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Bentestuen M, Ladekarl M, Knudsen A, Zacho HD. Diagnostic accuracy and clinical value of [68Ga]Ga-FAPI-46 PET/CT for staging patients with ovarian cancer: study protocol for a prospective clinical trial. BMC Cancer 2024; 24:699. [PMID: 38849741 PMCID: PMC11157941 DOI: 10.1186/s12885-024-12461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND [18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) is recommended during diagnostic work-up for ovarian cancer; however, [18F]FDG PET has several inherent limitations. The novel oncologic PET-tracer fibroblast activation protein inhibitor (FAPI) has demonstrated promising results in multiple cancer types, including ovarian cancer, and could overcome the limitations of [18F]FDG PET; however, high-quality clinical studies are lacking. The primary objective of the present study is to compare the diagnostic accuracy of [68Ga]Ga-FAPI-46 PET/CT and [18F]FDG PET/CT in ovarian cancer patients and to investigate how this potential difference impacts staging and patient management. METHODS AND DESIGN Fifty consecutive ovarian cancer patients will be recruited from Aalborg University Hospital, Denmark. This study will be a single-center, prospective, exploratory clinical trial that adheres to the standards for reporting diagnostic accuracy studies (STARD). This study will be conducted under continuous Good Clinical Practice monitoring. The eligibility criteria for patients are as follows: (1) biopsy verified newly diagnosed ovarian cancer or a high risk of ovarian cancer and referred for primary staging with [18F]FDG PET/CT; and (2) resectable disease, i.e., candidate for primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery. All recruited study subjects will undergo [68Ga]Ga-FAPI-46 PET/CT at primary staging, before primary debulking surgery or neoadjuvant chemotherapy (Group A + B), in addition to conventional imaging (including [18F]FDG PET/CT). Study subjects in Group B will undergo an additional [68Ga]Ga-FAPI-46 PET/CT following neoadjuvant chemotherapy prior to interval debulking surgery. The results of the study-related [68Ga]Ga-FAPI-46 PET/CTs will be blinded, and treatment allocation will be based on common clinical practice in accordance with current guidelines. The histopathology of surgical specimens will serve as a reference standard. A recruitment period of 2 years is estimated; the trial is currently recruiting. DISCUSSION To our knowledge, this trial represents the largest, most extensive, and most meticulous prospective FAPI PET study conducted in patients with ovarian cancer thus far. This study aims to obtain a reliable estimation of the diagnostic accuracy of [68Ga]Ga-FAPI-46 PET/CT, shed light on the clinical importance of [68Ga]Ga-FAPI-46 PET/CT, and examine the potential applicability of [68Ga]Ga-FAPI-46 PET/CT for evaluating chemotherapy response. TRIAL REGISTRATION clinicaltrials.gov: NCT05903807, 2nd June 2023; and euclinicaltrials.eu EU CT Number: 2023-505938-98-00, authorized 11th September 2023.
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Affiliation(s)
- Morten Bentestuen
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18- 22, Aalborg, DK-9000, Denmark.
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 11, Aalborg, DK-9000, Denmark.
| | - Morten Ladekarl
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, Aalborg, DK- 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 11, Aalborg, DK-9000, Denmark
| | - Aage Knudsen
- Department of Gynecology and Obstetrics, Aalborg University Hospital, Reberbansgade 15, Aalborg, DK-9000, Denmark
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 11, Aalborg, DK-9000, Denmark
| | - Helle D Zacho
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18- 22, Aalborg, DK-9000, Denmark
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 11, Aalborg, DK-9000, Denmark
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Wang T, Huang G, Zhao H, Li L, Shen Y, Lou W, Liu J. [ 68Ga]Ga-FAPI-04 PET/MR imaging strategy in management of Krukenberg tumors (KTs) from gastric signet-ring-cell carcinoma: to overcome limitation of [ 68Ga]Ga-FAPI-04 PET imaging in KTs. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06761-3. [PMID: 38767660 DOI: 10.1007/s00259-024-06761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE To compare performance of whole-body [68Ga]Ga-FAPI-04 and [18F]FDG PET imaging in the detection of Krukenberg tumors (KTs), primary site and extra-ovarian metastases of gastric signet-ring-cell carcinoma (GSRCC), and evaluate the value of [68Ga]Ga-FAPI-04 PET/MR imaging strategy and its potential impact on the management of KTs from GSRCC. METHODS Twelve patients with twenty-three KTs from GSRCC, who underwent both [68Ga]Ga-FAPI-04 pelvic PET/MR and whole-body [68Ga]Ga-FAPI-04 and [18F]FDG PET imaging were retrospectively analyzed. [68Ga]Ga-FAPI-04 and [18F]FDG uptakes were compared by using Wilcoxon signed-rank test or paired t test. McNemar's test was used to compare lesion detectability between two modalities. Two-tailed P<0.05 was considered statistically significant. Immunohistochemistry staining was utilized to analyze the fibroblast activation protein (FAP) expression in KTs. RESULTS A total of 12 patients with 23 KTs from GSRCC (8 synchronous and 4 metachronous) were evaluated. [68Ga]Ga-FAPI-04 was superior to [18F]FDG PET in detecting primary sites of GSRCC (100% [11/11] vs. 18.2% [2/11], p = 0.002), involved lymph nodes (90.9% [10/11] vs. 54.5% [6/11], p = 0.046) and peritoneal metastases (100% [12/12] vs. 41.7% [5/12], p = 0.008), with higher SUVmax and TBR (all p < 0.005). Both tracers had limited value in identifying KTs, with 100% false negative rate on [68Ga]Ga-FAPI-04 PET and a low detection rate of 8.7% on [18F]FDG PET. Fap immunohistochemistry showed negative or slight FAP expression in neoplastic signet ring cells and ovarian stroma. [68Ga]Ga-FAPI-04 PET/MR imaging strategy greatly improved the detection rate of Krukenberg tumors (87%, 20/23). After adding diffusion-weighted imaging (DWI), the detection rate was further improved (87.5% vs. 100%, p = 0.083). [68Ga]Ga-FAPI-04 PET/MR imaging strategy either upgraded TNM staging or changed treatment management in twelve patients. CONCLUSIONS [68Ga]Ga-FAPI-04 PET outperformed [18F]FDG PET in detecting primary site and most extra-ovarian metastases of GSRCC, but both tracers had limited value in identifying Krukenberg tumors. Pelvis MRI should be applied to compensate the limitation of [68Ga]Ga-FAPI-04 PET imaging to identify Krukenberg tumours. The [68Ga]Ga-FAPI-04 PET/MR imaging strategy has the potential to impact treatment decisions for GSRCC patients with KTs.
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Affiliation(s)
- Tingting Wang
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Gan Huang
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Haitao Zhao
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Lianghua Li
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yanying Shen
- Department of Pathology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Weihua Lou
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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Li X, Lv X, Quan Z, Han T, Tang Y, Liu Y, Wang M, Li G, Ye J, Wang J, Lan X, Zhang X, Li M, Liu S, Kang F, Wang J. Surgical evidence-based comparison of [ 68Ga]Ga-FAPI-04 PET and MRI-DWI for assisting debulking surgery in ovarian cancer patients. Eur J Nucl Med Mol Imaging 2024; 51:1773-1785. [PMID: 38197954 DOI: 10.1007/s00259-023-06582-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Imaging assessment of abdominopelvic tumor burden is crucial for debulking surgery decision in ovarian cancer patients. This study aims to compare the efficiency of [68Ga]Ga-FAPI-04 FAPI PET and MRI-DWI in the preoperative evaluation and its potential impact to debulking surgery decision. METHODS Thirty-six patients with suspected/confirmed ovarian cancer