Impact of <sup>68</sup>Ga-FAPI PET/CT Imaging on the Therapeutic Management of Primary and Recurrent Pancreatic Ductal Adenocarcinomas

Röhrich, Manuel; Naumann, Patrick; Giesel, Frederik L.; Choyke, Peter L.; Staudinger, Fabian; Wefers, Annika K.; Liew, Dawn P.; Kratochwil, Clemens; Rathke, Hendrik; Liermann, Jakob; Herfarth, Klaus; Jäger, Dirk; Debus, Jürgen; Haberkorn, Uwe; Lang, Matthias; Koerber, Stefan A.

doi:10.2967/jnumed.120.253062

Cited by 139 publications

(227 citation statements)

References 34 publications

(30 reference statements)

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“…]Ga-DOTA-FAPI-04 PET/CT had a higher detection rate in metastatic LNs, liver, and peritoneum metastases, which was in consistent with the nding of a previous study [17]. The favorable imaging contrast de nitely makes [ 68 Ga]Ga-DOTA-FAPI-04 a tracer with high sensitivity for the diagnosis of pancreatic cancer.…”

Section: Clinical Characteristics Of the Patientssupporting

confidence: 88%

“…And most of them were with diffuse uptake in the body and tail of pancreas. Previous studies have also revealed the similar performance and tumors showed higher average SUV max than pancreatitis [17,23]. However, the SUV max of the tumors and non-tumor pancreas was similar in our study.…”

Section: Clinical Characteristics Of the Patientssupporting

confidence: 69%

“…Pancreatic cancer is one of the tumors with the highest desmoplastic reaction and intermediate radiolabeled-FAPI uptake. Röhrich et al have showed that [ 68 Ga]Ga-DOTA-FAPI-04 PET/CT could change the staging and detect the recurrences of pancreatic cancer with high sensitivity then CT [17]. One of the great advantages of [ 68 Ga]Ga-DOTA-FAPI-04 is the high tumor-to-background ratio (TBR), which may help to depict more primary and metastatic tumors.…”

Section: Introductionmentioning

confidence: 99%

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[68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the Assessment of Pancreatic Tumors: A Comparison Study

Liu¹,

Shi²,

Xu³

et al. 2021

Preprint

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Purpose Pancreatic tumors are characterized by abundant desmoplasia including cancer-associated fibroblasts (CAFs) that express fibroblast activation protein (FAP). Gallium-68-labeled fibroblast-activating protein inhibitor (FAPI) is promising probe for positron emission tomography/computed tomography (PET/CT) imaging of various types of cancers. This work aims to compare the diagnostic performances of [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in detecting primary pancreatic tumors and metastasis prospectively.Methods We collected patients with pancreatic tumors during May 1 to August 1, 2020. All the patients underwent [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT within 5 days at diagnosis, recurrence detection or therapeutic evaluation. The clinical information, PET/CT image characteristics, maximum standardized uptake (SUVmax) value of pancreatic tumors and metastases, target-to-background ratio (TBR) of the liver metastases were collected for analysis. The pathological results or follow-up clinical diagnostic results were obtained. Results A total of 45 patients (18 females and 27 males; median age of 62.4 years; range: 42 - 84 years) were enrolled for analysis, including 37 patients with pancreatic cancers and 8 patients with other types of pancreatic tumors. [68Ga]Ga-DOTA-FAPI-04 PET/CT detected abnormal pancreatic uptake in 36 patients (97.30%) with a SUVmax of 14.0 ± 5.4 (range 5.4 to 25.1), while 34 patients (91.89%) with abnormal pancreatic uptake with a SUVmax of 7.6 ± 3.9 (2.9 to 20.4) were detected by [18F]FDG PET/CT. Moreover, [68Ga]Ga-DOTA-FAPI-04 detected more lymph nodes (LNs) and metastases than [18F]FDG. The SUVmax of [68Ga]Ga-DOTA-FAPI-04 in LNs and TBR of liver metastases was higher than that of [18F]FDG (LNs: 6.1 ± 2.7 vs. 4.4 ± 1.6, TBR: 5.0 ± 3.1 vs. 2.9 ± 1.4 p < 0.0001), respectively. [68Ga]Ga-DOTA-FAPI-04 PET/CT successfully unregulated the clinical stage in 2 patients, visualized recurrence in 1 patient, and detected residual active tumor tissues in 2 patients with discordant imaging results (FAPI+/FDG-). In addition, there was nearly no [68Ga]Ga-DOTA-FAPI-04 or [18F]FDG uptake in pancreatic cystic neoplasms. Most of neuroendocrine neoplasms showed negligible [68Ga]Ga-DOTA-FAPI-04 uptake. Conclusion Compared with [18F]FDG PET/CT, [68Ga]Ga-DOTA-FAPI-04 PET/CT detected pancreatic tumors and associated metastases with a higher sensitivity and SUVmax value. However, false-positive uptake of [68Ga]Ga-DOTA-FAPI-04 in pancreatitis, cholangitis, some benign liver disease, and inflammatory LNs was also prominent.

