[68Ga]Ga-DOTA-FAPI-04 improves tumor staging and monitors early response to chemoradiotherapy in a patient with esophageal cancer

Zhao, Liang; Chen, Shanyu; Lin, Lianbo; Sun, Long; Wu, Hua; Qi, Lin; Chen, Haojun

doi:10.1007/s00259-020-04818-7

Cited by 42 publications

(28 citation statements)

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“…As mentioned in previous studies, the unspecific fibrosis induced by inflammation could also cause positive uptake of 68 Ga-FAPI (11,12,29). Like 18 F-FDG, the inflammation would be a predominant factor explaining false-positive findings on 68 Ga-FAPI PET scans.…”

Section: Discussionmentioning

confidence: 66%

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

et al. 2021

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Background: Accurate clinical staging is crucial to managing gastrointestinal cancer, but fluorine 18 (18 F) fluorodeoxyglucose (FDG) PET/CT has limitations. Targeting fibroblast-activation protein is a newer diagnostic approach for the visualization of tumor stroma, and gallium 68 (68 Ga)-labeled fibroblast-activation protein inhibitors (FAPIs), hereafter 68 Ga-FAPIs, present a promising alternative to 18 F-FDG. Purpose: To compare the diagnostic efficacy of 68 Ga-FAPI PET/CT in primary and metastatic lesions of gastrointestinal malignancies with that of 18 F-FDG PET/CT. Materials and Methods: Images from patients with gastric, duodenal, and colorectal cancers who underwent contemporaneous 18 F-FDG and 68 Ga-FAPI PET/CT between October 2019 through June 2020 were retrospectively analyzed. 18 F-FDG and 68 Ga-FAPI uptakes were compared by using the Wilcoxon signed-rank test. The McNemar test was used to compare the diagnostic performance between the two techniques. Results: Thirty-five patients (median age, 64 years [interquartile range, 53-68 years]; 18 men) were evaluated. In treatment-naive patients (n = 19), 68 Ga-FAPI PET/CT led to upstaging of the clinical TNM stage in four (21%) patients compared with 18 F-FDG PET/CT. Tracer uptake was higher with 68 Ga-FAPI PET/CT than with 18 F-FDG PET/CT in primary lesions (gastric cancer: 12.7 vs 3.7, respectively, P = .003; colorectal cancer: 15.9 vs 7.9, P = .03), involved lymph nodes (6.7 vs 2.4, P , .001), and bone and visceral metastases (liver metastases: 9.7 vs 5.2, P , .001; peritoneal metastases: 8.4 vs 3.6, P , .001; bone metastases: 4.3 vs 2.2, P , .001; lung metastases: 4.4 vs 1.9, P = .01). In addition, the sensitivity of 68 Ga-FAPI PET/CT was higher than that of 18 F-FDG PET/CT in the detection of primary tumors (100% [19 of 19] vs 53% [10 of 19], respectively; P = .004), lymph nodes (79% [22 of 28] vs 54% [15 of 28], P , .001), and bone and visceral metastases (89% [31 of 35] vs 57% [20 of 35], P , .001). Conclusion: Gallium 68 fibroblast-activation protein inhibitor PET/CT was superior to fluorine 18 fluorodeoxyglucose PET/CT in the detection of primary and metastatic lesions in gastric, duodenal, and colorectal cancers, with higher tracer uptake in most primary and metastatic lesions. Published under a CC BY 4.0 license.

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Section: Discussionmentioning

confidence: 66%

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

et al. 2021

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“…Additionally, FAPpositive fibroblasts were highly associated with lymph node metastasis in clinical specimens and mouse models [29,30]. We reported a case in which FAPI PET/CT could improve the detection of nodal metastasis and evaluate early response to chemoradiotherapy in oesophageal cancer [17], both of which are disadvantages of FDG PET/CT [31]. However, this finding needs more data to be verified in the future.…”

Section: Discussionmentioning

confidence: 89%

“…Moreover, studies have demonstrated a favourable tumour-to-background contrast in several types of cancer, including oesophageal cancer [13,14]. Recently, several case reports showed that 68 Ga-FAPI PET/CT could detect the primary tumour and metastatic lymph nodes with high sensitivity and clear image contrast in oesophageal cancer patients [15][16][17]. As a promising alternative to FDG in several oncologic indications, the usefulness of 68 Ga-FAPI in oesophageal cancer radiotherapy planning has not been explored.…”

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confidence: 99%

68Ga-fibroblast activation protein inhibitor PET/CT on gross tumour volume delineation for radiotherapy planning of oesophageal cancer

