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Abbasi S, Khademi S, Montazerabadi A, Sahebkar A. FAP-Targeted Nanoparticle-based Imaging in Cancer: A Systematic Review. J Biomed Phys Eng 2024; 14:323-334. [PMID: 39175559 PMCID: PMC11336055 DOI: 10.31661/jbpe.v0i0.2404-1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/12/2024] [Indexed: 08/24/2024]
Abstract
Background Fibroblast Activation Protein (FAP)-targeted nanoparticles (NPs) are designed to accumulate in cancerous stroma. These NPs hold promise for imaging applications in cancer therapy. Objective This systematic review aimed to comprehensively explore the use of FAP-targeting NPs for cancer diagnosis through different imaging modalities. Material and Methods This systematic review followed the framework proposed by O'Malley and Arksey. Peer-reviewed studies were searched in the Scopus, Science Direct, PubMed, and Google Scholar databases. Eligible studies were selected, and data were extracted to investigate the FAP-targeting NPs in imaging. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was also utilized to present the results. Results Five studies met the specified inclusion criteria and were finally selected for analysis. The extracted data was classified into two categories: general and specific data. The general group indicated that most studies have been conducted in Mexico and have increased since 2022, and the specific group showed that colorectal cancer and Nude mice have received the most research attention. Furthermore, FAP-targeted NPs have demonstrated superior diagnostic imaging capabilities, even compared to specific methods for each cancer type. Also, they have been safe, with no toxicity. Conclusion FAP-targeted NPs using different ligands, such as Fibroblast Activation Protein Inhibitor (FAPI), can accurately detect tumors and metastases, and outperform specific cancer peptides like PSMA in cancer diagnosis. They are also non-toxic and do not cause radiation damage to tissues. Therefore, FAP-targeted NPs have the potential to serve as a viable alternative to FAP-targeted radionuclides for cancer diagnosis.
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Affiliation(s)
- Samaneh Abbasi
- Department of Medical Physics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Khademi
- Department of Radiology Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Montazerabadi
- Department of Medical Physics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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2
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Hou P, Zhong K, Guo W, Chen H, Li Y, Ke M, Lv J, Liu S, Zhong H, Fu Y, Lin J, Liu C, Gu Y, Qin J, Hong C, Wang X. The diagnostic value of [ 18F]FAPI-42 PET/CT for pulmonary artery masses: comparison with [ 18F]FDG PET/CT. Eur Radiol 2024:10.1007/s00330-024-10821-5. [PMID: 38834788 DOI: 10.1007/s00330-024-10821-5] [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: 11/02/2023] [Revised: 03/20/2024] [Accepted: 04/21/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES To investigate the potential utility of [18F]fibroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography (PET/CT) for evaluating pulmonary artery (PA) masses, and compare it with [18F]fluorodeoxyglucose (FDG) PET/CT. METHODS Participants with clinically suspected PA malignancy were prospectively enrolled and underwent dual-tracer PET/CT ([18F]FAPI-42 and [18F]FDG) imaging. Visual analysis and semi-quantitative parameters were compared between the two types of radiotracers. The tissue specimen underwent immunohistochemical staining to verify FAP expression in the tissue. RESULTS Thirty-three patients (18 males/15 females; mean age 53.1 ± 15.4 years) were enrolled. All 21 patients with malignant PA masses were FDG-positive (100%), whereas 20 out of 21 patients were FAPI-positive (95.2%). All 12 patients with benign PA masses were both negative in FDG and FAPI PET. The mean maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR) of FAPI and FDG in malignant PA masses were significantly higher than those of benign masses. Although there was no significant difference in SUVmax between FDG and FAPI in malignant PA masses (11.36 vs. 9.18, p = 0.175), the TBR (liver) and TBR (left ventricle) were more favorable for FAPI than for FDG (13.04 vs. 5.17, p < 0.001); (median: 7.75 vs. 2.75, p = 0.007). Immunohistochemical analysis (n = 16) validated that the level of FAP expression corresponded strongly to the uptake of FAPI in PET/CT scans (rs = 0.712, p = 0.002). For clinical management, FAPI PET found more metastatic lesions than FDG PET in 4 patients, with 2 patients upgrading and 1 patient changing treatment decisions. CONCLUSIONS FAPI PET/CT is feasible in the diagnosis of PA masses. Although not superior to FDG PET/CT, FAPI PET/CT showed better target-to-background contrast. CLINICAL RELEVANCE STATEMENT This study found that FAPI PET/CT is not superior to FDG PET/CT in diagnosing PA masses, but FAPI PET/CT displays better target-to-background contrast and more positive lesions, which may help improve disease management. KEY POINTS Pulmonary malignancies lack specificity in clinical manifestations, laboratory tests, and routine imaging examinations. FAPI PET/CT is not diagnostically better than FDG PET/CT but displays better target-to-background contrast and more positive lesions. Dual-tracer PET/CT ([18F]FAPI-42 and [18F]FDG) imaging improves clinical management of pulmonary artery masses.
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Affiliation(s)
- Peng Hou
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Kaixiang Zhong
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Wenliang Guo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, 510010, China
| | - Haiming Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, 510010, China
| | - Youcai Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Miao Ke
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Jie Lv
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Shaoyu Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Huizhen Zhong
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Yimin Fu
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Jielong Lin
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Chunli Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, 510010, China
| | - Yingying Gu
- Department of Respiratory Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, 510010, China
| | - Jilong Qin
- Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China
| | - Cheng Hong
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, 510010, China.
| | - Xinlu Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China.
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3
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Lanzafame H, Mavroeidi IA, Pabst KM, Desaulniers M, Ingenwerth M, Hirmas N, Kessler L, Nader M, Bartel T, Leyser S, Barbato F, Schuler M, Bauer S, Siveke JT, Herrmann K, Hamacher R, Fendler WP. 68Ga-Fibroblast Activation Protein Inhibitor PET/CT Improves Detection of Intermediate and Low-Grade Sarcomas and Identifies Candidates for Radiopharmaceutical Therapy. J Nucl Med 2024; 65:880-887. [PMID: 38724279 DOI: 10.2967/jnumed.123.267248] [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: 12/15/2023] [Revised: 03/15/2024] [Indexed: 06/05/2024] Open
Abstract
Fibroblast activation protein-α (FAP) is often highly expressed by sarcoma cells and by sarcoma-associated fibroblasts in the tumor microenvironment. This makes it a promising target for imaging and therapy. The level of FAP expression and the diagnostic value of 68Ga-FAP inhibitor (FAPI) PET for sarcoma subtypes are unknown. We assessed the diagnostic performance and accuracy of 68Ga-FAPI PET in various bone and soft-tissue sarcomas. Potential eligibility for FAP-targeted radiopharmaceutical therapy (FAP-RPT) was evaluated. Methods: This prospective observational trial enrolled 200 patients with bone and soft-tissue sarcoma who underwent 68Ga-FAPI PET/CT and 18F-FDG PET/CT (186/200, or 93%) for staging or restaging. The number of lesions detected and the uptake (SUVmax) of the primary tumor, lymph nodes, and visceral and bone metastases were analyzed. The Wilcoxon test was used for semiquantitative assessment. The association of 68Ga-FAPI uptake intensity, histopathologic grade, and FAP expression in sarcoma biopsy samples was analyzed using Spearman r correlation. The impact of 68Ga-FAPI PET on clinical management was investigated using questionnaires before and after PET/CT. Eligibility for FAP-RPT was defined by an SUVmax greater than 10 for all tumor regions. Results: 68Ga-FAPI uptake was heterogeneous among sarcoma subtypes. The 3 sarcoma entities with the highest uptake (mean SUVmax ± SD) were solitary fibrous tumor (24.7 ± 11.9), undifferentiated pleomorphic sarcoma (18.8 ± 13.1), and leiomyosarcoma (15.2 ± 10.2). Uptake of 68Ga-FAPI versus 18F-FDG was significantly higher in low-grade sarcomas (10.4 ± 8.5 vs. 7.0 ± 4.5, P = 0.01) and in potentially malignant intermediate or unpredictable sarcomas without a World Health Organization grade (not applicable [NA]; 22.3 ± 12.5 vs. 8.5 ± 10.0, P = 0.0004), including solitary fibrous tumor. The accuracy, as well as the detection rates, of 68Ga-FAPI was higher than that of 18F-FDG in low-grade sarcomas (accuracy, 92.2 vs. 80.0) and NA sarcomas (accuracy, 96.9 vs. 81.9). 68Ga-FAPI uptake and the histopathologic FAP expression score (n = 89) were moderately correlated (Spearman r = 0.43, P < 0.0002). Of 138 patients, 62 (45%) with metastatic sarcoma were eligible for FAP-RPT. Conclusion: In patients with low-grade and NA sarcomas, 68Ga-FAPI PET demonstrates uptake, detection rates, and accuracy superior to those of 18F-FDG PET. 68Ga-FAPI PET criteria identified eligibility for FAP-RPT in about half of sarcoma patients.
