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Related Experiment Video

Updated: Jan 10, 2026

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[18F]F-FAPI PET/CT and LAparoscopy in STagIng advanced gastric Cancer: a multicenter prospective study (PLASTIC-3

Lianne Triemstra1,2, Sarah W J M Spruijt2, Dennis Vriens3

  • 1Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

BMC Cancer
|November 27, 2025
PubMed
Summary

This study investigates [18F]AlF-FAPI-74 PET/CT for staging locally advanced gastric cancer, aiming to improve accuracy and reduce unnecessary treatments. The new imaging technique shows promise in detecting metastases, potentially optimizing patient care and quality of life.

Keywords:
GastrectomyGastric cancerLaparoscopyPET-CTRadiopharmaceuticals

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Area of Science:

  • Oncology
  • Radiology
  • Nuclear Medicine

Background:

  • Locally advanced gastric adenocarcinoma staging relies on invasive methods like CT scans and staging laparoscopy, which have limitations in detecting distant metastases.
  • Fibroblast-activating protein inhibitors (FAPI) are emerging as promising radiotracers for PET/CT imaging, with preliminary studies suggesting superiority over [18F]FDG PET/CT in gastric cancer.
  • There is a need for larger studies in Western populations to validate the diagnostic accuracy and clinical impact of FAPI PET/CT for gastric cancer staging.

Purpose of the Study:

  • To evaluate the clinical impact and diagnostic accuracy of [18F]AlF-FAPI-74 PET/CT in staging patients with locally advanced gastric adenocarcinoma.
  • To determine if [18F]AlF-FAPI-74 PET/CT can optimize patient staging, reduce futile treatments, and improve quality of life.
  • To assess the potential of [18F]AlF-FAPI-74 PET/CT to decrease healthcare costs associated with gastric cancer management.

Main Methods:

  • A Dutch multicenter prospective clinical trial will enroll 250 patients with resectable, locally advanced gastric adenocarcinoma.
  • The study will investigate the diagnostic performance of [18F]AlF-FAPI-74 PET/CT compared to a composite reference standard including staging laparoscopy findings.
  • Primary outcome is the proportion of patients with a change in treatment intent based on [18F]AlF-FAPI-74 PET/CT results; secondary outcomes include diagnostic accuracy and patient burden.

Main Results:

  • The study hypothesizes that [18F]AlF-FAPI-74 PET/CT will detect M1-disease in approximately two-thirds of gastric cancer patients.
  • The trial aims to provide data on the diagnostic performance and clinical utility of [18F]AlF-FAPI-74 PET/CT in a representative Western cohort.
  • Cost-effectiveness will be compared to existing methods, potentially demonstrating reduced healthcare costs.

Conclusions:

  • This study is expected to validate [18F]AlF-FAPI-74 PET/CT as a valuable tool for staging gastric cancer, potentially improving treatment decisions.
  • The findings could lead to optimized treatment pathways, enhanced patient quality of life, and reduced healthcare expenditures.
  • Results will be relevant for healthcare systems with similar gastric cancer treatment algorithms.