Zhao

Chen

et al. 2021

Radiotherapy and Oncology

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Background and purpose: To compare 68 Ga-fibroblast activation protein inhibitor (FAPI) and 18 F-FDG PET/ CT in imaging locally advanced oesophageal cancer, and evaluate the potential usefulness of 68 Ga-FAPI PET/CT on gross target volume (GTV) delineation aimed at radiotherapy planning for oesophageal cancer as compared with contrast-enhanced CT (CE-CT) and 18 F-FDG PET/CT. Materials and methods: Twenty-one patients with newly diagnosed oesophageal cancer who underwent both 18 F-FDG and 68 Ga-FAPI PET/CT scans were selected. GTVs of the primary tumours based on CE-CT (GTV CT ), PET/CT, and CE-CT plus PET/CT were delineated. Gross tumour lengths were measured by GTVs and endoscopy and recorded. Results: The 68 Ga-FAPI PET showed significantly higher radiotracer uptake than 18 F-FDG PET (median SUVmax 16.71 vs. 11.23; P = 0.002) in the primary tumours. SUV thresholds of FAPI Â20%, 30%, 40%, and FDG Â40% showed similar lesion lengths compared with that in endoscopic examination (P > 0.05). GTV CT demonstrated the largest volume (median: 48.80 mm 3 , range: 14.83-162.23 mm 3 ) than PET-based GTVs. For PET/CT-guided complementary contouring of GTV CT , four patients (19%) were increased by FAPI Â20% and 30%, two patients (9.5%) were increased by FAPI Â40%, and only one patient was increased by FDG Â40%. Furthermore, the volume of GTV based on CE-CT plus FAPI Â20%, 30%, and 40% showed no significant difference with GTV CT and planning target volume based CE-CT plus FAPI-PET and meets the organ at risk standard. Conclusion:The 68 Ga-FAPI PET/CT methodology showed favourable tumour-to-background contrast in oesophageal cancer and might provide additional information for target volume delineation and help avoid tumour geographic misses.

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“…Another cancer group of interest for FAP-targeted imaging is the gastrointestinal malignancies. The advantages of 68 Ga-FAPI04 over 18 F-FDG PET/CT in the imaging of esophageal cancer were reported as single-case studies (39,40) and two small cohort studies which investigated the potential of 68 Ga-FAPI04 PET/CT on target volume delineation for radiotherapy planning. Overexpression of FAPs in gastric carcinomas has also been demonstrated (41)(42)(43).…”

Section: Fibroblast Activation Protein-targeted Imaging In Oncologymentioning

confidence: 99%

Fibroblast-Activated Protein Inhibitor PET/CT: Cancer Diagnosis and Management

2021

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Fibroblast activation protein (FAP), overexpressed on cancer-associated fibroblasts (CAFs), is a novel target for molecular imaging of various tumors. Recently, the development of several small-molecule FAP inhibitors for radiolabeling with 68Ga has resulted in the emergence of studies evaluating its clinical role in cancer imaging. Preliminary findings have demonstrated that, in contrast to radiotracers taking advantage of cancer-specific targets such as PSMA and DOTATATE, FAPs as a target are the most promising that can compete with 18FDG in terms of widespread indications. They also have the potential to overcome the shortcomings of 18FDG, particularly false-positive uptake due to inflammatory or infectious processes, low sensitivity in certain cancer types, and radiotherapy planning. In addition, the attractive theranostic properties may facilitate the treatment of many refractory cancers. This review summarizes the current FAP variants and related clinical studies, focusing on radiopharmacy, dosimetry, and diagnostic and theranostic applications.

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[68Ga]Ga-DOTA-FAPI-04 improves tumor staging and monitors early response to chemoradiotherapy in a patient with esophageal cancer

Cited by 42 publications

References 5 publications

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

68Ga-fibroblast activation protein inhibitor PET/CT on gross tumour volume delineation for radiotherapy planning of oesophageal cancer

Fibroblast-Activated Protein Inhibitor PET/CT: Cancer Diagnosis and Management

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[68Ga]Ga-DOTA-FAPI-04 improves tumor staging and monitors early response to chemoradiotherapy in a patient with esophageal cancer

Cited by 42 publications

References 5 publications

Comparison of 68Ga-FAPI and 18F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Comparison of 68Ga-FAPI and 18F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

68Ga-fibroblast activation protein inhibitor PET/CT on gross tumour volume delineation for radiotherapy planning of oesophageal cancer

Fibroblast-Activated Protein Inhibitor PET/CT: Cancer Diagnosis and Management

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Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers