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Research ArticleThe State of the Art

FAPI PET/CT: Will It End the Hegemony of 18F-FDG in Oncology?

Rodney J. Hicks, Peter J. Roselt, Kumarswamy G. Kallur, Richard W. Tothill and Linda Mileshkin
Journal of Nuclear Medicine March 2021, 62 (3) 296-302; DOI: https://doi.org/10.2967/jnumed.120.256271
Rodney J. Hicks
1Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Peter J. Roselt
2Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Kumarswamy G. Kallur
3Healthcare Global Enterprises Ltd., Bangalore, Karnataka, India; and
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Richard W. Tothill
4Department of Clinical Pathology and Centre for Cancer Research, University of Melbourne, Melbourne, Australia
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Linda Mileshkin
1Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Abstract

For over 40 years, 18F-FDG has been the dominant PET tracer in neurology, cardiology, inflammatory diseases, and, most particularly, oncology. Combined with the ability to perform whole-body scanning, 18F-FDG has revolutionized the evaluation of cancer and has stifled the adoption of other tracers, except in situations where low avidity or high background activity limits diagnostic performance. The strength of 18F-FDG has generally been its ability to detect disease in the absence of structural abnormality, thereby enhancing diagnostic sensitivity, but its simultaneous weakness has been a lack of specificity due to diverse pathologies with enhanced glycolysis. Radiotracers that leverage other hallmarks of cancer or specific cell-surface targets are gradually finding a niche in the diagnostic armamentarium. However, none have had sufficient sensitivity to realistically compete with 18F-FDG for evaluation of the broad spectrum of malignancies. Perhaps, this situation is about to change with development of a class of tracers targeting fibroblast activation protein that have low uptake in almost all normal tissues but high uptake in most cancer types. In this review, the development and exciting preliminary clinical data relating to various fibroblast activation protein–specific small-molecule inhibitor tracers in oncology will be discussed along with potential nononcologic applications.

  • PET
  • theranostics
  • fibroblast activation protein
  • oncology
  • radiochemistry

Footnotes

  • Published online Dec. 4, 2020.

  • © 2021 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 62 (3)
Journal of Nuclear Medicine
Vol. 62, Issue 3
March 1, 2021
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FAPI PET/CT: Will It End the Hegemony of 18F-FDG in Oncology?
Rodney J. Hicks, Peter J. Roselt, Kumarswamy G. Kallur, Richard W. Tothill, Linda Mileshkin
Journal of Nuclear Medicine Mar 2021, 62 (3) 296-302; DOI: 10.2967/jnumed.120.256271

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FAPI PET/CT: Will It End the Hegemony of 18F-FDG in Oncology?
Rodney J. Hicks, Peter J. Roselt, Kumarswamy G. Kallur, Richard W. Tothill, Linda Mileshkin
Journal of Nuclear Medicine Mar 2021, 62 (3) 296-302; DOI: 10.2967/jnumed.120.256271
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  • Article
    • Abstract
    • THE ROLE OF CAFs IN CANCER
    • FIBROBLAST ACTIVATION PROTEIN (FAP) AND CANCER BIOLOGY
    • FAP AS A TARGET FOR IMAGING CANCER
    • THERAPEUTIC TARGETING OF FAP IN CANCER
    • FAP IMAGING IN OTHER PATHOLOGIES
    • FUTURE DIRECTIONS
    • CONCLUSION
    • DISCLOSURE
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Keywords

  • PET
  • theranostics
  • fibroblast activation protein
  • oncology
  • radiochemistry
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