The inferior performance of [<SUP>68</SUP>Ga]Ga-FAPI-04 PET/CT as a diagnostic and theranostic biomarker in [<SUP>177</SUP>Lu]Lu-DOTATATE refractory well-differentiated neuroendocrine tumors

Has Simsek D., Guzel Y., Denizmen D., Sanli Y., Buyukkaya F., Kovan B., ...Daha Fazla

EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, sa.3, ss.828-840, 2024 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Basım Tarihi: 2024
  • Doi Numarası: 10.1007/s00259-023-06497-6
  • Dergi Adı: EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Biotechnology Research Abstracts, CINAHL, EMBASE, MEDLINE
  • Sayfa Sayıları: ss.828-840
  • Anahtar Kelimeler: 68Ga-DOTATATE PET/CT, 68Ga-FAPI PET/CT, Cancer-associated fibroblast, Neuroendocrine tumor, Theranostic
  • İstanbul Üniversitesi Adresli: Evet

Özet

Purpose We aimed to investigate the potential of [Ga-68]Ga-FAPI-04 PET/CT as an alternative diagnostic and theranostic tool in well-differentiated NETs refractory to [Lu-177]Lu-DOTATATE therapy.Methods Patients who received at least two cycles of [Lu-177]Lu-DOTATATE therapy for metastatic NETs and progressed under treatment were included. All patients had performed [Ga-68]Ga-DOTATATE and [Ga-68]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 [Ga-68]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 [Ga-68]Ga-DOTATATE PET/CT (p=<0.001). [Ga-68]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 [Ga-68]Ga-FAPI-04 PET/CT. In only one patient (8%), tumor uptakes were higher in [Ga-68]Ga-FAPI-04 PET/CT. Low-dose [Lu-177]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 [Ga-68]Ga-FAPI-04 PET/CT mainly failed in well-differentiated NETs refractory to [Lu-177]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 [Ga-68]Ga-FAPI-04 PET/CT on NETs.