. Each part names its source. Where we have none, it says unknown.
What is sold
Unknown: we hold no regulator's label that says in what form Trivehexin is supplied. It is a radioactive drug: the next part says where it is prepared and given.
Mixing a vial: a worked example
Nothing to mix at home, and no syringe units to work out: Trivehexin is a radioactive drug, prepared and given in nuclear-medicine departments, and its dose is an amount of radioactivity (MBq or GBq), not a weight.
This page's dosing note: “Trivehexin is labelled with gallium-68 shortly before the scan and dosed by radioactivity in nuclear-medicine departments.”
Source: this page's own note in Dosing Data below; the amount of each dose row in Dosing Data below.
Storage before and after mixing
Unknown: no label on file says how Trivehexin is stored. It is a radioactive drug held by the nuclear-medicine department that prepares and gives it (see the part above); the home rules for a mixed vial in the mixing guide do not apply to it.
How it is taken
As it was given in human studies: Intravenous (Single injection; Study: kit-like labelling, head and neck and pancreatic cancer).
Source: Used in human trials: the route and frequency of each row in Dosing Data below.
What to expect, and when
How long it stays in the body: not established by a measurement cited on this entry.
How long the doses were given: Study: kit-like labelling, head and neck and pancreatic cancer: PET/CT at about 60 minutes.
When effects appear: unknown; no source on this page gives a time to effect for Trivehexin. Results reported in the studies are under Published Research.
Source: Used in human trials, the duration of each row in Dosing Data below.
Side effects, and when to stop or get help
From the Side Effects section: A single diagnostic injection; the abstracts read give no side-effect data; High uptake in the kidneys and bladder, the route by which it leaves. Full list and cautions ↓
When to stop or get help: unknown; no label or trial on file sets rules for stopping Trivehexin. Treat a severe or unexpected reaction as a reason to stop and see a doctor.
Source: the Side Effects section below (“From the studies above”).
Interactions
Unknown: a PubMed search for human interaction studies of Trivehexin (reviewed 2026-10-28) found none. Unknown is not the same as safe to combine.
Every peptide's record, with its source: the interaction matrix.
Checking what you bought
Unknown: no published independent test of Trivehexin products is in our lab-results database yet, so how products sold under this name measure up is not known.
To read a certificate of analysis, paste it into the COA decoder; it checks the measured mass against Trivehexin's expected mass, 4,301.0 Da, from this entry's molecular data. Trust & Verification explains what independent testing can and cannot show.
Legal status
US: In Clinical Trials (Not approved: Drugs@FDA and the EMA medicines list hold no record (searched October 28 and 29, 2026)). Sport: Prohibited (S0 catch-all).
Country by country ↓ · Regulatory tracker
Source: this entry's approval status and the WADA Prohibited List, as in Legal Status below.
Side Effects & Contraindications
Reported Side Effects
From the studies above. None of the abstracts read reports an adverse reaction to the tracer.
Contraindications & Cautions
No approved label exists, so there are no official contraindications. Points from the studies above:
Legal Status
Trivehexin is investigational in every jurisdiction checked.
Frequently Asked Questions
?What is trivehexin?
A PET tracer made of three copies of a small cyclic peptide that binds integrin αvβ6, joined on a TRAP cage that holds gallium-68.
?What is αvβ6 and why target it?
An integrin that healthy adult tissue carries little of but that many carcinomas display, including pancreatic, head and neck and lung cancers. Targeting it can show those cancers with little background.
?Is it better than FDG?
Not across the board, but in 58 people with lung cancer it was far more specific for lymph nodes and much better at finding brain metastases, and in several cancers it stayed negative in inflamed nodes that FDG lit up.
?Why is it used for the parathyroid glands?
Because studies found it shows overactive parathyroid tissue well. In three series it found overactive glands in about 82% to 92% of patients, more than sestamibi scans and ultrasound.
?Is it approved?
No. Drugs@FDA and the EMA hold no record. ClinicalTrials.gov lists one recruiting study.
?How is it made?
By heating 30 to 50 micrograms of the precursor with gallium-68 for about 12 minutes, in a kit-like or automated process, giving over 99% purity.
References
- [other] PubChem CID 178273454, Trivehexin: formula C195H291N54O51P3, molecular weight 4301. Read October 28, 2026. https://pubchem.ncbi.nlm.nih.gov/compound/178273454
- [registry] ClinicalTrials.gov API v2, read October 29, 2026: NCT05835570 (integrin αvβ6-targeted PET in malignant tumours, 200 participants, recruiting), the registration cited by the 2024 automated-synthesis and 2025 lung-cancer studies.