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Affiliation(s)
- Helena Lanzafame
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany;
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
| | - Ilektra A Mavroeidi
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
| | - Mélanie Desaulniers
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marc Ingenwerth
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Nader Hirmas
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Nader
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
| | - Timo Bartel
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
| | - Stephan Leyser
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
| | - Francesco Barbato
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
| | - Martin Schuler
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases West, Campus Essen, Essen, Germany; and
| | - Sebastian Bauer
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases West, Campus Essen, Essen, Germany; and
| | - Jens T Siveke
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases West, Campus Essen, Essen, Germany; and
- Bridge Institute of Experimental Tumor Therapy and Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Rainer Hamacher
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Consortium partner site Essen/Düsseldorf, DKFZ and University Hospital Essen, Essen, Germany
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Broski SM. Positron Emission Tomography/Computed Tomography Transformation of Oncology: Musculoskeletal Cancers. PET Clin 2024; 19:217-229. [PMID: 38184453 DOI: 10.1016/j.cpet.2023.12.008] [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] [Indexed: 01/08/2024]
Abstract
The past 25 years have seen significant growth in the role of positron emission tomography/computed tomography (PET/CT) in musculoskeletal oncology. Substantiative advances in technical capability and image quality have been paralleled by increasingly widespread clinical adoption and implementation. It is now recognized that PET/CT is useful in diagnosis, staging, prognostication, response assessment, and surveillance of bone and soft tissue sarcomas, often providing critical information in addition to conventional imaging assessment. As individualized, precision medicine continues to evolve for patients with sarcoma, PET/CT is uniquely positioned to offer additional insight into the biology and management of these tumors.
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Affiliation(s)
- Stephen M Broski
- Department of Radiology, Mayo Clinic, Mayo Building, 2nd Floor, 200 First Street SW, Rochester, MN 55905, USA.
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5
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Zhang Z, Tao J, Qiu J, Cao Z, Huang H, Xiao J, Zhang T. From basic research to clinical application: targeting fibroblast activation protein for cancer diagnosis and treatment. Cell Oncol (Dordr) 2024; 47:361-381. [PMID: 37726505 DOI: 10.1007/s13402-023-00872-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE This study aims to review the multifaceted roles of a membrane protein named Fibroblast Activation Protein (FAP) expressed in tumor tissue, including its molecular functionalities, regulatory mechanisms governing its expression, prognostic significance, and its crucial role in cancer diagnosis and treatment. METHODS Articles that have uncovered the regulatory role of FAP in tumor, as well as its potential utility within clinical realms, spanning diagnosis to therapeutic intervention has been screened for a comprehensive review. RESULTS Our review reveals that FAP plays a pivotal role in solid tumor progression by undertaking a multitude of enzymatic and nonenzymatic roles within the tumor stroma. The exclusive presence of FAP within tumor tissues highlights its potential as a diagnostic marker and therapeutic target. The review also emphasizes the prognostic significance of FAP in predicting tumor progression and patient outcomes. Furthermore, the emerging strategies involving FAPI inhibitor (FAPI) in cancer research and clinical trials for PET/CT diagnosis are discussed. And targeted therapy utilizing FAP including FAPI, chimeric antigen receptor (CAR) T cell therapy, tumor vaccine, antibody-drug conjugates, bispecific T-cell engagers, FAP cleavable prodrugs, and drug delivery system are also introduced. CONCLUSION FAP's intricate interactions with tumor cells and the tumor microenvironment make it a promising target for diagnosis and treatment. Promising strategies such as FAPI offer potential avenues for accurate tumor diagnosis, while multiple therapeutic strategies highlight the prospects of FAP targeting treatments which needs further clinical evaluation.
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Affiliation(s)
- Zeyu Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jinxin Tao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jiangdong Qiu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhe Cao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hua Huang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jianchun Xiao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Taiping Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Li Z, Qiu L, Xu T, Su D, Chen Y. 18 F-FDG PET/CT Versus 68 Ga-FAPI PET/CT in a Case of Isolated Nodal-Type Follicular Dendritic Cell Sarcoma. Clin Nucl Med 2024; 49:268-269. [PMID: 38048566 DOI: 10.1097/rlu.0000000000004986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
ABSTRACT Follicular dendritic cell sarcoma is a rare low-grade sarcoma originating from mesenchymal dendritic cells. We presented 18 F-FDG and 68 Ga-FAPI PET/CT findings in a 32-year-old woman with pathologically confirmed nodal-type follicular dendritic cell sarcoma. In this case, follicular dendritic cell sarcoma demonstrated lower uptake with FAPI than FDG.
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Affiliation(s)
- Zhuoyuan Li
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; and Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
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7
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Hamacher R, Pabst KM, Cheung PF, Heilig CE, Hüllein J, Liffers ST, Borchert S, Costa PF, Schaarschmidt BM, Kessler L, Miera MA, Droste M, Akbulut M, Falkenhorst J, Zarrad F, Kostbade K, Mavroeidi IA, Glimm H, Umutlu L, Schuler M, Hübschmann D, Bauer S, Fröhling S, Herrmann K, Siveke JT, Schildhaus HU, Fendler WP. Fibroblast Activation Protein α-Directed Imaging and Therapy of Solitary Fibrous Tumor. J Nucl Med 2024; 65:252-257. [PMID: 38176718 DOI: 10.2967/jnumed.123.266411] [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: 07/24/2023] [Revised: 11/07/2023] [Indexed: 01/06/2024] Open
Abstract
Fibroblast activation protein α (FAPα) is expressed at high levels in several types of tumors. Here, we report the expression pattern of FAPα in solitary fibrous tumor (SFT) and its potential use as a radiotheranostic target. Methods: We analyzed FAPα messenger RNA and protein expression in biopsy samples from SFT patients using immunohistochemistry and multiplexed immunofluorescence. Tracer uptake and detection efficacy were assessed in patients undergoing clinical 68Ga-FAPα inhibitor (FAPI)-46 PET,18F-FDG PET, and contrast-enhanced CT. 90Y-FAPI-46 radioligand therapy was offered to eligible patients with progressive SFT. Results: Among 813 patients and 126 tumor entities analyzed from the prospective observational MASTER program of the German Cancer Consortium, SFT (n = 34) had the highest median FAPα messenger RNA expression. Protein expression was confirmed in tumor biopsies from 29 of 38 SFT patients (76%) in an independent cohort. Most cases showed intermediate to high FAPα expression by immunohistochemistry (24/38 samples, 63%), which was located primarily on the tumor cell surface. Nineteen patients who underwent 68Ga-FAPI-46 PET imaging demonstrated significantly increased tumor uptake, with an SUVmax of 13.2 (interquartile range [IQR], 10.2), and an improved mean detection efficacy of 94.5% (SEM, 4.2%), as compared with 18F-FDG PET (SUVmax, 3.2 [IQR, 3.1]; detection efficacy, 77.3% [SEM, 5.5%]). Eleven patients received a total of 34 cycles (median, 3 cycles [IQR, 2 cycles]) of 90Y-FAPI-46 radioligand therapy, which resulted in disease control in 9 patients (82%). Median progression-free survival was 227 d (IQR, 220 d). Conclusion: FAPα is highly expressed by SFT and may serve as a target for imaging and therapy. Further studies are warranted to define the role of FAPα-directed theranostics in the care of SFT patients.
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Affiliation(s)
- Rainer Hamacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Kim M Pabst
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Phyllis F Cheung
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
| | - Christoph E Heilig
- Department of Translational Medical Oncology, National Center for Tumor Diseases, Heidelberg and German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Core Center Heidelberg, Heidelberg, Germany
| | - Jennifer Hüllein
- Computational Oncology, Molecular Precision Oncology Program, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
| | - Sven-Thorsten Liffers
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
| | - Sabrina Borchert
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Pedro Fragoso Costa
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Lukas Kessler
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Monika A Miera
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Margret Droste
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
| | - Merve Akbulut
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Johanna Falkenhorst
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Fadi Zarrad
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Karina Kostbade
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Ilektra A Mavroeidi
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Hanno Glimm
- Department for Translational Medical Oncology, National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center, Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Translational Medical Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium, Dresden, Germany; and
| | - Lale Umutlu
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Daniel Hübschmann
- German Cancer Consortium, Core Center Heidelberg, Heidelberg, Germany
- Computational Oncology, Molecular Precision Oncology Program, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine, Heidelberg, Germany
| | - Sebastian Bauer
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
| | - Stefan Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases, Heidelberg and German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Core Center Heidelberg, Heidelberg, Germany
| | - Ken Herrmann
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Jens T Siveke
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- German Cancer Consortium, Partner site University Hospital Essen, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
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8
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Guo C, Li L, Peng D, Zhang F, Huang Z. Pigmented villonodular synovitis detected by [ 68Ga]Ga-FAPI-04 PET/CT. Eur J Nucl Med Mol Imaging 2024; 51:928-929. [PMID: 37889300 DOI: 10.1007/s00259-023-06477-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Chunmei Guo
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, 646000, People's Republic of China
| | - Lingzhi Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People's Republic of China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Dengsai Peng
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, 646000, People's Republic of China
| | - Feiyu Zhang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, 646000, People's Republic of China
| | - Zhanwen Huang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, Sichuan, 646000, People's Republic of China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, 646000, People's Republic of China.
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9
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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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10
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Jiang S, Jiang M, Rao S, Liang J, Zhang R. 18 F-FDG PET/CT Versus 18 F-FAPI PET/CT in a Case of Recurrent Malignant Phyllodes Breast Tumor. Clin Nucl Med 2024; 49:e35-e37. [PMID: 37962169 DOI: 10.1097/rlu.0000000000004936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
ABSTRACT A 52-year-old woman with medical history of surgery for left malignant phyllodes breast tumor found a mass on the left chest 3 months ago. A suspicion of recurrent malignant phyllodes breast tumor was made. The patient was enrolled in the clinical trial of 18 F-FAPI PET/CT in recurrent sarcoma (no. NCT05485792). 18 F-FAPI PET/CT and 18 F-FDG PET/CT were performed, and the images demonstrated intense uptake in a huge mass in the left anterior chest wall. Then the patient underwent extended resection of left chest wall tumor. The tumor proved to be recurrent malignant phyllodes breast tumor pathologically.
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Affiliation(s)
| | - Ming Jiang
- Breast Surgery, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong, China
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11
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Shen Z, Wang R. Comparison of 18F-FDG PET/CT and 68Ga-FAPI in Spindle Cell Rhabdomyosarcoma. Diagnostics (Basel) 2023; 13:3006. [PMID: 37761371 PMCID: PMC10530021 DOI: 10.3390/diagnostics13183006] [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: 08/20/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
We report a rare case of spindle cell rhabdomyosarcoma. Sarcomas generally exhibit an abnormal increased FDG uptake on 18F-FDG PET/CT imaging, while spindle cell rhabdosarcomas exhibits a significantly increased lesion uptake on 68Ga FAPI PET/CT imaging compared to 18F-FDG. This case suggests that 68Ga-FAPI PET/CT has potential value in evaluating spindle cell rhabdomyosarcoma.
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Affiliation(s)
| | - Ruimin Wang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China;
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12
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Escudero-Castellanos A, Kurth J, Imlimthan S, Menéndez E, Pilatis E, Moon ES, Läppchen T, Rathke H, Schwarzenböck SM, Krause BJ, Rösch F, Rominger A, Gourni E. Translational assessment of a DATA-functionalized FAP inhibitor with facile 68Ga-labeling at room temperature. Eur J Nucl Med Mol Imaging 2023; 50:3202-3213. [PMID: 37284857 PMCID: PMC10541845 DOI: 10.1007/s00259-023-06285-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The present study aims at evaluating the preclinical and the clinical performance of [68Ga]Ga-DATA5m.SA.FAPi, which has the advantage to be labeled with gallium-68 at room temperature. METHODS [68Ga]Ga-DATA5m.SA.FAPi was assessed in vitro on FAP-expressing stromal cells, followed by biodistribution and in vivo imaging on prostate and glioblastoma xenografts. Moreover, the clinical assessment of [68Ga]Ga-DATA5m.SA.FAPi was conducted on six patients with prostate cancer, aiming on investigating, biodistribution, biokinetics, and determining tumor uptake. RESULTS [68Ga]Ga-DATA5m.SA.FAPi is quantitatively prepared in an instant kit-type version at room temperature. It demonstrated high stability in human serum, affinity for FAP in the low nanomolar range, and high internalization rate when associated with CAFs. Biodistribution and PET studies in prostate and glioblastoma xenografts revealed high and specific tumor uptake. Elimination of the radiotracer mainly occurred through the urinary tract. The clinical data are in accordance with the preclinical data concerning the organ receiving the highest absorbed dose (urinary bladder wall, heart wall, spleen, and kidneys). Different to the small-animal data, uptake of [68Ga]Ga-DATA5m.SA.FAPi in tumor lesions is rapid and stable and tumor-to-organ and tumor-to-blood uptake ratios are high. CONCLUSION The radiochemical, preclinical, and clinical data obtained in this study strongly support further development of [68Ga]Ga-DATA5m.SA.FAPi as a diagnostic tool for FAP imaging.
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Affiliation(s)
| | - Jens Kurth
- Department of Nuclear Medicine, Rostock University Medical Centre, Rostock, Germany
| | - Surachet Imlimthan
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elena Menéndez
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eirinaios Pilatis
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Euy Sung Moon
- Department of Chemistry-TRIGA site, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Tilman Läppchen
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hendrik Rathke
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Centre, Rostock, Germany
| | - Frank Rösch
- Department of Chemistry-TRIGA site, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eleni Gourni
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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13
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Beer P, Pauli C, Haberecker M, Grest P, Beebe E, Fuchs D, Markkanen E, Krudewig C, Nolff MC. Cross-species evaluation of fibroblast activation protein alpha as potential imaging target for soft tissue sarcoma: a comparative immunohistochemical study in humans, dogs, and cats. Front Oncol 2023; 13:1210004. [PMID: 37727209 PMCID: PMC10505752 DOI: 10.3389/fonc.2023.1210004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Complete surgical tumor resection is paramount in the management of soft tissue sarcoma (STS) in humans, dogs, and cats alike. Near-infrared targeted tracers for fluorescence-guided surgery (FGS) could facilitate intraoperative visualization of the tumor and improve resection accuracy. Target identification is complicated in STS due to the rarity and heterogeneity of the disease. This study aims to validate the expression of fibroblast activation protein alpha (FAP) in selected human, canine, and feline STS subtypes to assess the value of FAP as a target for FGS and to validate companion animals as a translational model. Methods Formalin-fixed and paraffin-embedded tissue samples from 53 canine STSs (perivascular wall tumor (PWT), canine fibrosarcoma (cFS), and STS not further specified (NOS)), 24 feline fibrosarcomas, and 39 human STSs (myxofibrosarcoma, undifferentiated pleomorphic sarcoma, dermatofibrosarcoma protuberans, and malignant peripheral nerve sheath tumor) as well as six canine and seven feline healthy controls and 10 inflamed tissue samples were immunohistochemically stained for their FAP expression. FAP labeling in tumor, peritumoral, healthy skin, and inflamed tissue samples was quantified using a visually assessed semiquantitative expression score and digital image analysis. Target selection criteria (TASC) scoring was subsequently performed as previously described. Results Eighty-five percent (85%) of human (33/39), 76% of canine (40/53), and 92% of feline (22/24) STSs showed FAP positivity in over 10% of the tumor cells. A high expression was determined in 53% canine (28/53), 67% feline (16/24), and 44% human STSs (17/39). The average FAP-labeled area of canine, feline, and human STSs was 31%, 33%, and 42%, respectively (p > 0.8990). The FAP-positive tumor area was larger in STS compared to healthy and peritumoral tissue samples (p < 0.0001). TASC scores were above 18 for all feline and human STS subtypes and canine PWTs but not for canine STS NOS and cFS. Conclusion This study represents the first cross-species target evaluation of FAP for STS. Our results demonstrate that FAP expression is increased in various STS subtypes compared to non-cancerous tissues across species, thereby validating dogs and cats as suitable animal models. Based on a TASC score, FAP could be considered a target for FGS.
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Affiliation(s)
- Patricia Beer
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Chantal Pauli
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Martina Haberecker
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - Paula Grest
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Erin Beebe
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Daniel Fuchs
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Enni Markkanen
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Christiane Krudewig
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Mirja Christine Nolff
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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14
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Abstract
Computed tomography (CT), MR imaging, and PET with fluorodeoxyglucose F18/CT are commonly used for radiation therapy planning; however, issues including precise nodal staging on CT or false positive results on PET/CT limit their usability. Clinical trials using fibroblast activation protein ligands for additional imaging have provided promising results regarding staging and target volume delineation-particularly suitable for sarcoma, some gastrointestinal tumors, head and neck tumors, and lung and pancreatic cancer. Although further prospective trials are necessary to identify clinical settings for its application in radiation oncology, fibroblast activation protein inhibitor PET/CT indisputably represents an excellent opportunity for assisting radiotherapy planning.
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Affiliation(s)
- Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany; Department of Radiation Oncology, Barmherzige Brueder Hospital Regensburgh, Regensburg, Germany.
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15
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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 PMCID: PMC10297281 DOI: 10.3390/diagnostics13122018] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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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16
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Crane JN, Graham DS, Mona CE, Nelson SD, Samiei A, Dawson DW, Dry SM, Masri MG, Crompton JG, Benz MR, Czernin J, Eilber FC, Graeber TG, Calais J, Federman NC. Fibroblast Activation Protein Expression in Sarcomas. Sarcoma 2023; 2023:2480493. [PMID: 37333052 PMCID: PMC10275689 DOI: 10.1155/2023/2480493] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives Fibroblast activation protein alpha (FAP) is highly expressed by cancer-associated fibroblasts in multiple epithelial cancers. The aim of this study was to characterize FAP expression in sarcomas to explore its potential utility as a diagnostic and therapeutic target and prognostic biomarker in sarcomas. Methods Available tissue samples from patients with bone or soft tissue tumors were identified at the University of California, Los Angeles. FAP expression was evaluated via immunohistochemistry (IHC) in tumor samples (n = 63), adjacent normal tissues (n = 30), and positive controls (n = 2) using semiquantitative systems for intensity (0 = negative; 1 = weak; 2 = moderate; and 3 = strong) and density (none, <25%, 25-75%; >75%) in stromal and tumor/nonstromal cells and using a qualitative overall score (not detected, low, medium, and high). Additionally, RNA sequencing data in publicly available databases were utilized to compare FAP expression in samples (n = 10,626) from various cancer types and evaluate the association between FAP expression and overall survival (OS) in sarcoma (n = 168). Results The majority of tumor samples had FAP IHC intensity scores ≥2 and density scores ≥25% for stromal cells (77.7%) and tumor cells (50.7%). All desmoid fibromatosis, myxofibrosarcoma, solitary fibrous tumor, and undifferentiated pleomorphic sarcoma samples had medium or high FAP overall scores. Sarcomas were among cancer types with the highest mean FAP expression by RNA sequencing. There was no significant difference in OS in patients with sarcoma with low versus high FAP expression. Conclusion The majority of the sarcoma samples showed FAP expression by both stromal and tumor/nonstromal cells. Further investigation of FAP as a potential diagnostic and therapeutic target in sarcomas is warranted.
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Affiliation(s)
- Jacquelyn N. Crane
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Stanford University School of Medicine, 1000 Welch Rd, Suite 300, Palo Alto, CA 94304, USA
| | - Danielle S. Graham
- University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA
| | - Christine E. Mona
- University of California Los Angeles, Department of Molecular and Medical Pharmacology, Los Angeles, CA, USA
| | - Scott D. Nelson
- University of California Los Angeles, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Alireza Samiei
- University of California Los Angeles, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA
| | - David W. Dawson
- University of California Los Angeles, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Sarah M. Dry
- University of California Los Angeles, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Marwan G. Masri
- University of California Los Angeles, Department of Molecular and Medical Pharmacology, Los Angeles, CA, USA
| | - Joseph G. Crompton
- University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Matthias R. Benz
- University of California Los Angeles, Department of Molecular and Medical Pharmacology, Los Angeles, CA, USA
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Johannes Czernin
- University of California Los Angeles, Department of Molecular and Medical Pharmacology, Los Angeles, CA, USA
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Fritz C. Eilber
- University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA
- University of California Los Angeles, Department of Molecular and Medical Pharmacology, Los Angeles, CA, USA
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Thomas G. Graeber
- University of California Los Angeles, Department of Molecular and Medical Pharmacology, Los Angeles, CA, USA
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jeremie Calais
- University of California Los Angeles, Department of Molecular and Medical Pharmacology, Los Angeles, CA, USA
| | - Noah C. Federman
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
- University of California Los Angeles, Department of Pediatrics, Los Angeles, CA, USA
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17
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Oh C, Bishop MW, Cho SY, Im HJ, Shulkin BL. 18F-FDG PET/CT in the Management of Osteosarcoma. J Nucl Med 2023:jnumed.123.265592. [PMID: 37201958 DOI: 10.2967/jnumed.123.265592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/26/2023] [Indexed: 05/20/2023] Open
Abstract
Osteosarcoma is the most common type of primary malignant bone tumor. 18F-FDG PET/CT is useful for staging, detecting recurrence, monitoring response to neoadjuvant chemotherapy, and predicting prognosis. Here, we review the clinical aspects of osteosarcoma management and assess the role of 18F-FDG PET/CT, in particular with regard to pediatric and young adult patients.
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Affiliation(s)
- Chiwoo Oh
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Michael W Bishop
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Steve Y Cho
- Nuclear Medicine and Molecular Imaging Section, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hyung-Jun Im
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea;
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea; and
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
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18
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Abstract
Advances in histopathologic and molecular genetic subtyping of sarcoma will potentially allow identification of novel diagnostic and therapeutic targets for specific subtypes, but a "pan-sarcoma" target is needed. This article provides an overview on expression of one potential candidate, fibroblast activation protein alpha in soft tissue and bone sarcoma, and the resulting application of 68Ga-FAPI as novel imaging probes in these rare tumor entities. Current preclinical and clinical data on 68Ga-FAPI-PET/CT in sarcomas are summarized. 68Ga-FAPI-PET-CT potentially offers important complementary information to be used in diagnostic work-up, assessment of therapy response, and prognostication of soft tissue and bone sarcomas.
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Affiliation(s)
- Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, and German Cancer Research Center (DKFZ), Essen, Germany.
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19
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Liu S, Feng Z, Xu X, Ge H, Ju X, Wu X, Song S. Head-to-head comparison of [ 18F]-FDG and [ 68 Ga]-DOTA-FAPI-04 PET/CT for radiological evaluation of platinum-sensitive recurrent ovarian cancer. Eur J Nucl Med Mol Imaging 2023; 50:1521-1531. [PMID: 36624168 DOI: 10.1007/s00259-022-06096-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Precise radiological evaluation is pivotal for the management of platinum-sensitive recurrent ovarian cancer. We aimed to compare the value of [68 Ga]-FAPI and [18F]-FDG PET/CT for the detection of relapsed lesions. METHODS Twenty-nine suspected platinum-sensitive recurrent ovarian cancers were enrolled from January 2022 to July 2022. [18F]-FDG and [68 Ga]-FAPI PET/CT were obtained within 1 week for radiological evaluation. Treatment strategies, visual scores, and Eisenkop scores were recorded. A paired T test was used to compare differences between two scans. Sensitivity, specificity, PPV, NPV, and accuracy were also evaluated. RESULTS Up to 22 (75.86%) patients displayed inconsistency between two scans. Among them, 4 patients with negative [18F]-FDG imaging had measurable lesions in [68 Ga]-FAPI scans. The treatment strategies were changed in 5 patients (17.24%) due to discrepancies. Finally, 15 (35.7%) patients underwent surgeries, and 14 patients achieved complete resection, except for 1 patient who had milliarc residual disease. TBR, but not SUVmax, of [68 Ga]-FAPI was significantly higher than that of [18F]-FDG in recurrent lesions. Compared with [18F]-FDG, [68 Ga]-FAPI PET presented higher sensitivity and accuracy for lesion detection (96.30% vs. 49.07% and 97.40% vs. 63.87%, respectively). Additionally, [68 Ga]-FAPI PET showed a much higher visual score than [18F]-FDG PET (41 vs. 4), especially for peritoneal metastasis (35 vs. 1). [68 Ga]-FAPI PET also presented a larger tumor burden than [18F]-FDG according to the Eisenkop score (27 vs. 16, p = 0.025). CONCLUSIONS [68 Ga]-FAPI was superior to [18F]-FDG PET/CT for the detection of recurrent lesions, which is pivotal for the individualized management of platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- Shuai Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, No. 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Zheng Feng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, No. 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Center for Biomedical Imaging, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Huijuan Ge
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xingzhu Ju
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Xiaohua Wu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, No. 270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
- Center for Biomedical Imaging, Fudan University, Shanghai, China.
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.
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20
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Shu Q, Wang Y, Deng M, Chen X, Liu M, Cai L. Benign lesions with 68Ga-FAPI uptake: a retrospective study. Br J Radiol 2023; 96:20220994. [PMID: 36715164 PMCID: PMC10078866 DOI: 10.1259/bjr.20220994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/15/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Although FAPI, as a pan-tumor tracer, shows high expression in the malignancy imaging, FAPI uptake is also seen in some benign lesions. The purpose of this study was to retrospectively analyze the characteristics of benign lesions with FAPI uptake on 68Ga-FAPI PET/CT imaging. METHODS The electronic medical and imaging records of patients undergoing 68Ga-FAPI PET/CT imaging in the Department of Nuclear Medicine of our hospital from March 2020 to March 2022 were retrospectively analyzed. Patients with benign lesions confirmed by histopathological analysis or long-term follow-up of FAPI-positive lesions were included in the study. RESULTS A total of 44 patients (i.e., 44 benign lesions) were included in this study, including 14 women and 30 men, ranging in age from 19 to 74 years. Benign lesions involved eight systems, including liver (n = 3), tail of pancreas (n = 3), stomach (n = 3), esophagus (n = 1), lung (n = 14), and mediastinum (n = 2), sinuses (n = 1), brain (n = 2), lymph nodes (n = 5), kidneys (n = 4), bones (n = 2), muscles (n = 1), thyroid (n = 1), parathyroid gland (n = 1), and breast (n = 1). The mean SUVmax (p = 0.471) and mean TBR (p = 0.830) of benign lesions in the eight systems were not significantly different. CONCLUSION Our studies have shown that in addition to malignant tumors, certain benign lesions also show uptake of FAPI, and it is necessary for doctors to distinguish these benign lesions from true malignant tumors. ADVANCES IN KNOWLEDGE Benign lesions may also show FAPI expression, which may make the differential diagnosis of benign and malignant lesions difficult and should be alerted by physicians.
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21
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Hamacher R, Lanzafame H, Mavroeidi IA, Pabst KM, Kessler L, Cheung PF, Bauer S, Herrmann K, Schildhaus HU, Siveke JT, Fendler WP. Fibroblast Activation Protein Inhibitor Theranostics. PET Clin 2023:S1556-8598(23)00021-4. [PMID: 36997366 DOI: 10.1016/j.cpet.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
The theranostic use of fibroblast activation protein inhibitors (FAPIs) is a novel approach in oncology. Sarcomas are a heterogenous group of rare malignant tumors. Prognosis remains poor in advanced/metastatic disease due to limited therapeutic options. Sarcoma frequently demonstrate high expression of fibroblast activation protein alpha on the tumor cells themselves, in contrast to other solid tumors, where it is mainly expressed on cancer-associated fibroblasts. Consequently, high in vivo uptake of FAPI in PET is observed in sarcoma. Moreover, retrospective case reports and series demonstrated feasibility of FAPI radioligand therapy with signs of tumor response.
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22
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Dong Y, Zhou H, Alhaskawi A, Wang Z, Lai J, Yao C, Liu Z, Hasan Abdullah Ezzi S, Goutham Kota V, Hasan Abdulla Hasan Abdulla M, Lu H. The Superiority of Fibroblast Activation Protein Inhibitor (FAPI) PET/CT Versus FDG PET/CT in the Diagnosis of Various Malignancies. Cancers (Basel) 2023; 15:cancers15041193. [PMID: 36831535 PMCID: PMC9954090 DOI: 10.3390/cancers15041193] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Cancer represents a major cause of death worldwide and is characterized by the uncontrolled proliferation of abnormal cells that escape immune regulation. It is now understood that cancer-associated fibroblasts (CAFs), which express specific fibroblast activation protein (FAP), are critical participants in tumor development and metastasis. Researchers have developed various FAP-targeted probes for imaging of different tumors from antibodies to boronic acid-based inhibitor molecules and determined that quinoline-based FAP inhibitors (FAPIs) are the most appropriate candidate as the radiopharmaceutical for FAPI PET/CT imaging. When applied clinically, FAPI PET/CT yielded satisfactory results. Over the past few years, the utility and effectiveness of tumor detection and staging of FAPI PET/CT have been compared with FDG PET/CT in various aspects, including standardized uptake values (SUVs), rate of absorbance and clearance. This review summarizes the development and clinical application of FAPI PET/CT, emphasizing the diagnosis and management of various tumor types and the future prospects of FAPI imaging.
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Affiliation(s)
- Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
| | - Zewei Wang
- School of Medicine, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
| | - Jingtian Lai
- School of Medicine, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
| | - Chengjun Yao
- School of Medicine, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
| | - Zhenfeng Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
| | - Sohaib Hasan Abdullah Ezzi
- Department of Orthopaedics, Third Xiangya Hospital of Central South University, #138 Tongzipo Road, Changsha 410013, China
| | - Vishnu Goutham Kota
- School of Medicine, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
| | | | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
- Correspondence: ; Tel.: +86-0571-87236121
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23
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Mori Y, Dendl K, Cardinale J, Kratochwil C, Giesel FL, Haberkorn U. FAPI PET: Fibroblast Activation Protein Inhibitor Use in Oncologic and Nononcologic Disease. Radiology 2023; 306:e220749. [PMID: 36594838 DOI: 10.1148/radiol.220749] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Gallium 68 (68Ga)-labeled fibroblast activation protein (FAP) inhibitor (FAPI) PET is based on the molecular targeting of the FAP, which is known to be highly expressed in the major cell population in tumor stroma, termed cancer-associated fibroblasts. Among many FAP-targeted radiopharmaceuticals developed so far, 68Ga-FAPI exhibits rapid tracer accumulation in target lesions and low background signal, which results in excellent imaging features. FAPI PET can be integrated in the clinical workflow and enables the detection of small primary or metastatic lesions, especially in the brain, liver, pancreas, and gastrointestinal tract due to the low tracer accumulation in these organs. Moreover, the DOTA (1,4,7,10-tetraazacylclododecane-1,4,7,10-tetrayl tetraacetic acid) chelator in the molecular structure allows coupling of the FAPI molecules with therapeutic emitters such as yttrium 90 for theranostic applications. This review provides an overview of the state of the art in FAP imaging, summarizes the current knowledge of relevant cancer biology, and highlights the latest findings in the clinical use of 68Ga-FAPI PET and other current FAPI tracers. Published under a CC BY 4.0 license.
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Affiliation(s)
- Yuriko Mori
- From the Department of Nuclear Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany (Y.M., K.D., J.C., F.L.G.); Department of Nuclear Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (K.D., J.C., C.K., F.L.G., U.H.); and Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (F.L.G., U.H.)
| | - Katharina Dendl
- From the Department of Nuclear Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany (Y.M., K.D., J.C., F.L.G.); Department of Nuclear Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (K.D., J.C., C.K., F.L.G., U.H.); and Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (F.L.G., U.H.)
| | - Jens Cardinale
- From the Department of Nuclear Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany (Y.M., K.D., J.C., F.L.G.); Department of Nuclear Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (K.D., J.C., C.K., F.L.G., U.H.); and Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (F.L.G., U.H.)
| | - Clemens Kratochwil
- From the Department of Nuclear Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany (Y.M., K.D., J.C., F.L.G.); Department of Nuclear Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (K.D., J.C., C.K., F.L.G., U.H.); and Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (F.L.G., U.H.)
| | - Frederik L Giesel
- From the Department of Nuclear Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany (Y.M., K.D., J.C., F.L.G.); Department of Nuclear Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (K.D., J.C., C.K., F.L.G., U.H.); and Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (F.L.G., U.H.)
| | - Uwe Haberkorn
- From the Department of Nuclear Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany (Y.M., K.D., J.C., F.L.G.); Department of Nuclear Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (K.D., J.C., C.K., F.L.G., U.H.); and Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (F.L.G., U.H.)
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24
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Zana A, Galbiati A, Gilardoni E, Bocci M, Millul J, Sturm T, Stucchi R, Elsayed A, Nadal L, Cirillo M, Roll W, Stegger L, Asmus I, Backhaus P, Schäfers M, Neri D, Cazzamalli S. Fibroblast Activation Protein Triggers Release of Drug Payload from Non-internalizing Small Molecule Drug Conjugates in Solid Tumors. Clin Cancer Res 2022; 28:5440-5454. [PMID: 36215129 DOI: 10.1158/1078-0432.ccr-22-1788] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/08/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Small molecule drug conjugates (SMDC) are modular anticancer prodrugs that include a tumor-targeting small organic ligand, a cleavable linker, and a potent cytotoxic agent. Most of the SMDC products that have been developed for clinical applications target internalizing tumor-associated antigens on the surface of tumor cells. We have recently described a novel non-internalizing small organic ligand (named OncoFAP) of fibroblast activation protein (FAP), a tumor-associated antigen highly expressed in the stroma of most solid human malignancies. EXPERIMENTAL DESIGN In this article, we describe a new series of OncoFAP-Drug derivatives based on monomethyl auristatin E (MMAE; a potent cytotoxic tubulin poison) and dipeptide linkers that are selectively cleaved by FAP in the tumor microenvironment. RESULTS The tumor-targeting potential of OncoFAP was confirmed in patients with cancer using nuclear medicine procedures. We used mass spectrometry methodologies to quantify the amount of prodrug delivered to tumors and normal organs, as well as the efficiency of the drug release process. Linkers previously exploited for anticancer drug conjugates were used as benchmark. We identified OncoFAP-Gly-Pro-MMAE as the best performing SMDC, which has now been prioritized for further clinical development. OncoFAP-Gly-Pro-MMAE selectively delivered more than 10% injected dose per gram of MMAE to FAP-positive tumors, with a tumor-to-kidney ratio of 16:1 at 24 hours post-injection. CONCLUSIONS The FAP-specific drug conjugates described in this article promise to be efficacious for the targeting of human malignancies. The extracellular release of potent anticancer payloads mediates durable complete remission in difficult-to-treat animal models of cancer.
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Affiliation(s)
- Aureliano Zana
- R&D Department, Philochem AG, Otelfingen, Zurich, Switzerland
| | - Andrea Galbiati
- R&D Department, Philochem AG, Otelfingen, Zurich, Switzerland
| | | | - Matilde Bocci
- R&D Department, Philochem AG, Otelfingen, Zurich, Switzerland
| | - Jacopo Millul
- R&D Department, Philochem AG, Otelfingen, Zurich, Switzerland
| | - Theo Sturm
- R&D Department, Philochem AG, Otelfingen, Zurich, Switzerland
| | | | - Abdullah Elsayed
- R&D Department, Philochem AG, Otelfingen, Zurich, Switzerland.,Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zürich, Switzerland
| | - Lisa Nadal
- R&D Department, Philochem AG, Otelfingen, Zurich, Switzerland
| | - Martina Cirillo
- Department of Chemistry "G. Ciamician," University of Bologna, Bologna, Italy
| | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Inga Asmus
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Philipp Backhaus
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Dario Neri
- R&D Department, Philochem AG, Otelfingen, Zurich, Switzerland.,Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zürich, Switzerland.,Philogen S.p.A., Siena, Italy
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25
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Zhang L, Liu Z, Jiang S, He Q, Zhang R. 68 Ga-FAPI Versus 18 F-FDG PET/CT in Recurrent Undifferentiated Pleomorphic Sarcoma of Colon Mesentery. Clin Nucl Med 2022; 47:e651-e653. [PMID: 35605050 DOI: 10.1097/rlu.0000000000004275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 56-year-old woman presented with primary undifferentiated pleomorphic sarcoma of colon mesentery underwent complete surgical resection approximately 7 months ago. Abdominal contrast-enhanced CT showed a new mass in the descending colon, suggesting a high probability of tumor recurrence. Under a clinical trial, the patient underwent 68 Ga-FAPI and 18 F-FDG PET/CT to detect whether there are additional recurrent lesions. Compared with 18 F-FDG PET/CT, the recurrent undifferentiated pleomorphic sarcoma of colon mesentery, peritoneum, pelvic lymph node, and lung metastases showed higher uptake in 68 Ga-FAPI PET/CT. This case showed that 68 Ga-FAPI might be a promising radiopharmaceutical in the evaluation of undifferentiated pleomorphic sarcoma.
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Affiliation(s)
- Linqi Zhang
- From the Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University
| | - Zhidong Liu
- From the Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University
| | - Shuqin Jiang
- From the Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University
| | - Qiao He
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rusen Zhang
- From the Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University
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26
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Zboralski D, Hoehne A, Bredenbeck A, Schumann A, Nguyen M, Schneider E, Ungewiss J, Paschke M, Haase C, von Hacht JL, Kwan T, Lin KK, Lenore J, Harding TC, Xiao J, Simmons AD, Mohan AM, Beindorff N, Reineke U, Smerling C, Osterkamp F. Preclinical evaluation of FAP-2286 for fibroblast activation protein targeted radionuclide imaging and therapy. Eur J Nucl Med Mol Imaging 2022; 49:3651-3667. [PMID: 35608703 PMCID: PMC9399058 DOI: 10.1007/s00259-022-05842-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/10/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE Fibroblast activation protein (FAP) is a membrane-bound protease that has limited expression in normal adult tissues but is highly expressed in the tumor microenvironment of many solid cancers. FAP-2286 is a FAP-binding peptide coupled to a radionuclide chelator that is currently being investigated in patients as an imaging and therapeutic agent. The potency, selectivity, and efficacy of FAP-2286 were evaluated in preclinical studies. METHODS FAP expression analysis was performed by immunohistochemistry and autoradiography on primary human cancer specimens. FAP-2286 was assessed in biochemical and cellular assays and in in vivo imaging and efficacy studies, and was further evaluated against FAPI-46, a small molecule-based FAP-targeting agent. RESULTS Immunohistochemistry confirmed elevated levels of FAP expression in multiple tumor types including pancreatic, breast, and sarcoma, which correlated with FAP binding by FAP-2286 autoradiography. FAP-2286 and its metal complexes demonstrated high affinity to FAP recombinant protein and cell surface FAP expressed on fibroblasts. Biodistribution studies in mice showed rapid and persistent uptake of 68Ga-FAP-2286, 111In-FAP-2286, and 177Lu-FAP-2286 in FAP-positive tumors, with renal clearance and minimal uptake in normal tissues. 177Lu-FAP-2286 exhibited antitumor activity in FAP-expressing HEK293 tumors and sarcoma patient-derived xenografts, with no significant weight loss. In addition, FAP-2286 maintained longer tumor retention and suppression in comparison to FAPI-46. CONCLUSION In preclinical models, radiolabeled FAP-2286 demonstrated high tumor uptake and retention, as well as potent efficacy in FAP-positive tumors. These results support clinical development of 68Ga-FAP-2286 for imaging and 177Lu-FAP-2286 for therapeutic use in a broad spectrum of FAP-positive tumors.
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Affiliation(s)
- Dirk Zboralski
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany.
| | - Aileen Hoehne
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
| | - Anne Bredenbeck
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
| | - Anne Schumann
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
| | | | | | - Jan Ungewiss
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
| | - Matthias Paschke
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
| | - Christian Haase
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
| | - Jan L von Hacht
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
| | | | | | | | | | - Jim Xiao
- Clovis Oncology, Inc, Boulder, CO, USA
| | | | - Ajay-Mohan Mohan
- Berlin Experimental Radionuclide Imaging Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nicola Beindorff
- Berlin Experimental Radionuclide Imaging Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Reineke
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
| | | | - Frank Osterkamp
- 3B Pharmaceuticals GmbH, Magnusstraße 11, 12489, Berlin, Germany
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27
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Dong A, Zhang Z, Yang Q, Cheng C, Zuo C. 68 Ga-FAPI-04 Versus 18 F-FDG PET/CT in a Case With Intimal Sarcoma of the Pulmonary Artery. Clin Nucl Med 2022; 47:748-750. [PMID: 35353737 DOI: 10.1097/rlu.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Intimal sarcoma of the pulmonary artery is a rare entity, mimicking acute or chronic pulmonary thromboembolism. We describe 68 Ga-FAPI-04 and 18 F-FDG PET/CT findings in a case with intimal sarcoma of the pulmonary artery. The intrapulmonary artery tumor showed inhomogeneously increased FDG and FAPI uptake. Compared with FDG PET/CT, FAPI PET/CT more clearly delineated the tumor partially because of a very low background FAPI activity in the walls of the main pulmonary artery and right ventricle, which showed diffuse FDG uptake.
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Affiliation(s)
- Aisheng Dong
- From the Department of Nuclear Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
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28
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Kou Y, Jiang X, Yao Y, Shen J, Jiang X, Chen S, Lu H, Wang X, Zhao M, Xiao D, Shen T, Zhang W, Cheng Z. Physiological tracer distribution and benign lesion incidental uptake of Al18F-NOTA-FAPI-04 on PET/CT imaging. Nucl Med Commun 2022; 43:847-854. [PMID: 35506283 DOI: 10.1097/mnm.0000000000001563] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically investigate the physiological distribution and benign lesion incidental uptake of Al18F-NOTA-FAPI-04 (18F-FAPI) in cancer patients to establish the normal uptake range in relevant organs and lesions. METHODS Twenty patients who underwent 18F-FAPI PET/CT imaging were retrospectively assessed. Organ and benign lesion tracer uptake was quantified based on standardized uptake values (SUVmax and SUVmean). We compared the variation in tracer uptake in certain organs between men and women, analyzed the possible reasons for diffuse uptake in the thyroid, and assessed tracer uptake variations in the uterus in different menstrual cycle phases. Incidental tracer uptake in benign lesions was also assessed. RESULTS Physiological 18F-FAPI uptake was observed in the urinary tract, biliary tract system, submandibular glands, pancreas, thyroid, uterus, intestine, prostate gland, parotid gland, myocardium, kidney cortex, and muscles, but not the brain, lungs, liver, spleen, colon, and breasts. The SUVmean for each organ was similar for women and men (all P > 0.05). Diffuse tracer uptake in the thyroid was caused by normal thyroid or thyroiditis; there were no statistically significant differences between them (SUVmax: t = -1.3, P = 0.25; SUVmean: t = -1.1, P = 0.31). There was a significant difference for uterus uptake among different menstrual cycle phases (SUVmax: F = 5.08, P = 0.04; SUVmean: F = 5.19, P = 0.04). Incidental benign lesion tracer uptake was observed in patients with esophagitis, thyroiditis, arthritis, fractures, and uterine fibroids. CONCLUSION This study provides a reference range for 18F-FAPI uptake in relevant organs and benign lesions. Benign lesion 18F-FAPI uptake may reduce 18F-FAPI PET/CT specificity.
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Affiliation(s)
- Ying Kou
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Xuemei Jiang
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Yutang Yao
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Jiaqi Shen
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Xiao Jiang
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
- Institute of Isotope, China Institute of Atomic Energy, Beijing, China
| | - Shirong Chen
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Hao Lu
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Xiaoxiong Wang
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Meng Zhao
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Dingqiong Xiao
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Taipeng Shen
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Wei Zhang
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Zhuzhong Cheng
- The PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
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Roustaei H, Kiamanesh Z, Askari E, Sadeghi R, Aryana K, Treglia G. Could Fibroblast Activation Protein (FAP)-Specific Radioligands Be Considered as Pan-Tumor Agents? CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3948873. [PMID: 35280710 PMCID: PMC8888077 DOI: 10.1155/2022/3948873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/10/2021] [Accepted: 01/29/2022] [Indexed: 02/07/2023]
Abstract
Background Cancer-associated fibroblasts (CAFs) can strongly modulate the response to therapy of malignant tumor cells, facilitating their continuous proliferation and invading behaviors. In this context, several efforts were made in identifying the fibroblast activation protein (FAP) as a CAF recognizer and in designing FAP-specific PET radiotracers (as 68Ga-FAPI) along with FAP-specific therapeutic radioligands. Herein, we review different clinical studies using the various FAP-specific radioligands as novel theranostic agents in a wide range of oncologic and nononcologic indications. Methods A comprehensive systematic search was conducted on the PubMed and Scopus databases to find relevant published articles concerning the FAP-specific PET imaging as well as the FAP-specific radionuclide therapy in patients with oncologic and nononcologic indications. The enrolled studies were dichotomized into oncologic and nononcologic categories, and the required data were extracted by precisely reviewing the whole text of each eligible study. A meta-analysis was also performed comparing the detection rates of 68Ga-FAPI vs. 18F-FDG PET/CT using odds ratio (OR) and risk difference as outcome measures. Results Of the initial 364 relevant papers, 49 eligible articles (1479 patients) and 55 case reports were enrolled in our systematic review. These studies observed high radiolabeled FAPI avidity as early as 10 minutes after administration in primary sites of various malignant tumors. Based on the meta-analysis which was done on the reported detection rates of the 68Ga-FAPI and 18F-FDG PET/CT scans, the highest OR belonged to the primary lesion detection rate of gastrointestinal tumors (OR = 32.079, 95% CI: 4.001-257.212; p = 0.001) with low heterogeneity (I2 = 0%). The corresponding value of the nodal metastases belonged to hepatobiliary tumors (OR = 11.609, 95% CI: 1.888-71.365; p = 0.008) with low heterogeneity (I2 = 0%). For distant metastases, the highest estimated OR belonged to nasopharyngeal carcinomas (OR = 77.451, 95% CI: 7.323-819.201; p < 0.001) with low heterogeneity (I2 = 0%). Conclusions The outperformance of 68Ga-FAPI PET/CT over 18F-FDG PET/CT in identifying certain primary tumors as well as in detecting their metastatic lesions may open indications for evaluation of cases with inconclusive 18F-FDG PET/CT findings. What needs to be emphasized is that the false-positive results might be problematic and must be taken into account in 68Ga-FAPI PET/CT interpretation. More clarification on the role of FAPI radioligands in oncologic imaging, radionuclide therapy, and radiotherapy treatment planning is therefore required.
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Affiliation(s)
- Hessamoddin Roustaei
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Kiamanesh
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Emran Askari
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kamran Aryana
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Giorgio Treglia
- Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Universitá della Svizzera italiana, Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Gu B, Liu X, Wang S, Xu X, Liu X, Hu S, Yan W, Luo Z, Song S. Head-to-head evaluation of [ 18F]FDG and [ 68 Ga]Ga-DOTA-FAPI-04 PET/CT in recurrent soft tissue sarcoma. Eur J Nucl Med Mol Imaging 2022; 49:2889-2901. [PMID: 35113192 PMCID: PMC9206606 DOI: 10.1007/s00259-022-05700-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023]
Abstract
Purpose We aimed to evaluate the value of [68 Ga]Ga-DOTA-FAPI-04 PET/CT for the diagnosis of recurrent soft tissue sarcoma (STS), compared with [18F]FDG PET/CT. Methods A total of 45 patients (21 females and 24 males; median age, 46 years; range, 18–71 years) with 13 subtypes of STS underwent [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 PET/CT examination within 1 week for assessment local relapse or distant metastasis. Positive lesions on PET/CT images were verified by biopsy or 3-month follow-up. Wilcoxon matched-pairs signed-rank test was used to compare the semiquantitative values (SUVmax and TBR) of [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 in tumor lesions, and McNemar test was applied to test for differences of both tracers. Results Among the 45 patients, 282 local relapses and distant metastases were identified. Compared to [18F]FDG, [68 Ga]Ga-DOTA-FAPI-04 PET/CT detected more lesions (275 vs. 186) and outperformed in sensitivity, specificity, PPV, NPV, and accuracy for the diagnosis of recurrent lesions (P < 0.001). [68 Ga]Ga-DOTA-FAPI-04 demonstrated significantly higher values of SUVmax and TBR than [18F]FDG PET/CT in liposarcoma (P = 0.011 and P < 0.001, respectively), malignant solitary fibrous tumor (MSFT) (P < 0.001 and P < 0.001, respectively), and interdigitating dendritic cell sarcoma (IDCS) (P < 0.001and P < 0.001, respectively). While mean SUVmax and TBR presented favorable uptake of [18F]FDG over [68 Ga]Ga-DOTA-FAPI-04 in undifferentiated pleomorphic sarcoma (UPS) (P = 0.003 and P < 0.001, respectively) and rhabdomyosarcoma (RMS) (P < 0.001 and P < 0.001, respectively). Conclusion [68 Ga]Ga-DOTA-FAPI-04 PET/CT is a promising new imaging modality for recurrent surveillance of STS, and compares favorably with [18F]FDG for identifying recurrent lesions of liposarcoma, MSFT, and IDCS. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05700-4.
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Affiliation(s)
- Bingxin Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China
| | - Xin Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shuoer Wang
- Department of Musculoskeletal Tumor, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China
| | - Xiaosheng Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China
| | - Silong Hu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Tumor, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. .,Center for Biomedical Imaging, Fudan University, Shanghai, China. .,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China. .,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China.
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31
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Yang T, Ma L, Hou H, Gao F, Tao W. FAPI PET/CT in the Diagnosis of Abdominal and Pelvic Tumors. Front Oncol 2022; 11:797960. [PMID: 35059319 PMCID: PMC8763785 DOI: 10.3389/fonc.2021.797960] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) is currently a standard imaging examination used in clinical practice, and plays an essential role in preoperative systemic evaluation and tumor staging in patients with tumors. However, 18F-FDG PET/CT has certain limitations in imaging of some tumors, like gastric mucus adenocarcinoma, highly differentiated hepatocellular carcinoma, renal cell carcinoma, and peritoneal metastasis. Therefore, to search for new tumor diagnosis methods has always been an important topic in radiographic imaging research. Fibroblast activation protein (FAP) is highly expressed in many epithelial carcinomas, and various isotope-labelled fibroblast activation protein inhibitors (FAPI) show lower uptake in the brain and abdominal tissues than in tumor, thus achieving high image contrast and good tumor delineation. In addition to primary tumors, FAPI PET/CT is better than FDG PET/CT for detecting lymph nodes and metastases. Additionally, the highly selective tumor uptake of FAPI may open up new application areas for the non-invasive characterization, staging of tumors, as well as monitoring tumor treatment efficacy. This review focuses on the recent research progress of FAPI PET/CT in the application to abdominal and pelvic tumors, with the aim of providing new insights for diagnostic strategies for tumor patients, especially those with metastases.