were enrolled and underwent integrated [68Ga]Ga-FAPI-04 PET/MRI. Nineteen patients (15 stage III-IV and 4 I-II stage) who underwent debulking surgery were involved in the diagnostic efficiency analysis. The images of [68Ga]Ga-FAPI-04 PET and MRI-DWI were visually analyzed respectively. Immunohistochemistry on FAP was performed in metastatic lesions to investigate the radiological missing of [68Ga]Ga-FAPI-04 PET as well as its different performance in primary debulking surgery (PDS) and interval debulking surgery (IDS) patients. Potential imaging impact on management was also studied in 35 confirmed ovarian cancer patients. RESULTS [68Ga]Ga-FAPI-04 PET displayed higher sensitivity (76.8% vs.59.9%), higher accuracy (84.9% vs. 80.7%), and lower missing rate (23.2% vs. 40.1%) than MRI-DWI in detecting abdominopelvic metastasis. The diagnostic superiority of [68Ga]Ga-FAPI-04 PET is more obvious in PDS patients but diminished in IDS patients. [68Ga]Ga-FAPI-04 PET outperformed MRI-DWI in 70.8% abdominopelvic regions (17/24), which contained seven key regions that impact the resectability and surgical complexity. MRI-DWI hold advantage in the peritoneal surface of the bladder and the central tendon of the diaphragm. Of the contradictory judgments between the two modalities (14.9%), [68Ga]Ga-FAPI-04 PET correctly identified more lesions, particularly in PDS patients (73.8%). In addition, FAP expression was independent of lesion size and decreased in IDS patients. [68Ga]Ga-FAPI-04 PET changed 42% of surgical planning that was previously based on MRI-DWI. CONCLUSION [68Ga]Ga-FAPI-04 PET is more efficient in assisting debulking surgery in ovarian cancer patients than MRI-DWI. Integrated [68Ga]Ga-FAPI-04 PET/MR imaging is a potential method for planning debulking surgery in ovarian cancer patients.
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Affiliation(s)
- Xiang Li
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Xiaohui Lv
- Department of Gynaecology and Obstetrics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Zhiyong Quan
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Tingting Han
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Yongqiang Tang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Ying Liu
- Department of Gynaecology and Obstetrics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Mengxin Wang
- Department of Gynaecology and Obstetrics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Guiyu Li
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Jiajun Ye
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Jingyi Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiao Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Mengting Li
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shujuan Liu
- Department of Gynaecology and Obstetrics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| | - Fei Kang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
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Li T, Zhang J, Yan Y, Tan M, Chen Y. Applications of FAPI PET/CT in the diagnosis and treatment of breast and the most common gynecologic malignancies: a literature review. Front Oncol 2024; 14:1358070. [PMID: 38505595 PMCID: PMC10949888 DOI: 10.3389/fonc.2024.1358070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
The fibroblast activating protein (FAP) is expressed by some fibroblasts found in healthy tissues. However, FAP is overexpressed in more than 90% of epithelial tumors, including breast and gynecological tumors. As a result, the FAP ligand could be used as a target for diagnosis and treatment purposes. Positron emission tomography/computed tomography (PET/CT) is a hybrid imaging technique commonly used to locate and assess the tumor's molecular and metabolic functions. PET imaging involves the injection of a radiotracer that tends to accumulate more in metabolically active lesions such as cancer. Several radiotracers have been developed to target FAP in PET/CT imaging, such as the fibroblast-activation protein inhibitor (FAPI). These tracers bind to FAP with high specificity and affinity, allowing for the non-invasive detection and quantification of FAP expression in tumors. In this review, we discussed the applications of FAPI PET/CT in the diagnosis and treatment of breast and the most common gynecologic malignancies. Radiolabeled FAPI can improve the detection, staging, and assessment of treatment response in breast and the most common gynecologic malignancies, but the problem with normal hormone-responsive organs remains insurmountable. Compared to the diagnostic applications of FAPI, further research is needed for future therapeutic applications.
