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Arak H, Elboga U, Cayirli YB, Aytekin A. Prognostic significance of 68 Ga-FAPI PET/CT in patients with bone metastases in various cancers. Ann Nucl Med 2024:10.1007/s12149-024-01935-3. [PMID: 38684594 DOI: 10.1007/s12149-024-01935-3] [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: 02/19/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE This study aimed to compare 18FDGPET/CT in patients who develop bone metastases due to various cancers and to investigate the prognostic significance of the 68FAPI-PET/CT SUVmax value for survival. METHODS Patients with bone metastases who underwent both 68 Ga-FAPI PET/CT and 18FDGPET/CT within a 1 week period were included in this retrospective study. The effect of the SUVmax value of bone lesions on overall survival was analyzed. RESULTS A total of 75 eligible patients with 139 bone lesions were included in this study. The median age of the patients was 55 (30-83) and 48(64%) patients were newly diagnosed. The primary lesion median 68 Ga-FAPI PET/CT SUVmax value was higher than the median 18FDGPET/CT SUVmax (10.75 versus 6.7). Bone lesions 68 Ga-FAPI PET/CT SUVmax median (IQR) were 7.8 (4.6-13.2), and 18FDGPET/CT SUVmax of bone lesions were 5.9 (3.8-8.2). More bone lesions were detected on 68 Ga-FAPI PET/CT than on 18FDGPET/CT(median IQR 4 [1-9] versus 2 [1-6] (p = 0.014). The extra lesions observed on 68 Ga-FAPI PET/CT were mostly sclerotic bone lesions (p = 0.001).68 Ga-FAPI PET/CT SUVmax was significantly higher in vertebra and thorax lesions (p = 0.011 and p = 0.018, respectively). While the bone lesion 68 Ga-FAPI PET/CT SUVmax affected the OS, the 18FDGPET/CT SUVmax value did not affect the OS (p < 0.001 and p = 0.079, respectively). In ROC analysis, a cut-off-off value of 68 Ga-FAPI PET/CT SUVmax > 7.7 was found for OS (AUC: 0.619). The median OS in the group above the cut-off value was worse than that in the group below the cut-off value (32 versus 45) months (p = 0.002). In the multivariate analysis for OS, the 68 Ga-FAPI PET/CT SUVmax of bone lesions was an important parameter, as well as cancer subtype, ALP level, and disease occurrence. CONCLUSIONS 68 Ga-FAPI PET/CT detected more bone lesions and higher SUVmax values than 18FDGPET/CT in various cancers. The prognostic value of the SUVmax value of 68 Ga-FAPI PET/CT bone lesions was observed regardless of disease subtype.
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Affiliation(s)
- Hacı Arak
- Department of Medical Oncology, Gaziantep University Şahinbey Training and Research Hospital, TR-27310, Gaziantep, Turkey.
| | - Umut Elboga
- Department of Nuclear Medicine, Gaziantep University Şahinbey Training and Research Hospital, Şahinbey, Gaziantep, Turkey
| | - Yusuf Burak Cayirli
- Department of Nuclear Medicine, Gaziantep University Şahinbey Training and Research Hospital, Şahinbey, Gaziantep, Turkey
| | - Aydın Aytekin
- Department of Medical Oncology, Gaziantep University Şahinbey Training and Research Hospital, TR-27310, Gaziantep, Turkey
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Has Simsek D, Guzel Y, Denizmen D, Sanli Y, Buyukkaya F, Kovan B, Komek H, Isik EG, Ozkan ZG, Kuyumcu S. The inferior performance of [ 68Ga]Ga-FAPI-04 PET/CT as a diagnostic and theranostic biomarker in [ 177Lu]Lu-DOTATATE refractory well-differentiated neuroendocrine tumors. Eur J Nucl Med Mol Imaging 2024; 51:828-840. [PMID: 37947850 DOI: 10.1007/s00259-023-06497-6] [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: 08/04/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE We aimed to investigate the potential of [68Ga]Ga-FAPI-04 PET/CT as an alternative diagnostic and theranostic tool in well-differentiated NETs refractory to [177Lu]Lu-DOTATATE therapy. METHODS Patients who received at least two cycles of [177Lu]Lu-DOTATATE therapy for metastatic NETs and progressed under treatment were included. All patients had performed [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI-04 PET/CT within 3 weeks. The number of PET-positive lesions related to NETs and tumor sites was documented. Mann-Whitney U and chi-square tests were used to compare SUVmax levels of tracers and the number of detected metastases. RESULTS Twelve patients (7 male, 5 female) who met the eligibility criteria were included in the study. Ten patients had grade 1-2 NET of various origins, and two had paraganglioma and pheochromocytoma. One hundred ninety-eight of 230 lesions (86%) were SSTR positive with a median SUVmax of 16.6 (2.2-76.5), and 88 of 230 lesions (38.2%) were [68Ga]Ga-FAPI-04 positive with a median SUVmax of 5.1 (2.3-21). Median SUVmax level and detected number of tumors were significantly higher in [68Ga]Ga-DOTATATE PET/CT (p=<0.001). [68Ga]Ga-FAPI-04 PET/CT was completely (n:2) or almost completely (n:3) negative in 5 (42%) patients. Two (17%) patients had flip-flop SSTR/FAPI uptake in tumors. In four patients (33%), tumor uptake or the number of PET-positive lesions was inferior in [68Ga]Ga-FAPI-04 PET/CT. In only one patient (8%), tumor uptakes were higher in [68Ga]Ga-FAPI-04 PET/CT. Low-dose [177Lu]Lu-FAPI-46 dosimetry was performed on the FAPI-dominant patient; absorbed radiation doses per GBq were 1.26 Gy, 0.36 Gy, 0.32 Gy, and 0.2 Gy for kidneys, liver, spleen, and total body, respectively. The mean absorbed dose per GBq was 0.33 Gy for liver mass and 0.41 Gy for metastatic lymph nodes. CONCLUSION Our preliminary results demonstrated that [68Ga]Ga-FAPI-04 PET/CT mainly failed in well-differentiated NETs refractory to [177Lu]Lu-DOTATATE therapy and had a limited role as an alternative diagnostic or theranostic agent. Further investigations with a larger patient population are required to determine the impact of [68Ga]Ga-FAPI-04 PET/CT on NETs.
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Affiliation(s)
- Duygu Has Simsek
- Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul, Turkey.
| | - Yunus Guzel
- Gazi Yasargil Training and Research Hospital, Department of Nuclear Medicine, Saglik Bilimleri University, 21070 Kayapinar, Diyarbakir, Turkey
| | - Dilara Denizmen
- Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul, Turkey
| | - Yasemin Sanli
- Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul, Turkey
| | - Fikret Buyukkaya
- Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul, Turkey
| | - Bilal Kovan
- Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul, Turkey
| | - Halil Komek
- Gazi Yasargil Training and Research Hospital, Department of Nuclear Medicine, Saglik Bilimleri University, 21070 Kayapinar, Diyarbakir, Turkey
| | - Emine Goknur Isik
- Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul, Turkey
| | - Zeynep Gozde Ozkan
- Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul, Turkey
| | - Serkan Kuyumcu
- Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul, Turkey
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Liu G, Mao W, Yu H, Hu Y, Gu J, Shi H. One-stop [ 18F]FDG and [ 68Ga]Ga-DOTA-FAPI-04 total-body PET/CT examination with dual-low activity: a feasibility study. Eur J Nucl Med Mol Imaging 2023; 50:2271-2281. [PMID: 36971806 DOI: 10.1007/s00259-023-06207-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Positron emission tomography/computed tomography (PET/CT) based on fibroblast activation protein inhibitors (FAPI) has shown complementary values to 2-[18F]-fluoro-2-deoxy-D-glucose ([18F]FDG) in cancer imaging. This study aimed to investigate the feasibility of a one-stop FDG-FAPI dual-tracer imaging protocol with dual-low activity for oncological imaging. METHODS Nineteen patients with malignancies underwent one-stop [18F]FDG (0.37 MBq/kg) PET (PETFDG) and dual-tracer PET 30-40 and 50-60 min (hereafter, PETD30-40 and PETD50-60, respectively) after additional injection of [68Ga]Ga-DOTA-FAPI-04 (0.925 MBq/kg), with a single diagnostic CT to generate the PET/CT. The lesion detection rate and tumor-to-normal ratios (TNRs) of tracer uptake were compared between PETFDG/CT and PETD50-60/CT and between PETD50-60/CT and PETD30-40/CT. In addition, a visual scoring system was established to compare the lesion detectability. RESULTS The dual-tracer PETD50-60 and PETD30-40/CT showed similar performance in detecting primary tumors but presented significantly higher lesion TNRs than PETFDG. Significantly, more metastases with higher TNRs were identified on PETD50-60 than PETFDG (491 vs. 261, P < 0.001). The dual-tracer PETD50-60 received significantly higher visual scores than single PETFDG (111 vs. 10) in demonstrating both primary tumors (12 vs. 2) and metastases (99 vs. 8). However, these differences were not significant between PETD50-60 and PETD30-40. These resulted in tumor upstaging in 44.4% patients taking PET/CT for initial assessment, and more recurrences (68 vs. 7) were identified in patients taking PET/CT for restaging, both on PETD50-60 and PETD30-40, compared to PETFDG. The reduced effective dosimetry per patient (26.2 ± 2.57 mSv) was equal to that of a single standard whole-body PET/CT. CONCLUSION The one-stop dual-tracer dual-low-activity PET imaging protocol combines the strengths of [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 with shorter duration and lesser radiation and is thus clinically applicable.
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Affiliation(s)
- Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wujian Mao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Hu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianying Gu
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
- Institute of Nuclear Medicine, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
- Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Güzel Y, Kömek H, Can C, Kaplan İ, Kepenek F, Ebinç S, Büyükdeniz MP, Gündoğan C, Oruç Z. Comparison of the role of 18 F-fluorodeoxyglucose PET/computed tomography and 68 Ga-labeled FAP inhibitor-04 PET/CT in patients with malignant mesothelioma. Nucl Med Commun 2023; 44:631-639. [PMID: 37114422 DOI: 10.1097/mnm.0000000000001702] [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: 04/29/2023]
Abstract
OBJECTIVE In this study, we aimed to compare the role of 68 Ga-labeled FAP inhibitor ( 68 Ga-FAPI)-04 PET/computed tomography (CT) and 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/CT in the evaluation of primary tumor and metastases in patients diagnosed with malignant mesothelioma. MATERIALS AND METHODS Our prospective study included 21 patients with histopathological diagnosis of malignant mesothelioma who underwent both 68 Ga-FAPI-04 PET/CT and 18 F-FDG PET/CT imaging between April 2022 and September 2022. Maximum standardized uptake value (SUVmax), metabolic tumor volume, total lesion glycolysis, tumor-to-background ratio (TBR) and highest SUVpeak (HPeak) values and lesion numbers were calculated from primary and metastatic lesions on FDG and FAPI PET/CT images. Findings obtained from FAPI and FDG PET/CT were compared. RESULTS More lesions were detected in 68 Ga-FAPI-04 PET/CT compared to 18 F-FDG PET/CT in primary tumor and lymph node metastases. Statistically significantly higher SUVmax and TBR values were found with FAPI PET/CT (primary lesion SUVmax and TBR, P = 0.001 and P < 0.001, respectively; lymph node SUVmax and TBR, P = 0.016 and P = 0.005, respectively). With FAPI PET/CT, upstage was observed according to tumor-node-metastasis staging in a total of seven patients including three patients with pleural origin, three patients with peritoneal origin and one patient with pericardial origin. CONCLUSION In addition to the stage change with 68 Ga-FAPI-04 PET/CT in malignant mesothelioma patients, a statistically significant superiority was observed in SUVmax, TBR and volumetric parameters in primary tumors and metastases.
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Affiliation(s)
- Yunus Güzel
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital
| | - Halil Kömek
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital
| | - Canan Can
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital
| | - İhsan Kaplan
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital
| | - Ferat Kepenek
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital
| | - Senar Ebinç
- Department of Medical Oncology, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital
| | | | - Cihan Gündoğan
- Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital
| | - Zeynep Oruç
- Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
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Fibroblast Activation Protein Inhibitor (FAPI)-Based Theranostics-Where We Are at and Where We Are Heading: A Systematic Review. Int J Mol Sci 2023; 24:ijms24043863. [PMID: 36835275 PMCID: PMC9965519 DOI: 10.3390/ijms24043863] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Cancer is the leading cause of death around the globe, followed by heart disease and stroke, with the highest mortality to this day. We have reached great levels of understanding of how these various types of cancer operate at a cellular level and this has brought us to what we call "precision medicine" where every diagnostic examination and the therapeutic procedure is tailored to the patient. FAPI is among the new tracers that can be used to assess and treat many types of cancer. The aim of this review was to gather all the known literature on FAPI theranostics. A MEDLINE search was conducted on four web libraries, PUBMED, Cochrane, Scopus, and Web of Sciences. All of the available articles that included both diagnoses and therapy with FAPI tracers were collected and put through the CASP (Critical Appraisal Skills Programme) questionnaire for systematic reviewing. A total of 8 records were deemed suitable for CASP review, ranging from 2018 to November 2022. These studies were put through the CASP diagnostic checklist, in order to assess the goal of the study, diagnostic and reference tests, results, descriptions of the patient sample, and future applications. Sample sizes were heterogeneous, both for size as well as for tumor type. Only one author studied a single type of cancer with FAPI tracers. Progression of disease was the most common outcome, and no relevant collateral effects were noted. Although FAPI theranostics is still in its infancy and lacks solid grounds to be brought into clinical practice, it does not show any collateral effects that prohibit administration to patients, thus far, and has good tolerability profiles.
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