Targeting Fibroblast Activation Protein in Newly Diagnosed Squamous Cell Carcinoma of the Oral Cavity - Initial Experience and Comparison to [F]FDG PET/CT and MRI

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2021 May 29

PMID 34050405

Citations 20

Authors

Christian Linz

Roman C Brands

Olivia Kertels

Alexander Dierks

Joachim Brumberg

Elena Gerhard-Hartmann

Stefan Hartmann

Andreas Schirbel

Sebastian Serfling

Yingjun Zhi

Andreas K Buck

Alexander Kubler

Julian Hohm

Constantin Lapa

Malte Kircher

Affiliations

Soon will be listed here.

Abstract

Purpose: While [F]-fluorodeoxyglucose ([F]FDG) is the standard for positron emission tomography/computed tomography (PET/CT) imaging of oral squamous cell carcinoma (OSCC), diagnostic specificity is hampered by uptake in inflammatory cells such as neutrophils or macrophages. Recently, molecular imaging probes targeting fibroblast activation protein α (FAP), which is overexpressed in a variety of cancer-associated fibroblasts, have become available and might constitute a feasible alternative to FDG PET/CT.

Methods: Ten consecutive, treatment-naïve patients (8 males, 2 females; mean age, 62 ± 9 years) with biopsy-proven OSCC underwent both whole-body [F]FDG and [Ga]FAPI-04 (FAP-directed) PET/CT for primary staging prior to tumor resection and cervical lymph node dissection. Detection of the primary tumor, as well as the presence and number of lymph node and distant metastases was analysed. Intensity of tracer accumulation was assessed by means of maximum (SUV) and peak (SUV) standardized uptake values. Histological work-up including immunohistochemical staining for FAP served as standard of reference.

Results: [F]FDG and FAP-directed PET/CT detected all primary tumors with a SUV of 25.5 ± 13.2 (FDG) and 20.5 ± 6.4 (FAP-directed) and a SUV of 16.1 ± 10.3 ([F]FDG) and 13.8 ± 3.9 (FAP-directed), respectively. Regarding cervical lymph node metastases, FAP-directed PET/CT demonstrated comparable sensitivity (81.3% vs. 87.5%; P = 0.32) and specificity (93.3% vs. 81.3%; P = 0.16) to [F]FDG PET/CT. FAP expression on the cell surface of cancer-associated fibroblasts in both primary lesions as well as lymph nodes metastases was confirmed in all samples.

Conclusion: FAP-directed PET/CT in OSCC seems feasible. Future research to investigate its potential to improve patient staging is highly warranted.

Citing Articles

Unveiling the Tumor Microenvironment Through Fibroblast Activation Protein Targeting in Diagnostic Nuclear Medicine: A Didactic Review on Biological Rationales and Key Imaging Agents.

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Recent advances of photodiagnosis and treatment for head and neck squamous cell carcinoma.

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The comparative utility of FAPI-based PET radiotracers over [F]FDG in the assessment of malignancies.

Singh S, Shrestha B, Gandhi O, Shah R, Mukhtiar V, Ayubcha C Am J Nucl Med Mol Imaging. 2024; 14(4):190-207.

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Role of F-FDG PET/CT in Head and Neck Squamous Cell Carcinoma: Current Evidence and Innovative Applications.

Caldarella C, De Risi M, Massaccesi M, Micciche F, Bussu F, Galli J Cancers (Basel). 2024; 16(10).

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Evaluating the Patterns of FAPI Uptake in the Shoulder Joint: a Preliminary Study Comparing with FDG Uptake in Oncological Studies.

Matsusaka Y, Werner R, Serfling S, Buck A, Kosmala A, Sasaki T Mol Imaging Biol. 2024; 26(2):294-300.

PMID: 38177615 PMC: 10972909. DOI: 10.1007/s11307-023-01893-8.

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