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Affiliation(s)
- Tengfei Li
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Jintao Zhang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Yuanzhuo Yan
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Min Tan
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Nuclear Medicine Institute of Southwest Medical University, Luzhou, Sichuan, China
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Wu G, Wang D, Zhang W, Jia Z, Li J, Zhang L. Head-to-head comparison of [68Ga]Ga-FAPI PET and [18F]FDG PET in the detection of bone and lymph node metastasis in various cancers: A systematic review and meta-analysis. Eur J Radiol 2024; 171:111302. [PMID: 38219352 DOI: 10.1016/j.ejrad.2024.111302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE The aim of our meta-analysis and systematic review was to contrast the positivity rates of [68Ga]Ga-FAPI PET and [18F]FDG PET in detecting bone and lymph node metastases across diverse cancer types. METHODS We conducted a comprehensive search for eligible articles up until August 2023, utilizing databases including PubMed, Embase, and Web of Science. Studies focusing on the positivity rate of [68Ga]Ga-FAPI PET vs. [18F]FDG PET for bone and lymph metastasis were included. Using random-effect model, the positivity rate for [68Ga]Ga-FAPI PET and [18F]FDG PET were generated. In order to gauge the heterogeneity among aggregated studies, we utilized the I2 statistic. Additionally, we applied the Quality Assessment of Diagnostic Performance Studies (QUADAS-2) methodology to evaluate the caliber of the studies encompassed in our analysis. RESULTS A total of 430 publications were initially identified in the search. Eventually, 25 studies, involving 779 patients, met the inclusion criteria. In terms of bone metastasis, the findings indicate no statistically significant difference between the use of [68Ga]Ga-FAPI PET and [18F]FDG PET (P = 0.34). However, concerning lymph node metastasis, the results demonstrate significant difference between the two imaging agents (P = 0.04). CONCLUSIONS This systematic review suggests that [68Ga]Ga-FAPI PET appears to outperform [18F]FDG PET in detecting lymph node metastases. However, when it comes to bone metastasis, no statistically significant difference was observed. It is crucial to acknowledge that the insights concerning bone metastasis stem from studies with comparatively modest sample sizes. Consequently, there is a pressing demand for further, expansive prospective studies in this field.
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Affiliation(s)
- Guiyou Wu
- Joint Training Base of Jinzhou Medical University, China Postgraduate Training Base of The Fourth Medical Center of PLA General Hospital, Hospital of Jinzhou, Medical University, China; Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Department of Sports Medicine, Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Zhengfeng Jia
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Nakamoto Y, Baba S, Kaida H, Manabe O, Uehara T. Recent topics in fibroblast activation protein inhibitor-PET/CT: clinical and pharmacological aspects. Ann Nucl Med 2024; 38:10-19. [PMID: 37861977 DOI: 10.1007/s12149-023-01873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
Recently, positron emission tomography (PET) with fibroblast activation protein inhibitor (FAPI) has gained significant attention as an advanced tumor diagnostic imaging tool. FAPI PET has a promising potential owing to its ability to accurately depict most malignant tumors. It has an accuracy that is comparable to or surpassing the diagnostic accuracy of PET using 18F-fluorodeoxyglucose (FDG). Moreover, FAPI PET can identify malignant lesions that may be inconclusive on FDG PET. Beyond its application in neoplastic disorders, there have been encouraging reports suggesting the utility of FAPI PET in non-neoplastic conditions such as respiratory or cardiac diseases. This article aimed to provide a comprehensive overview of the recently published articles investigating FAPI and discuss its clinical utility with an emphasis on its application in tumor diagnostics. Numerous radiopharmaceutical FAPIs, including 18F- and 68Ga-labeled compounds, have been developed, and they offer various advantages and applications. With the progress in the FAPI PET synthesis to enhance accumulation and retention in pathological lesions, future studies are expected to provide valuable data on its therapeutic efficacy.
