Radiolabeled FAPI in pancreatic cancer: can it be an additional value in the management of patients?

IntroductionTo discuss the current evidence about radiolabeled-FAPI in patients affected by pancreatic cancer by underlying the advantages, disadvantages, and the future perspectives also in the theragnostic field.Areas coveredA literature search up until February 2023 was performed in PubMed, EBSCO, and EMBASE databases. Clinical reports, conference abstracts, editorials, and letters-to-the-editor were excluded. The results were presented according to the PRISMA guidelines. The quality of studies was evaluated by using the Critical Appraisal Skill Program checklist.Expert opinionFrom the initial 139 studies, 21 papers were selected for the final analysis. Ten papers were related to FAPI-uptake in health/benign/malignant pancreas, eight studies were focalized on the utility of radiolabeled-FAPI for the identification of premalignant and malignant pancreatic lesions and only three papers were related to the the theragnostic approach. Only two papers enrolled exclusively patients with pancreatic cancer undergoing FAPI-PET. In total, 55 patients underwent FAPI-PET for the identification of the suspicious mass/primary tumor (n = 43) and recurrent disease (n = 12). In both the studies, FAPI-PET detected more lesions than 2-[F-18]FDG. Preliminary data about the FAPI-based theragnostic approach in patients with pancreatic cancer (n = 9 patients, totally) are now available. Radiolabeled-FAPI is a promising agent for the identification of pancreatic malignant lesions, but further prospective studies are still necessary.

Automated summary

This study reviewed the application of radiolabeled-FAPI in patients with pancreatic cancer, discussing its advantages, disadvantages, and future prospects, especially in the field of theragnostic. A literature search was performed in PubMed, EBSCO, and EMBASE databases, and 21 studies were selected for comprehensive analysis. The results showed that FAPI could better detect pancreatic malignant lesions, but further prospective studies are needed to validate its effectiveness.