Fibroblast Activation Protein Inhibitor-PET Imaging in Colorectal Cancer

Area of Science:

• Oncology
• Nuclear Medicine
• Molecular Imaging

Background:

• Colorectal cancer (CRC) management faces challenges, particularly with aggressive subtypes and metastases.
• Fibroblast activation protein (FAP) is upregulated in various cancers, including CRC, and is associated with poor prognosis.
• FAPI-PET imaging offers a novel approach to visualize FAP expression in vivo.

Purpose of the Study:

• To explore the potential of FAPI-PET imaging in addressing key clinical dilemmas in colorectal cancer diagnosis and treatment.
• To highlight the role of FAPI expression in specific CRC contexts, such as lymph node and peritoneal metastases, and Consensus Molecular Subtype 4.
• To propose FAPI-PET as a tool to guide therapeutic strategies, especially for immunotherapy-resistant tumors.

Main Methods:

• Review and analysis of existing literature on FAPI-PET imaging in colorectal cancer.
• Identification of clinical scenarios where FAPI expression is a significant factor.
• Proposal for future clinical trial designs incorporating FAPI-PET.

Main Results:

• FAPI expression is notably high in lymph node metastases, peritoneal metastases, and Consensus Molecular Subtype 4 CRC.
• FAPI-PET imaging can potentially differentiate aggressive tumor phenotypes and predict treatment response.
• FAPI-PET may help resolve six defined clinical dilemmas in CRC management.

Conclusions:

• FAPI-PET imaging is a promising tool for enhancing colorectal cancer management.
• Targeting FAP with PET imaging can provide valuable insights into tumor biology and guide treatment decisions.
• Future research should integrate FAPI-PET with histopathological and molecular analyses in clinical trials.