Wang Rongxi, Wang Jiarou, Xiang Jialin, Sui Huimin, Li Linlin, Jia Chenhao, Peng Xingtong, Chen Xiaoyuan, Zhu Zhaohui, Zhang Jingjing
Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
J Nucl Med. 2025 Apr 1;66(4):585-591. doi: 10.2967/jnumed.124.268258.
Solitary fibrous tumor (SFT) is a rare sarcoma of mesenchymal origin. Although generally benign, SFTs carry the risk of recurrence and metastasis, with limited effective treatment options. The aims of this study are to compare the performance of fibroblast activation protein inhibitor (FAPI), [Ga]Ga-DOTA-FAPI-04 (denoted as [Ga]Ga-FAPI-04), and conventional [F]FDG PET/CT in patients with recurrent or metastatic SFTs head to head and to preliminarily explore the value of FAP-targeted radiopharmaceutical therapy with Lu for SFT patients. Thirty-one participants (21 men, 44 ± 13 y) with suspected recurrent or metastatic SFTs underwent both [F]FDG and [Ga]Ga-FAPI-04 PET/CT within 1 wk. The positive-lesion rates of the 2 PET/CT scans in the different organs involved and the uptake values (SUV) were compared. Four patients with high [Ga]Ga-FAPI-04 uptake received single-cycle therapy of 2.22 GBq of a [Lu]Lu-labeled, FAP-targeted radiopharmaceutical, [Lu]Lu-Evans blue-FAPI, and were followed up for 4 mo. In 522 local recurrences and distant metastases in the 31 patients, [Ga]Ga-FAPI-04 PET detected significantly more lesions than did [F]FDG (87.0% vs. 45.4%, < 0.001). In terms of lesion uptake values, [Ga]Ga-FAPI-04 PET showed a mean SUV higher than that of [F]FDG in most recurrence or metastatic organs (bone, lung, central nervous system, pancreas, and pleura, < 0.001; kidney and abdominopelvic cavity, = 0.001; muscle and pericardium, < 0.05). Four patients tolerated [Lu]Lu-Evans blue-FAPI well. The total-body absorbed dose and the effective dose were 4.02E-01 ± 3.54E-02 Gy and 4.01E+02 ± 4.18E+01 mSv, respectively. Subsequent follow-up with [Ga]Ga-FAPI-04 PET showed that these patients were in stable condition. [Ga]Ga-FAPI-04 may be a promising PET agent for the assessment of SFTs. Given the lack of effective treatments for advanced SFTs, high FAP expression in this type of tumor is expected to become a potential treatment target.
孤立性纤维瘤（SFT）是一种罕见的间充质来源肉瘤。虽然通常为良性，但SFT有复发和转移风险，有效治疗选择有限。本研究旨在直接比较成纤维细胞活化蛋白抑制剂（FAPI）、[镓]Ga-DOTA-FAPI-04（记为[镓]Ga-FAPI-04）与传统的[氟]FDG PET/CT在复发性或转移性SFT患者中的表现，并初步探索用镥进行FAP靶向放射性药物治疗对SFT患者的价值。31名疑似复发性或转移性SFT的参与者（21名男性，44±13岁）在1周内接受了[氟]FDG和[镓]Ga-FAPI-04 PET/CT检查。比较了两种PET/CT扫描在不同受累器官中的阳性病变率和摄取值（SUV）。4名[镓]Ga-FAPI-04摄取高的患者接受了单周期2.22 GBq的[镥]Lu标记的FAP靶向放射性药物[镥]Lu-伊文思蓝-FAPI治疗，并随访4个月。在31例患者的522处局部复发和远处转移中，[镓]Ga-FAPI-04 PET检测到的病变明显多于[氟]FDG（87.0%对45.4%，P<0.001）。在病变摄取值方面，[镓]Ga-FAPI-04 PET在大多数复发或转移器官（骨、肺、中枢神经系统、胰腺和胸膜，P<0.001；肾和腹腔盆腔，P = 0.001；肌肉和心包，P<0.05）中的平均SUV高于[氟]FDG。4名患者对[镥]Lu-伊文思蓝-FAPI耐受性良好。全身吸收剂量和有效剂量分别为4.02E-01±3.54E-02 Gy和4.01E+02±4.18E+01 mSv。随后用[镓]Ga-FAPI-04 PET进行的随访显示这些患者病情稳定。[镓]Ga-FAPI-04可能是一种有前景的用于评估SFT的PET显像剂。鉴于晚期SFT缺乏有效治疗方法，这种肿瘤中高表达的FAP有望成为潜在的治疗靶点。
