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000307575 1001_ $$0P:(DE-HGF)0$$aKessler, Lukas$$b0
000307575 245__ $$aPrognostic Value of Fibroblast Activation Protein-Directed PET Imaging in Pleural Mesothelioma.
000307575 260__ $$aNew York, NY$$bSoc.$$c2026
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000307575 520__ $$aHigh expression of fibroblast activation protein (FAP) has been associated with inferior survival in several tumor entities. Novel 68Ga-radiolabeled FAP inhibitors (68Ga-FAPIs) allow noninvasive measurement of FAP, which enables the development of prognostic imaging parameters from 68Ga-FAPI PET/CT. In this study, we compared the prognostic value of 68Ga-FAPI-46 with 18F-FDG PET in a cohort of patients with malignant pleural mesothelioma from the FAPI PET observational trial (NCT04571086). Methods: Between May 2020 and January 2024, 49 patients with suspected or proven malignant mesothelioma were recruited, 39 of whom were eligible for data analysis. All patients underwent 68Ga-FAPI-46 and 18F-FDG PET/CT less than 4 wk apart. Tumor burden was measured semiautomatically, and SUVmax, SUVmean, and volumetric parameters (metabolic tumor volume [MTV], total lesion glycolysis/total lesion fibroblast activation, and total tumor SUV) were calculated. The FAP immunoreactive score (IRS) was calculated for tumor samples from a subset of patients (n = 19). Overall survival and progression-free survival were assessed per revised mRECIST (version 1.1). