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

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

doi:10.2967/jnumed.120.253062

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

J Nucl Med. 2021 Jun 1;62(6):779-786. doi: 10.2967/jnumed.120.253062. Epub 2020 Oct 23.

Authors

Manuel Röhrich¹, Patrick Naumann^{2

3

4}, Frederik L Giesel^{5

6}, Peter L Choyke⁷, Fabian Staudinger⁵, Annika Wefers^{8

9}, Dawn P Liew⁵, Clemens Kratochwil⁵, Hendrik Rathke⁵, Jakob Liermann^{2

3

4}, Klaus Herfarth^{2

3

4}, Dirk Jäger^{10

11}, Jürgen Debus^{2

3

4

6

12

13}, Uwe Haberkorn^{5

6

14

15}, Matthias Lang^{8

16}, Stefan A Koerber^{2

3

4}

Affiliations

¹ Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany manuel.roehrich@med.uni-heidelberg.de.
² Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
³ National Center for Tumor diseases (NCT), Heidelberg, Germany.
⁴ Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
⁵ Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.
⁶ German Cancer Consortium (DKTK), partner site Heidelberg, Germany.
⁷ Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
⁸ Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.
⁹ Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁰ Department of Medical Oncology and Internal Medicine Virgin Islands, National Center for Tumor Diseases, University Hospital Heidelberg, Germany.
¹¹ Clinical Cooperation Unit Applied Tumor Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹² Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
¹³ Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁴ Clinical Cooperation Unit, Department of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁵ Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany; and.
¹⁶ Department of Surgery, Heidelberg University Hospital, Heidelberg, GermanyMember of the German Center for Lung Research DZL, Heidelberg, Germany.

Abstract

Pancreatic ductal carcinoma (PDAC) is a highly lethal cancer, and early detection and accurate staging are critical to prolonging survival. PDAC typically has a prominent stroma including cancer-associated fibroblasts that express fibroblast activation protein (FAP). FAP is a new target molecule for PET imaging of various tumors. In this retrospective study, we describe the clinical impact of PET/CT imaging using ⁶⁸Ga-labeled FAP-inhibitors (⁶⁸Ga-FAPI PET/CT) in 19 patients with PDAC (7 primary, 12 progressive/recurrent). Methods: All patients underwent contrast-enhanced CT (ceCT) for TNM staging before ⁶⁸Ga-FAPI PET/CT imaging. PET scans were acquired 60 min after administration of 150-250 MBq of ⁶⁸Ga-labeled FAP-specific tracers. To characterize ⁶⁸Ga-FAPI uptake over time, additional scans after 10 or 180 min were acquired in 6 patients. SUV_max and SUV_mean values of PDAC manifestations and healthy organs were analyzed. The tumor burden according to ⁶⁸Ga-FAPI PET/CT was compared with TNM staging based on ceCT and changes in oncologic management were recorded. Results: Compared with ceCT, ⁶⁸Ga-FAPI PET/CT results led to changes in TNM staging in 10 of 19 patients. Eight of 12 patients with recurrent/progressive disease were upstaged, 1 was downstaged, and 3 had no change. In newly diagnosed PDAC, 1 of 7 patients was upstaged, and the staging of 6 patients did not change. Changes in oncologic management occurred in 7 patients. Markedly elevated uptake of ⁶⁸Ga-FAPI in PDAC manifestations after 1 h was seen in most cases. Differentiation from pancreatitis based on static imaging 1 h after injection was challenging. With respect to imaging after multiple time points, PDAC and pancreatitis showed a trend for differential uptake kinetics. Conclusion:⁶⁸Ga-FAPI PET/CT led to restaging in half of the patients with PDAC and most patients with recurrent disease compared with standard of care imaging. The clinical value of ⁶⁸Ga-FAPI PET/CT should be further investigated.

Keywords: FAP; PDAC; PET; TNM; fibroblast activation protein; pancreatic ductal adenocarcinoma; staging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma / diagnostic imaging*
Adenocarcinoma / pathology
Adenocarcinoma / therapy*
Female
Humans
Male
Middle Aged
Pancreatic Neoplasms / diagnostic imaging*
Pancreatic Neoplasms / pathology
Pancreatic Neoplasms / therapy*
Positron Emission Tomography Computed Tomography*
Quinolines*
Recurrence
Retrospective Studies

Substances

68Ga-FAPI
Quinolines