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Affiliation(s)
- Tianshuo Yang
- Department of Nuclear Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Long Ma
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Haodong Hou
- Key Laboratory for Experimental Teratology of the Ministry of Education and Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feng Gao
- Key Laboratory for Experimental Teratology of the Ministry of Education and Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Weijing Tao
- Department of Nuclear Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
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Kuyumcu S, Sanli Y, Subramaniam RM. Fibroblast-Activated Protein Inhibitor PET/CT: Cancer Diagnosis and Management. Front Oncol 2021; 11:758958. [PMID: 34858834 PMCID: PMC8632139 DOI: 10.3389/fonc.2021.758958] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/18/2021] [Indexed: 01/13/2023] Open
Abstract
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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Affiliation(s)
- Serkan Kuyumcu
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rathan M. Subramaniam
- Otago Medical School, University of Otago, Dunedin, New Zealand
- Department of Radiology, Duke University, Durham, NC, United States
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Dendl K, Koerber SA, Finck R, Mokoala KMG, Staudinger F, Schillings L, Heger U, Röhrich M, Kratochwil C, Sathekge M, Jäger D, Debus J, Haberkorn U, Giesel FL. 68Ga-FAPI-PET/CT in patients with various gynecological malignancies. Eur J Nucl Med Mol Imaging 2021; 48:4089-4100. [PMID: 34050777 PMCID: PMC8484099 DOI: 10.1007/s00259-021-05378-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE 68Ga-FAPI (fibroblast activation protein inhibitor) is a novel and highly promising radiotracer for PET/CT imaging. The aim of this retrospective analysis is to explore the potential of FAPI-PET/CT in gynecological malignancies. We assessed biodistribution, tumor uptake, and the influence of pre- or postmenopausal status on tracer accumulation in hormone-sensitive organs. Furthermore, a comparison with the current standard oncological tracer 18F-FDG was performed in selected cases. PATIENTS AND METHODS A total of 31 patients (median age 59.5) from two centers with several gynecological tumors (breast cancer; ovarian cancer; cervical cancer; endometrial cancer; leiomyosarcoma of the uterus; tubal cancer) underwent 68Ga-FAPI-PET/CT. Out of 31 patients, 10 received an additional 18F-FDG scan within a median time interval of 12.5 days (range 1-76). Tracer uptake was quantified by standardized uptake values (SUV)max and (SUV)mean, and tumor-to-background ratio (TBR) was calculated (SUVmax tumor/ SUVmean organ). Moreover, a second cohort of 167 female patients with different malignancies was analyzed regarding their FAPI uptake in normal hormone-responsive organs: endometrium (n = 128), ovary (n = 64), and breast (n = 147). These patients were categorized by age as premenopausal (<35 years; n = 12), postmenopausal (>65 years; n = 68), and unknown menstrual status (35-65 years; n = 87), followed by an analysis of FAPI uptake of the pre- and postmenopausal group. RESULTS In 8 out of 31 patients, the primary tumor was present, and all 31 patients showed lesions suspicious for metastasis (n = 81) demonstrating a high mean SUVmax in both the primary (SUVmax 11.6) and metastatic lesions (SUVmax 9.7). TBR was significantly higher in 68Ga-FAPI compared to 18F-FDG for distant metastases (13.0 vs. 5.7; p = 0.047) and by trend for regional lymph node metastases (31.9 vs 27.3; p = 0.6). Biodistribution of 68Ga-FAPI-PET/CT presented significantly lower uptake or no significant differences in 15 out of 16 organs, compared to 18F-FDG-PET/CT. The highest uptake of all primary lesions was obtained in endometrial carcinomas (mean SUVmax 18.4), followed by cervical carcinomas (mean SUVmax 15.22). In the second cohort, uptake in premenopausal patients differed significantly from postmenopausal patients in endometrium (11.7 vs 3.9; p < 0.0001) and breast (1.8 vs 1.0; p = 0.004), whereas no significant difference concerning ovaries (2.8 vs 1.6; p = 0.141) was observed. CONCLUSION Due to high tracer uptake resulting in sharp contrasts in primary and metastatic lesions and higher TBRs than 18F-FDG-PET/CT, 68Ga-FAPI-PET/CT presents a promising imaging method for staging and follow-up of gynecological tumors. The presence or absence of the menstrual cycle seems to correlate with FAPI accumulation in the normal endometrium and breast. This first investigation of FAP ligands in gynecological tumor entities supports clinical application and further research in this field.
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Affiliation(s)
- Katharina Dendl
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Rebecca Finck
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Kgomotso M G Mokoala
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Fabian Staudinger
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Lisa Schillings
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Dirk Jäger
- Department of Medical Oncology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.
- German Cancer Consortium (DKTK), partner site, Heidelberg, Germany.
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany.
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Imlimthan S, Moon ES, Rathke H, Afshar-Oromieh A, Rösch F, Rominger A, Gourni E. New Frontiers in Cancer Imaging and Therapy Based on Radiolabeled Fibroblast Activation Protein Inhibitors: A Rational Review and Current Progress. Pharmaceuticals (Basel) 2021; 14:1023. [PMID: 34681246 PMCID: PMC8540221 DOI: 10.3390/ph14101023] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
Over the past decade, the tumor microenvironment (TME) has become a new paradigm of cancer diagnosis and therapy due to its unique biological features, mainly the interconnection between cancer and stromal cells. Within the TME, cancer-associated fibroblasts (CAFs) demonstrate as one of the most critical stromal cells that regulate tumor cell growth, progression, immunosuppression, and metastasis. CAFs are identified by various biomarkers that are expressed on their surfaces, such as fibroblast activation protein (FAP), which could be utilized as a useful target for diagnostic imaging and treatment. One of the advantages of targeting FAP-expressing CAFs is the absence of FAP expression in quiescent fibroblasts, leading to a controlled targetability of diagnostic and therapeutic compounds to the malignant tumor stromal area using radiolabeled FAP-based ligands. FAP-based radiopharmaceuticals have been investigated strenuously for the visualization of malignancies and delivery of theranostic radiopharmaceuticals to the TME. This review provides an overview of the state of the art in TME compositions, particularly CAFs and FAP, and their roles in cancer biology. Moreover, relevant reports on radiolabeled FAP inhibitors until the year 2021 are highlighted-as well as the current limitations, challenges, and requirements for those radiolabeled FAP inhibitors in clinical translation.
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Affiliation(s)
- Surachet Imlimthan
- Department of Nuclear Medicine, the Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (S.I.); (H.R.); (A.A.-O.); (A.R.)
| | - Euy Sung Moon
- Department of Chemistry—TRIGA Site, Johannes Gutenberg—University Mainz, 55128 Mainz, Germany; (E.S.M.); (F.R.)
| | - Hendrik Rathke
- Department of Nuclear Medicine, the Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (S.I.); (H.R.); (A.A.-O.); (A.R.)
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, the Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (S.I.); (H.R.); (A.A.-O.); (A.R.)
| | - Frank Rösch
- Department of Chemistry—TRIGA Site, Johannes Gutenberg—University Mainz, 55128 Mainz, Germany; (E.S.M.); (F.R.)
| | - Axel Rominger
- Department of Nuclear Medicine, the Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (S.I.); (H.R.); (A.A.-O.); (A.R.)
| | - Eleni Gourni
- Department of Nuclear Medicine, the Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; (S.I.); (H.R.); (A.A.-O.); (A.R.)
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Dendl K, Koerber SA, Kratochwil C, Cardinale J, Finck R, Dabir M, Novruzov E, Watabe T, Kramer V, Choyke PL, Haberkorn U, Giesel FL. FAP and FAPI-PET/CT in Malignant and Non-Malignant Diseases: A Perfect Symbiosis? Cancers (Basel) 2021; 13:4946. [PMID: 34638433 PMCID: PMC8508433 DOI: 10.3390/cancers13194946] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/13/2022] Open
Abstract
A fibroblast activation protein (FAP) is an atypical type II transmembrane serine protease with both endopeptidase and post-proline dipeptidyl peptidase activity. FAP is overexpressed in cancer-associated fibroblasts (CAFs), which are found in most epithelial tumors. CAFs have been implicated in promoting tumor cell invasion, angiogenesis and growth and their presence correlates with a poor prognosis. However, FAP can generally be found during the remodeling of the extracellular matrix and therefore can be detected in wound healing and benign diseases. For instance, chronic inflammation, arthritis, fibrosis and ischemic heart tissue after a myocardial infarction are FAP-positive diseases. Therefore, quinoline-based FAP inhibitors (FAPIs) bind with a high affinity not only to tumors but also to a variety of benign pathologic processes. When these inhibitors are radiolabeled with positron emitting radioisotopes, they provide new diagnostic and prognostic tools as well as insights into the role of the microenvironment in a disease. In this respect, they deliver additional information beyond what is afforded by conventional FDG PET scans that typically report on glucose uptake. Thus, FAP ligands are considered to be highly promising novel tracers that offer a new diagnostic and theranostic potential in a variety of diseases.
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Affiliation(s)
- Katharina Dendl
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany; (C.K.); (J.C.); (R.F.); (U.H.); (F.L.G.)
- Department of Nuclear Medicine, Düsseldorf University Hospital, 40225 Düsseldorf, Germany; (M.D.); (E.N.)
| | - Stefan A. Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany; (C.K.); (J.C.); (R.F.); (U.H.); (F.L.G.)
| | - Jens Cardinale
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany; (C.K.); (J.C.); (R.F.); (U.H.); (F.L.G.)
- Department of Nuclear Medicine, Düsseldorf University Hospital, 40225 Düsseldorf, Germany; (M.D.); (E.N.)
| | - Rebecca Finck
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany; (C.K.); (J.C.); (R.F.); (U.H.); (F.L.G.)
| | - Mardjan Dabir
- Department of Nuclear Medicine, Düsseldorf University Hospital, 40225 Düsseldorf, Germany; (M.D.); (E.N.)
| | - Emil Novruzov
- Department of Nuclear Medicine, Düsseldorf University Hospital, 40225 Düsseldorf, Germany; (M.D.); (E.N.)
| | - Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan;
| | - Vasko Kramer
- Positronpharma SA, Santiago 7500921, Chile;
- Center of Nuclear Medicine, PositronMed, Santiago 7501068, Chile
| | - Peter L. Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1088, USA;
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany; (C.K.); (J.C.); (R.F.); (U.H.); (F.L.G.)
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research DZL, 69120 Heidelberg, Germany
| | - Frederik L. Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany; (C.K.); (J.C.); (R.F.); (U.H.); (F.L.G.)
- Department of Nuclear Medicine, Düsseldorf University Hospital, 40225 Düsseldorf, Germany; (M.D.); (E.N.)
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