Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities

Nader Hirmas; Rainer Hamacher; Miriam Sraieb; Marc Ingenwerth; Lukas Kessler; Kim M. Pabst; Francesco Barbato; Katharina Lueckerath; Stefan Kasper; Michael Nader; Hans Ulrich Schildhaus; Claudia Kesch; Bastian von Tresckow; Christine Hanoun; Hubertus Hautzel; Clemens Aigner; Martin Glas; Martin Stuschke; Sherko Kummel; Philipp Harter; Celine Lugnier; Waldemar Uhl; Marco Niedergethmann; Boris Hadaschik; Viktor Grunwald; Jens T. Siveke; Ken Herrmann; Wolfgang P. Fendler

doi:10.2967/jnumed.122.264689

Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities

Nader Hirmas
, Rainer Hamacher
, Miriam Sraieb
, Marc Ingenwerth
, Lukas Kessler
, Kim M. Pabst
, Francesco Barbato
, Katharina Lueckerath
, Stefan Kasper
, Michael Nader
, Hans Ulrich Schildhaus
, Claudia Kesch
, Bastian von Tresckow
, Christine Hanoun
, Hubertus Hautzel
, Clemens Aigner
, Martin Glas
, Martin Stuschke
, Sherko Kummel
, Philipp Harter

Celine Lugnier, Waldemar Uhl, Marco Niedergethmann, Boris Hadaschik, Viktor Grunwald, Jens T. Siveke, Ken Herrmann, Wolfgang P. Fendler

University Hospital of Essen
Targos Molecular Pathology
Pediatric Urology and Urological Oncology
Charité – Universitätsmedizin Berlin
Evang. Kliniken Essen–Mitte
Max-Planck-lnstitut für Kohlenforschung
Alfried Krupp Krankenhaus
German Cancer Research Center

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

We present an overview of our prospective fibroblast-activation protein inhibitor (FAPI) registry study across a 3-y period, with head-to-head comparison of tumor uptake in ⁶⁸Ga-FAPI and ¹⁸F-FDG PET, as well as FAP immunohistochemistry. Methods: This is an interim analysis of the ongoing ⁶⁸Ga-FAPI PET prospective observational trial at our department. Patients who underwent clinical imaging with ⁶⁸Ga-FAPI PET between October 2018 and October 2021 were included. Tracer uptake was quantified by SUV_max for tumor lesions and by SUV_mean for normal organs. PET tumor volume (40% isocontour) and tumor-to-background ratios were calculated. Correlation between SUV_max and FAP staining in tissue samples was analyzed. Results: In total, 324 patients with 21 different tumor entities underwent ⁶⁸Ga-FAPI imaging; 237 patients additionally received ¹⁸F-FDG PET. The most common tumor entities were sarcoma (131/324, 40%), pancreatic cancer (67/324, 21%), and primary tumors of the brain (22/324, 7%). The mean primary tumor SUV_max was significantly higher for ⁶⁸Ga-FAPI than ¹⁸F-FDG among pancreatic cancer (13.2 vs. 6.1, P, 0.001) and sarcoma (14.3 vs. 9.4, P, 0.001), and the same was true for mean SUV_max in metastatic lesions of pancreatic cancer (9.4 vs. 5.5, P, 0.001). Mean primary tumor maximum tumor-to-background ratio was significantly higher for ⁶⁸Ga-FAPI than ¹⁸F-FDG across several tumor entities, most prominently pancreatic cancer (14.7 vs. 3.0, P, 0.001) and sarcoma (17.3 vs. 4.7, P, 0.001). Compared with ¹⁸F-FDG, ⁶⁸Ga-FAPI showed superior detection for locoregional disease in sarcoma (52 vs. 48 total regions detected) and for distant metastatic disease in both sarcoma (137 vs. 131) and pancreatic cancer (65 vs. 57), respectively. Among 61 histopathology samples, there was a positive correlation between ⁶⁸Ga-FAPI SUV_max and overall FAP immunohistochemistry score (r 5 0.352, P 5 0.005). Conclusion: ⁶⁸Ga-FAPI demonstrates higher absolute uptake in pancreatic cancer and sarcoma, as well as higher tumor-to-background uptake along with improved tumor detection for pancreatic cancer, sarcoma, and other tumor entities when compared with ¹⁸F-FDG. ⁶⁸Ga-FAPI is a new tool for tumor staging with theranostic potential.