- [pubmed] Quigley NG, et al. "PET/CT imaging of head-and-neck and pancreatic cancer in humans by targeting the 'Cancer Integrin' αvβ6 with Ga-68-Trivehexin." Eur J Nucl Med Mol Imaging, 2022;49(4):1136-1147. PMID: 34559266.
- [pubmed] Rehm J, et al. "αvβ6-integrin targeted PET/CT imaging in pancreatic cancer patients using (68)Ga-Trivehexin." Front Nucl Med, 2024;4:1487602. PMID: 39618940.
- [pubmed] Kuyumcu S, et al. "(68)Ga-Trivehexin PET/CT: a promising novel tracer for primary hyperparathyroidism." Eur J Nucl Med Mol Imaging, 2024;51(13):3912-3923. PMID: 39028425.
- [pubmed] Güzel F, et al. "Beyond conventional maging: the diagnostic performance of [(68)Ga]Ga-Trivehexin PET/CT for detecting hyperfunctioning parathyroid tissue in primary hyperparathyroidism." Ann Nucl Med, 2026;40(9):1063-1072. PMID: 42113418.
- [pubmed] Erdogan M, et al. "Early clinical experience with ⁶⁸Ga-Trivehexin PET/CT in parathyroid adenomas: a proof-of- concept imaging study." Ann Nucl Med, 2026;40(9):1131-1137. PMID: 42171874.
- [pubmed] Denizmen Zorba D, et al. "A novel imaging approach in hyperparathyroidism: [68Ga]Ga-Trivehexin PET/CT." Eur J Nucl Med Mol Imaging, 2026;53(11):6651-6660. PMID: 42234003.
- [pubmed] Karaoğlan H, et al. "Comparison of the diagnostic accuracy of [ 68 Ga]Ga-Trivehexin PET/computed tomography and [ 18 F]FDG PET/computed tomography in nodal staging of various solid tumors." Nucl Med Commun, 2026;47(4):470-478. PMID: 41536191.
- [clinical-trial] Wu H, et al. "Integrin αvβ6-Targeted PET/CT Imaging of Non-Small Cell Lung Cancer with [(68)Ga]Ga-Trivehexin: Improved Preoperative Lymph Node Staging and Association with Immunohistochemistry." Adv Sci (Weinh), 2025;12(44):e08225. PMID: 40899568.
- [pubmed] Thakral P, et al. "Validation of In-House Kit-Like Synthesis of (68)Ga-Trivehexin and Its Biodistribution for Targeting the Integrin αvβ6 Expressing Tumors." Cancer Biother Radiopharm, 2023;38(7):468-474. PMID: 37093129.
- [pubmed] Wang B, et al. "Fully-automated production of [(68)Ga]Ga-Trivehexin for clinical application and its biodistribution in healthy volunteers." Front Oncol, 2024;14:1445415. PMID: 39156699.
- [pubmed] Liu Z, et al. "68 Ga-Trivehexin PET/CT Enhances Detection of Small Primary Lesions Than 18 F-FDG PET/CT in Breast Cancer." Clin Nucl Med, 2026;51(2):e129-e131. PMID: 40644590.
- [pubmed] Kömek H, et al. "Superiority of 68 Ga-Trivehexin PET/CT Over 18 F-FDG PET/CT in the Evaluation of Lymph Nodes in Patients With Breast Cancer." Clin Nucl Med, 2025;50(3):e175-e177. PMID: 39601487.
- [pubmed] Denizmen Zorba D, et al. "Optimizing Intrahepatic Cholangiocarcinoma Staging: Comparison of [ 18 F]FDG, [ 68 Ga]Ga-FAPI, and [ 68 Ga]Ga-Trivehexin PET/CT Imaging." Clin Nucl Med, 2026;51(8):e657-e658. PMID: 41627164.
- [pubmed] Arca B, et al. "Focal 68 Ga-Trivehexin Uptake in a Normal Pituitary Gland : Expanding the Spectrum of αvβ6-integrin PET Findings." Clin Nucl Med, 2026;51(8):e726-e727. PMID: 41432598.
- [review] Urso L, et al. "(68)Ga-Trivehexin: Current Status of αvβ6-Integrin Imaging and Perspectives." Cancers (Basel), 2025;17(9). PMID: 40361431.
Sources & Citations
Studies were read from their PubMed abstracts on October 29, 2026. Formula and weight are PubChem's. Status is from Drugs@FDA, the EMA medicines list and ClinicalTrials.gov. Grey Peptides sells nothing and links to no vendor.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Talk to a licensed clinician about your own situation.