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Section: Clinical Characteristics Of the Patientssupporting

confidence: 88%

Section: Clinical Characteristics Of the Patientssupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

[68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the Assessment of Pancreatic Tumors: A Comparison Study

Liu¹,

Shi²,

Xu³

et al. 2021

Preprint

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“…Recently, significant FAPI avidity was demonstrated in pancreatic cancer patients [ 13 ]. Furthermore, FAPI-PET/CT imaging influences tumor staging and oncological treatment when compared to contrast-enhanced CT scans [ 15 ]. Therefore, we hypothesized that FAPI-PET/CT imaging could improve GTV definition in locally recurrent pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

“…CAFs, especially in higher density are known to play an essential role in the development, progression, expansion and therapy resistance of PDACs [ 14 ]. Recently, Röhrich et al could demonstrate that FAPI-PET/CT imaging leads to significant changes in tumor staging compared to standard imaging [ 15 ]. In seven of the 19 analyzed patients, FAPI-PET/CT even influenced oncological treatment.…”

Section: Introductionmentioning

confidence: 99%

Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer

Liermann

Syed

Ben‐Josef

et al. 2021

Cancers

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(1) Background: A new radioactive positron emission tomography (PET) tracer uses inhibitors of fibroblast activation protein (FAPI) to visualize FAP-expressing cancer associated fibroblasts. Significant FAPI-uptake has recently been demonstrated in pancreatic cancer patients. Target volume delineation for radiation therapy still relies on often less precise conventional computed tomography (CT) imaging, especially in locally recurrent pancreatic cancer patients. The need for improvement in precise tumor detection and delineation led us to innovatively use the novel FAPI-PET/CT for radiation treatment planning. (2) Methods: Gross tumor volumes (GTVs) of seven locally recurrent pancreatic cancer cases were contoured by six radiation oncologists. In addition, FAPI-PET/CT was used to automatically delineate tumors. The interobserver variability in target definition was analyzed and FAPI-based automatic GTVs were compared to the manually defined GTVs. (3) Results: Target definition differed significantly between different radiation oncologists with mean dice similarity coefficients (DSCs) between 0.55 and 0.65. There was no significant difference between the volumes of automatic FAPI-GTVs based on the threshold of 2.0 and most of the manually contoured GTVs by radiation oncologists. (4) Conclusion: Due to its high tumor to background contrast, FAPI-PET/CT seems to be a superior imaging modality compared to the current gold standard contrast-enhanced CT in pancreatic cancer. For the first time, we demonstrate how FAPI-PET/CT could facilitate target definition and increases consistency in radiation oncology in pancreatic cancer.

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⁶⁸ Ga‐FAPI, a Twin Tracer for ¹⁸ F‐FDG in the Era of Evolving PET Imaging

Manafi‐Farid

Divband

Amini

et al. 2023

Radiology‐Nuclear Medicine Diagnostic Imaging

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Impact of ⁶⁸Ga-FAPI PET/CT Imaging on the Therapeutic Management of Primary and Recurrent Pancreatic Ductal Adenocarcinomas

Abstract: German Cancer Consortium (DKTK), partner site Heidelberg, Germany.

Cited by 139 publications

References 34 publications

[68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the Assessment of Pancreatic Tumors: A Comparison Study

[68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the Assessment of Pancreatic Tumors: A Comparison Study

Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer

⁶⁸ Ga‐FAPI, a Twin Tracer for ¹⁸ F‐FDG in the Era of Evolving PET Imaging

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Impact of 68Ga-FAPI PET/CT Imaging on the Therapeutic Management of Primary and Recurrent Pancreatic Ductal Adenocarcinomas

Abstract: German Cancer Consortium (DKTK), partner site Heidelberg, Germany.

Cited by 139 publications

References 34 publications

[68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the Assessment of Pancreatic Tumors: A Comparison Study

[68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the Assessment of Pancreatic Tumors: A Comparison Study

Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer

68 Ga‐FAPI, a Twin Tracer for 18 F‐FDG in the Era of Evolving PET Imaging

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Impact of ⁶⁸Ga-FAPI PET/CT Imaging on the Therapeutic Management of Primary and Recurrent Pancreatic Ductal Adenocarcinomas

⁶⁸ Ga‐FAPI, a Twin Tracer for ¹⁸ F‐FDG in the Era of Evolving PET Imaging