Positron emission tomography and computed tomography with [68Ga]Ga-fibroblast activation protein inhibitors improves tumor detection and staging in patients with pancreatic cancer

Pang, Yizhen; Zhao, Long; Shang, Qihang; Meng, Tinghua; Zhao, Liang; Feng, Liuxing; Wang, Shuangjia; Guo, Ping; Wu, Xiurong; Qi, Lin; Wu, Hua; Huang, Weipeng; Sun, Long; Chen, Haojun

doi:10.1007/s00259-021-05576-w

Cited by 69 publications

(112 citation statements)

References 36 publications

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“…Diffuse high uptake in pancreatitis was observed by Chen [ 10 ] ( n = 1), Rohrich [ 14 ] ( n = 8/19) and Pang et al [ 18 ] ( n = 12/26). In the latter two studies, pancreatic carcinoma could be differentiated from underlying pancreatitis by increasing/stable vs. decreasing uptake over time (measured at 10, 60 and 180 min and 1 h and 3 h post-injection, respectively).…”

Section: Resultsmentioning

confidence: 95%

“…Another nine were excluded because they did not meet the relevance criteria (i.e., studies not reporting FAPI PET results for pancreatic-, gastric- or cholangiocarcinoma) and three for not reporting numeric data. Finally, ten articles met all inclusion criteria and were further analysed [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Figure 1 shows a flowchart of the process of in- and exclusion.…”

Section: Resultsmentioning

confidence: 99%

“…Qin et al reported enhanced confidence for the diagnosis of ovarian metastases ( n = 6/14), hepatic metastases ( n = 3) and uterine/rectal metastases ( n = 1) with use of MRI (combined with FAPI PET) compared with FDG PET-CT in patients with gastric carcinoma. Sensitivities for comparative CECT used by Rohrich et al [ 14 ], CECT/MRI by Shi et al [ 16 ] and CECT used by Pang et al [ 18 ] were not specifically reported.…”

Section: Discussionmentioning

confidence: 99%

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FAPI PET versus FDG PET, CT or MRI for Staging Pancreatic-, Gastric- and Cholangiocarcinoma: Systematic Review and Head-to-Head Comparisons of Diagnostic Performances

et al. 2022

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Introduction: There is a pressing demand for the development of cancer-specific diagnostic imaging tools, particularly for staging of pancreatic-, gastric- or cholangiocarcinoma, as current diagnostic imaging techniques, including CT, MRI and PET using FDG, are not fully adequate. The novel PET-tracer “FAPI” has the potential to visualize even small tumour deposits employing the tumour-specific expression of fibroblast-activating protein (FAP) in malignant cells. Methods: We performed a systematic review to select studies investigating the use of FAPI PET for staging pancreatic-, gastric- and cholangiocarcinoma (PROSPERO CRD42022329512). Patient-wise and lesion-wise comparisons were performed for primary tumour (T), lymph nodes (N), organ metastases (M) and peritoneal carcinomatosis (PC). Maximum standardized uptake values (SUVmax) and tumour-to-background ratios (TBR) were compared between PET using FAPI versus FDG (if reported). Results: Ten articles met the inclusion criteria. In all studies, FAPI PET showed superiority over FDG-PET/CT/MRI for the detection of T, N, M and PC, both in the patient-wise and in lesion-wise comparisons (when performed). Additionally, higher SUVmax and TBRmax values were reported for use of FAPI compared to FDG. Conclusions: The positive results of this review warrant prospective clinical studies to investigate the accuracy and clinical value of FAPI PET for diagnosing and staging patients with pancreatic-, gastric- and cholangiocarcinoma.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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FAPI PET versus FDG PET, CT or MRI for Staging Pancreatic-, Gastric- and Cholangiocarcinoma: Systematic Review and Head-to-Head Comparisons of Diagnostic Performances

et al. 2022

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“…In addition, OncoFAP-derivatives can be exploited as PET/CT imaging agents for a broader window of malignancies, which are not e ciently detected by other marketed radiopharmaceuticals, such as [ 18 F]FDG, [ 18 F]FLT, [ 18 F]F-MCH and [ 18 F]F-PSMA-1007 [1,34]. Examples are represented by esophageal [35], liver [36] and pancreatic cancers [4], brain primary tumours and metastases [37] or head and neck cancers [38].…”

Section: Discussionmentioning

confidence: 99%

“…Favourable biodistribution pro le and tumour-to-background ratio have been demonstrated for several FAP-based radiopharmaceuticals in development for PET/CT imaging. A wide range of cancer types have been imaged successfully with FAP-radioligands based on small molecules, particularly in those clinical conditions where imaging with [ 18 F]FDG, the most extensively used PET radiopharmaceutical in oncology, has proved limitations [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Automated radiolabelling procedures for the preparation of OncoFAP-based radiopharmaceuticals for cancer imaging and therapy

Bartoli

Elsinga

Nazario

et al. 2022

Preprint

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FAP-targeted radiopharmaceuticals represent a breakthrough in cancer imaging and a viable option for therapeutic applications. OncoFAP, an ultra-high affinity ligand of FAP, has been recently discovered and clinically validated for PET imaging procedures in patients with solid malignancies. While more and more clinical validation is becoming available, the need for scalable and robust procedures for the preparation of this new class of radiopharmaceuticals continues to increase. In this article, we present the development of automated radiolabelling procedures with FASTlab 2 for the preparation of OncoFAP-based radiopharmaceuticals for cancer imaging and therapy. A new series of [68Ga]Ga-OncoFAP, [177Lu]Lu-OncoFAP and [18F]AlF-OncoFAP was produced with high-yields. Chemical and biochemical characterization after radiolabelling confirmed excellent stability, retention of high affinity for FAP and absence of radiolysis by-products. The in vivo biodistribution of [18F]AlF-OncoFAP-NOTA, a candidate for PET imaging procedures in patients, was assessed in mice bearing FAP-positive solid tumours. The product showed rapid accumulation in solid tumours, with an average of 6.6% ID/g one hour after systemic administration and excellent tumour-to-healthy organs ratio. We have established methodologies to efficiently produce an OncoFAP-based radiotheranostic pair in which [68Ga]Ga-OncoFAP-DOTAGA is used as a companion diagnostic of the targeted therapeutic agent [177Lu]Lu-OncoFAP-DOTAGA Objectives: We have developed simple, quick, safe and robust synthetic procedures for the preparation of theranostic OncoFAP-compounds based on Gallium-68, Lutetium-177 and Alluminium-Fluoride-18 using the commercially available FASTlab 2 synthesis module.

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Clinical applications of fibroblast activation protein‐targeted theranostics in oncologic and nononcologic disease: Current status and future directions

Fu,

Guo,

Huang

et al. 2023

iRADIOLOGY

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Quinoline‐based fibroblast activation protein (FAP) inhibitor (FAPI)‐based positron emission tomography (PET) imaging and radioligand therapy (RLT) are being investigated for use in a wide variety of diseases, and recent results have been promising. This review summarizes the current status of FAPI radiopharmaceuticals in PET imaging of malignant tumors and benign conditions and compares their diagnostic efficacy with 18F‐fluorodeoxyglucose. In addition, we summarize the previously published FAP‐targeted RLT data and discuss its current clinical use and future potential. Our qualitative summary can inform future research directions, medical guidelines, and optimal clinical decision‐making.

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Positron emission tomography and computed tomography with [68Ga]Ga-fibroblast activation protein inhibitors improves tumor detection and staging in patients with pancreatic cancer

Cited by 69 publications

References 36 publications

FAPI PET versus FDG PET, CT or MRI for Staging Pancreatic-, Gastric- and Cholangiocarcinoma: Systematic Review and Head-to-Head Comparisons of Diagnostic Performances

FAPI PET versus FDG PET, CT or MRI for Staging Pancreatic-, Gastric- and Cholangiocarcinoma: Systematic Review and Head-to-Head Comparisons of Diagnostic Performances

Automated radiolabelling procedures for the preparation of OncoFAP-based radiopharmaceuticals for cancer imaging and therapy

Clinical applications of fibroblast activation protein‐targeted theranostics in oncologic and nononcologic disease: Current status and future directions

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