Original language	English
Pages (from-to)	711-716
Number of pages	6
Journal	Journal of Nuclear Medicine
Volume	64
Issue number	5
DOIs	https://doi.org/10.2967/jnumed.122.264689
State	Published - 1 May 2023
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

FAPI
PET
oncology
staging
theranostic

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10.2967/jnumed.122.264689

Cite this

Hirmas, N., Hamacher, R., Sraieb, M., Ingenwerth, M., Kessler, L., Pabst, K. M., Barbato, F., Lueckerath, K., Kasper, S., Nader, M., Schildhaus, H. U., Kesch, C., von Tresckow, B., Hanoun, C., Hautzel, H., Aigner, C., Glas, M., Stuschke, M., Kummel, S., ... Fendler, W. P. (2023). Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities. Journal of Nuclear Medicine, 64(5), 711-716. https://doi.org/10.2967/jnumed.122.264689

@article{730fb119637f48c680439e90c7dd3f1a,

title = "Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities",

abstract = "We present an overview of our prospective fibroblast-activation protein inhibitor (FAPI) registry study across a 3-y period, with head-to-head comparison of tumor uptake in 68Ga-FAPI and 18F-FDG PET, as well as FAP immunohistochemistry. Methods: This is an interim analysis of the ongoing 68Ga-FAPI PET prospective observational trial at our department. Patients who underwent clinical imaging with 68Ga-FAPI PET between October 2018 and October 2021 were included. Tracer uptake was quantified by SUVmax for tumor lesions and by SUVmean for normal organs. PET tumor volume (40\% isocontour) and tumor-to-background ratios were calculated. Correlation between SUVmax and FAP staining in tissue samples was analyzed. Results: In total, 324 patients with 21 different tumor entities underwent 68Ga-FAPI imaging; 237 patients additionally received 18F-FDG PET. The most common tumor entities were sarcoma (131/324, 40\%), pancreatic cancer (67/324, 21\%), and primary tumors of the brain (22/324, 7\%). The mean primary tumor SUVmax was significantly higher for 68Ga-FAPI than 18F-FDG among pancreatic cancer (13.2 vs. 6.1, P, 0.001) and sarcoma (14.3 vs. 9.4, P, 0.001), and the same was true for mean SUVmax in metastatic lesions of pancreatic cancer (9.4 vs. 5.5, P, 0.001). Mean primary tumor maximum tumor-to-background ratio was significantly higher for 68Ga-FAPI than 18F-FDG across several tumor entities, most prominently pancreatic cancer (14.7 vs. 3.0, P, 0.001) and sarcoma (17.3 vs. 4.7, P, 0.001). Compared with 18F-FDG, 68Ga-FAPI showed superior detection for locoregional disease in sarcoma (52 vs. 48 total regions detected) and for distant metastatic disease in both sarcoma (137 vs. 131) and pancreatic cancer (65 vs. 57), respectively. Among 61 histopathology samples, there was a positive correlation between 68Ga-FAPI SUVmax and overall FAP immunohistochemistry score (r 5 0.352, P 5 0.005). Conclusion: 68Ga-FAPI demonstrates higher absolute uptake in pancreatic cancer and sarcoma, as well as higher tumor-to-background uptake along with improved tumor detection for pancreatic cancer, sarcoma, and other tumor entities when compared with 18F-FDG. 68Ga-FAPI is a new tool for tumor staging with theranostic potential.",

keywords = "FAPI, PET, oncology, staging, theranostic",

author = "Nader Hirmas and Rainer Hamacher and Miriam Sraieb and Marc Ingenwerth and Lukas Kessler and Pabst, \{Kim M.\} and Francesco Barbato and Katharina Lueckerath and Stefan Kasper and Michael Nader and Schildhaus, \{Hans Ulrich\} and Claudia Kesch and \{von Tresckow\}, Bastian and Christine Hanoun and Hubertus Hautzel and Clemens Aigner and Martin Glas and Martin Stuschke and Sherko Kummel and Philipp Harter and Celine Lugnier and Waldemar Uhl and Marco Niedergethmann and Boris Hadaschik and Viktor Grunwald and Siveke, \{Jens T.\} and Ken Herrmann and Fendler, \{Wolfgang P.\}",

note = "Publisher Copyright: {\ss} 2023 by the Society of Nuclear Medicine and Molecular Imaging.",

year = "2023",

month = may,

day = "1",

doi = "10.2967/jnumed.122.264689",

language = "English",

volume = "64",

pages = "711--716",

journal = "Journal of Nuclear Medicine",

issn = "0161-5505",

publisher = "Society of Nuclear Medicine Inc.",

number = "5",

}

Hirmas, N, Hamacher, R, Sraieb, M, Ingenwerth, M, Kessler, L, Pabst, KM, Barbato, F, Lueckerath, K, Kasper, S, Nader, M, Schildhaus, HU, Kesch, C, von Tresckow, B, Hanoun, C, Hautzel, H, Aigner, C, Glas, M, Stuschke, M, Kummel, S, Harter, P, Lugnier, C, Uhl, W, Niedergethmann, M, Hadaschik, B, Grunwald, V, Siveke, JT, Herrmann, K & Fendler, WP 2023, 'Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities', Journal of Nuclear Medicine, vol. 64, no. 5, pp. 711-716. https://doi.org/10.2967/jnumed.122.264689

TY - JOUR

T1 - Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities

AU - Hirmas, Nader

AU - Hamacher, Rainer

AU - Sraieb, Miriam

AU - Ingenwerth, Marc

AU - Kessler, Lukas

AU - Pabst, Kim M.

AU - Barbato, Francesco

AU - Lueckerath, Katharina

AU - Kasper, Stefan

AU - Nader, Michael

AU - Schildhaus, Hans Ulrich

AU - Kesch, Claudia

AU - von Tresckow, Bastian

AU - Hanoun, Christine

AU - Hautzel, Hubertus

AU - Aigner, Clemens

AU - Glas, Martin

AU - Stuschke, Martin

AU - Kummel, Sherko

AU - Harter, Philipp

AU - Lugnier, Celine

AU - Uhl, Waldemar

AU - Niedergethmann, Marco

AU - Hadaschik, Boris

AU - Grunwald, Viktor

AU - Siveke, Jens T.

AU - Herrmann, Ken

AU - Fendler, Wolfgang P.

N1 - Publisher Copyright: ß 2023 by the Society of Nuclear Medicine and Molecular Imaging.

PY - 2023/5/1

Y1 - 2023/5/1

N2 - We present an overview of our prospective fibroblast-activation protein inhibitor (FAPI) registry study across a 3-y period, with head-to-head comparison of tumor uptake in 68Ga-FAPI and 18F-FDG PET, as well as FAP immunohistochemistry. Methods: This is an interim analysis of the ongoing 68Ga-FAPI PET prospective observational trial at our department. Patients who underwent clinical imaging with 68Ga-FAPI PET between October 2018 and October 2021 were included. Tracer uptake was quantified by SUVmax for tumor lesions and by SUVmean for normal organs. PET tumor volume (40% isocontour) and tumor-to-background ratios were calculated. Correlation between SUVmax and FAP staining in tissue samples was analyzed. Results: In total, 324 patients with 21 different tumor entities underwent 68Ga-FAPI imaging; 237 patients additionally received 18F-FDG PET. The most common tumor entities were sarcoma (131/324, 40%), pancreatic cancer (67/324, 21%), and primary tumors of the brain (22/324, 7%). The mean primary tumor SUVmax was significantly higher for 68Ga-FAPI than 18F-FDG among pancreatic cancer (13.2 vs. 6.1, P, 0.001) and sarcoma (14.3 vs. 9.4, P, 0.001), and the same was true for mean SUVmax in metastatic lesions of pancreatic cancer (9.4 vs. 5.5, P, 0.001). Mean primary tumor maximum tumor-to-background ratio was significantly higher for 68Ga-FAPI than 18F-FDG across several tumor entities, most prominently pancreatic cancer (14.7 vs. 3.0, P, 0.001) and sarcoma (17.3 vs. 4.7, P, 0.001). Compared with 18F-FDG, 68Ga-FAPI showed superior detection for locoregional disease in sarcoma (52 vs. 48 total regions detected) and for distant metastatic disease in both sarcoma (137 vs. 131) and pancreatic cancer (65 vs. 57), respectively. Among 61 histopathology samples, there was a positive correlation between 68Ga-FAPI SUVmax and overall FAP immunohistochemistry score (r 5 0.352, P 5 0.005). Conclusion: 68Ga-FAPI demonstrates higher absolute uptake in pancreatic cancer and sarcoma, as well as higher tumor-to-background uptake along with improved tumor detection for pancreatic cancer, sarcoma, and other tumor entities when compared with 18F-FDG. 68Ga-FAPI is a new tool for tumor staging with theranostic potential.

AB - We present an overview of our prospective fibroblast-activation protein inhibitor (FAPI) registry study across a 3-y period, with head-to-head comparison of tumor uptake in 68Ga-FAPI and 18F-FDG PET, as well as FAP immunohistochemistry. Methods: This is an interim analysis of the ongoing 68Ga-FAPI PET prospective observational trial at our department. Patients who underwent clinical imaging with 68Ga-FAPI PET between October 2018 and October 2021 were included. Tracer uptake was quantified by SUVmax for tumor lesions and by SUVmean for normal organs. PET tumor volume (40% isocontour) and tumor-to-background ratios were calculated. Correlation between SUVmax and FAP staining in tissue samples was analyzed. Results: In total, 324 patients with 21 different tumor entities underwent 68Ga-FAPI imaging; 237 patients additionally received 18F-FDG PET. The most common tumor entities were sarcoma (131/324, 40%), pancreatic cancer (67/324, 21%), and primary tumors of the brain (22/324, 7%). The mean primary tumor SUVmax was significantly higher for 68Ga-FAPI than 18F-FDG among pancreatic cancer (13.2 vs. 6.1, P, 0.001) and sarcoma (14.3 vs. 9.4, P, 0.001), and the same was true for mean SUVmax in metastatic lesions of pancreatic cancer (9.4 vs. 5.5, P, 0.001). Mean primary tumor maximum tumor-to-background ratio was significantly higher for 68Ga-FAPI than 18F-FDG across several tumor entities, most prominently pancreatic cancer (14.7 vs. 3.0, P, 0.001) and sarcoma (17.3 vs. 4.7, P, 0.001). Compared with 18F-FDG, 68Ga-FAPI showed superior detection for locoregional disease in sarcoma (52 vs. 48 total regions detected) and for distant metastatic disease in both sarcoma (137 vs. 131) and pancreatic cancer (65 vs. 57), respectively. Among 61 histopathology samples, there was a positive correlation between 68Ga-FAPI SUVmax and overall FAP immunohistochemistry score (r 5 0.352, P 5 0.005). Conclusion: 68Ga-FAPI demonstrates higher absolute uptake in pancreatic cancer and sarcoma, as well as higher tumor-to-background uptake along with improved tumor detection for pancreatic cancer, sarcoma, and other tumor entities when compared with 18F-FDG. 68Ga-FAPI is a new tool for tumor staging with theranostic potential.

KW - FAPI

KW - PET

KW - oncology

KW - staging

KW - theranostic

UR - https://www.scopus.com/pages/publications/85159243719

U2 - 10.2967/jnumed.122.264689

DO - 10.2967/jnumed.122.264689

M3 - Article

C2 - 36581374

AN - SCOPUS:85159243719

SN - 0161-5505

VL - 64

SP - 711

EP - 716

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

IS - 5

ER -

Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities

Abstract

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Keywords

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