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Affiliation(s)
- Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shingo Baba
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, Ohnohigashi 377-2, Osakasayama City, Osaka, 589-8511, Japan
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Tomoya Uehara
- Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8675, Japan
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Chen J, Xu K, Li C, Tian Y, Li L, Wen B, He C, Cai H, He Y. [ 68Ga]Ga-FAPI-04 PET/CT in the evaluation of epithelial ovarian cancer: comparison with [ 18F]F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2023; 50:4064-4076. [PMID: 37526694 DOI: 10.1007/s00259-023-06369-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To compare the efficacy of [68Ga]Ga-FAPI-04 PET/CT in primary or recurrent tumors and metastatic lesions of epithelial ovarian cancer (EOC) with that of fluorine-18 fluorodeoxyglucose ([18F]F-FDG) PET/CT. METHODS Forty-nine patients (median age, 57 years; IQR, 51-66 years) with histologically proven primary or relapsed EOC were enrolled. Participants underwent [18F]F-FDG and [68Ga]Ga-FAPI-04 PET/CT. The detection rate, diagnostic accuracy, semiquantitative parameters, tumor staging, and clinical management of the tracers were compared. The diagnostic performance of [18F]F-FDG and [68Ga]Ga-FAPI-04 PET/CT was evaluated and compared using surgical pathology. Differences between methods regarding the peritoneal cancer index (PCI) using preoperative imaging, surgical PCI, and tumor markers (CA125, HE4) were also assessed regarding peritoneal metastases. RESULTS Among the 49 patients, 28 had primary EOC; 21 had relapsed EOC. [68Ga]Ga-FAPI-04 PET/CT outperformed [18F]F-FDG PET/CT in detecting peritoneal metastases (96.8% vs. 83.0%; p < 0.001), retroperitoneal (99.5% vs. 91.4%; p < 0.001), and supradiaphragmatic lymph node metastases (100% vs. 80.4%; p < 0.001). Compared with [18F]F-FDG, [68Ga]Ga-FAPI-04 showed higher SUVmax for peritoneal metastases (17.31 vs. 13.68; p = 0.026) and retroperitoneal (8.72 vs. 6.56; p < 0.001) and supradiaphragmatic lymph node metastases (6.39 vs. 4.20; p < 0.001). Moreover, [68Ga]Ga-FAPI-04 PET/CT showed higher sensitivity compared with [18F]F-FDG PET/CT for detecting metastatic lymph nodes (80.6% vs. 61.3%; p = 0.031) and peritoneal metastases (97.5% vs. 75.9%; p < 0.001), using surgical pathology as the gold standard. Compared with [18F]F-FDG PET/CT, [68Ga]Ga-FAPI-04 PET/CT led to an upgrade in 14.3% and 33.3% of treatment-naive and relapse participants, resulting in management changes in 10.7% and 19.0% of the patients, respectively. The median PCIFAPI scores were significantly higher than PCIFDG (15 vs. 11; p < 0.001) and positively correlated with CA125 and HE4 levels and surgical PCI. CONCLUSION [68Ga]Ga-FAPI-04 PET/CT achieved higher sensitivity than [18F]F-FDG PET/CT in the detection and diagnosis of lymph node and peritoneal metastases, suggesting advantages regarding the preoperative staging of patients with EOC and, thereby, improving treatment decision-making. TRIAL REGISTRATION NCT05034146. Registered February 23, 2021.
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Affiliation(s)
- Jie Chen
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China
| | - Kui Xu
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China
| | - Chongjiao Li
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China
| | - Yueli Tian
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China
| | - Ling Li
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China
| | - Bing Wen
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China
| | - Can He
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China
| | - Hongbing Cai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China.
| | - Yong He
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430071, China.
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Koerber SA, Röhrich M, Walkenbach L, Liermann J, Choyke PL, Fink C, Schroeter C, Spektor AM, Herfarth K, Walle T, Calais J, Kauczor HU, Jaeger D, Debus J, Haberkorn U, Giesel FL. Impact of 68Ga-FAPI PET/CT on Staging and Oncologic Management in a Cohort of 226 Patients with Various Cancers. J Nucl Med 2023; 64:1712-1720. [PMID: 37678928 PMCID: PMC10626373 DOI: 10.2967/jnumed.123.266046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
Since the development of fibroblast activation protein-targeted radiopharmaceuticals, 68Ga-fibroblast activation protein inhibitor (FAPI) PET/CT has been found to be suitable for detecting primary and metastatic lesions in many types of tumors. However, there is currently a lack of reliable data regarding the clinical impact of this family of probes. To address this gap, the present study aimed to analyze the clinical impact of 68Ga-FAPI PET/CT by examining a large cohort of patients with various tumors. Methods: In total, 226 patients (137 male and 89 female) were included in this retrospective analysis. Pancreatic cancer and head and neck cancers were the most common tumor types in this cohort. TNM stage and oncologic management were initially determined with gold standard imaging, and these results were compared with 68Ga-FAPI PET/CT. Changes were classified as major and minor. Results: For 42% of all patients, TNM stage was changed by 68Ga-FAPI PET/CT results. Most of these changes resulted in upstaging. A change in clinical management occurred in 117 of 226 patients. Although a major change in management occurred in only 12% of patients, there was a significant improvement in the ability to accurately plan radiation therapy. In general, the highest clinical impact of 68Ga-FAPI PET/CT imaging was found in patients with lung cancer, pancreatic cancer, and head and neck tumors. Conclusion: 68Ga-FAPI PET/CT is a promising imaging probe that has a significant impact on TNM stage and clinical management. 68Ga-FAPI PET/CT promises to be a crucial new technology that will improve on conventional radiologic imaging methods such as contrast-enhanced CT and contrast-enhanced MRI typically acquired for cancer staging.
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Affiliation(s)
- Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Department of Radiation Oncology, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany;
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany
| | - Leon Walkenbach
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Christoph Fink
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Cathrin Schroeter
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna-Maria Spektor
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Thomas Walle
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Virotherapy, German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Heidelberg, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dirk Jaeger
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Düsseldorf, Germany; and
- Institute for Radiation Sciences, Osaka University, Osaka, Japan
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9
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Guglielmo P, Alongi P, Baratto L, Abenavoli E, Buschiazzo A, Celesti G, Conte M, Filice R, Gorica J, Jonghi-Lavarini L, Lanzafame H, Laudicella R, Librando M, Linguanti F, Mattana F, Miceli A, Olivari L, Piscopo L, Romagnolo C, Santo G, Vento A, Volpe F, Evangelista L. Head-to-Head Comparison of FDG and Radiolabeled FAPI PET: A Systematic Review of the Literature. Life (Basel) 2023; 13:1821. [PMID: 37763225 PMCID: PMC10533171 DOI: 10.3390/life13091821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
FAPI-based radiopharmaceuticals are a novel class of tracers, mainly used for PET imaging, which have demonstrated several advantages over [18F]FDG, especially in the case of low-grade or well-differentiated tumors. We conducted this systematic review to evaluate all the studies where a head-to-head comparison had been performed to explore the potential utility of FAPI tracers in clinical practice. FAPI-based radiopharmaceuticals have shown promising results globally, in particular in detecting peritoneal carcinomatosis, but studies with wider populations are needed to better understand all the advantages of these new radiopharmaceuticals.
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Affiliation(s)
| | - Pierpaolo Alongi
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy;
| | - Lucia Baratto
- Department of Radiology, Division of Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA 94304, USA;
| | - Elisabetta Abenavoli
- Nuclear Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy;
| | - Ambra Buschiazzo
- Nuclear Medicine Division, Santa Croce and Carle Hospital, 12100 Cuneo, Italy;
| | - Greta Celesti
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy; (G.C.); (M.L.)
| | - Miriam Conte
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (J.G.)
| | - Rossella Filice
- Unit of Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, 90133 Palermo, Italy; (R.F.); (R.L.)
| | - Joana Gorica
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (J.G.)
| | - Lorenzo Jonghi-Lavarini
- Department of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Helena Lanzafame
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - Riccardo Laudicella
- Unit of Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, 90133 Palermo, Italy; (R.F.); (R.L.)
| | - Maria Librando
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy; (G.C.); (M.L.)
| | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
| | - Francesco Mattana
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCSS, 20141 Milan, Italy;
| | - Alberto Miceli
- Nuclear Medicine Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Laura Olivari
- Nuclear Medicine Unit, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Leandra Piscopo
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy; (L.P.); (F.V.)
| | - Cinzia Romagnolo
- Department of Nuclear Medicine, “Ospedali Riuniti” Hospital, 60126 Ancona, Italy;
| | - Giulia Santo
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Antonio Vento
- Nuclear Medicine Department, ASP 1-P.O. San Giovanni di Dio, 92100 Agrigento, Italy;
| | - Fabio Volpe
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy; (L.P.); (F.V.)
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy;
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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10
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Mokoala KMG, Lawal IO, Maserumule LC, Bida M, Maes A, Ndlovu H, Reed J, Mahapane J, Davis C, Van de Wiele C, Popoola G, Giesel FL, Vorster M, Sathekge MM. Correlation between [ 68Ga]Ga-FAPI-46 PET Imaging and HIF-1α Immunohistochemical Analysis in Cervical Cancer: Proof-of-Concept. Cancers (Basel) 2023; 15:3953. [PMID: 37568769 PMCID: PMC10417683 DOI: 10.3390/cancers15153953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Hypoxia leads to changes in tumor microenvironment (upregulated CAFs) with resultant aggressiveness. A key factor in the physiological response to hypoxia is hypoxia-inducible factor-1alpha (HIF-1α). [68Ga]Ga-FAPI PET imaging has been demonstrated in various cancer types. We hypothesized that [68Ga]Ga-FAPI PET may be used as an indirect tracer for mapping hypoxia by correlating the image findings to pathological analysis of HIF-1α expression. The [68Ga]Ga-FAPI PET/CT scans of women with cancer of the cervix were reviewed and the maximum and mean standardized uptake value (SUVmax and SUVmean) and FAPI tumor volume (FAPI-TV) were documented. Correlation analysis was performed between PET-derived parameters and immunohistochemical staining as well as between PET-derived parameters and the presence of metastasis. Ten women were included. All patients demonstrated tracer uptake in the primary site or region of the primary. All patients had lymph node metastases while only six patients had distant visceral or skeletal metastases. The mean SUVmax, SUVmean, and FAPI-TV was 18.89, 6.88, and 195.66 cm3, respectively. The average FAPI-TV for patients with additional sites of metastases was higher than those without. Immunohistochemistry revealed varying intensities of HIF-1α expression in all tested samples. There was a positive correlation between the presence of skeletal metastases and staining for HIF-1α (r=0.80;p=0.017). The presence of skeletal metastasis was correlated to the HIF-1⍺ staining (percentage distribution). Furthermore, the FAPI-TV was a better predictor of metastatic disease than the SUVmax.
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Affiliation(s)
- Kgomotso M. G. Mokoala
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Ismaheel O. Lawal
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Letjie C. Maserumule
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Meshack Bida
- National Health Laboratory Services, Department of Anatomical Pathology, Pretoria 0001, South Africa;
| | - Alex Maes
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
- Katholieke University Leuven, 3000 Kortrijk, Belgium
| | - Honest Ndlovu
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Janet Reed
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Johncy Mahapane
- Department of Radiography, University of Pretoria, Pretoria 0028, South Africa;
| | - Cindy Davis
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
| | - Christophe Van de Wiele
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
- Department of Diagnostic Sciences, University Ghent, 9000 Ghent, Belgium
| | - Gbenga Popoola
- Lincolnshire Partnership NHS Foundation Trust, St George’s, Lincoln, Lincolnshire LN1 1FS, UK;
| | - Frederik L. Giesel
- Department of Nuclear Medicine, Medical Faculty, University Hospital Dusseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Kwazulu Natal, Durban 4001, South Africa;
| | - Mike M. Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0028, South Africa; (K.M.G.M.); (I.O.L.); (L.C.M.); (A.M.); (H.N.); (J.R.); (C.D.); (C.V.d.W.)
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
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11
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Chandekar KR, Prashanth A, Vinjamuri S, Kumar R. FAPI PET/CT Imaging-An Updated Review. Diagnostics (Basel) 2023; 13:2018. [PMID: 37370912 DOI: 10.3390/diagnostics13122018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Despite revolutionizing the field of oncological imaging, Positron Emission Tomography (PET) with [18F]Fluorodeoxyglucose (FDG) as its workhorse is limited by a lack of specificity and low sensitivity in certain tumor subtypes. Fibroblast activation protein (FAP), a type II transmembrane glycoprotein, is expressed by cancer-associated fibroblasts (CAFs) that form a major component of the tumor stroma. FAP holds the promise to be a pan-cancer target, owing to its selective over-expression in a vast majority of neoplasms, particularly epithelial cancers. Several radiolabeled FAP inhibitors (FAPI) have been developed for molecular imaging and potential theranostic applications. Preliminary data on FAPI PET/CT remains encouraging, with extensive multi-disciplinary clinical research currently underway. This review summarizes the existing literature on FAPI PET/CT imaging with an emphasis on diagnostic applications, comparison with FDG, pitfalls, and future directions.
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Affiliation(s)
- Kunal Ramesh Chandekar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Arun Prashanth
- Department of Nuclear Medicine, MIOT International Hospital, Chennai 600089, India
| | - Sobhan Vinjamuri
- Department of Nuclear Medicine, Royal Liverpool and Broadgreen University Hospital, Liverpool L7-8YE, UK
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
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