Purpose: The study was undertaken to develop and evaluate the potential of an integrin a v b 6-binding peptide (a v b 6-BP) for noninvasive imaging of a diverse range of malignancies with PET. Experimental Design: The peptide a v b 6-BP was prepared on solid phase and radiolabeled with 4-[ 18 F]fluorobenzoic acid. In vitro testing included ELISA, serum stability, and cell binding studies using paired a v b 6-expressing and a v b 6-null cell lines. In vivo evaluation (PET/CT, biodistribution, and autoradiography) was performed in a mouse model bearing the same paired a v b 6-expressing and a v b 6-null cell xenografts. A first-inhuman PET/CT imaging study was performed in patients with metastatic lung, colon, breast, or pancreatic cancer. Results: [ 18 F]a v b 6-BP displayed excellent affinity and selectivity for the integrin a v b 6 in vitro [IC 50 (a v b 6) ¼ 1.2 nmol/L vs IC 50 (a v b 3) >10 mmol/L] in addition to rapid target-specific cell binding and internalization (72.5% AE 0.9% binding and 52.5% AE 1.8%, respectively). Favorable tumor affinity and selectivity were retained in the mouse model and excretion of unbound [ 18 F]a v b 6-BP was rapid, primarily via the kidneys. In patients, [ 18 F]a v b 6-BP was well tolerated without noticeable adverse side effects. PET images showed significant uptake of [ 18 F]a v b 6-BP in both the primary lesion and metastases, including metastasis to brain, bone, liver, and lung. Conclusions: The clinical impact of [ 18 F]a v b 6-BP PET imaging demonstrated in this first-inhuman study is immediate for a broad spectrum of malignancies.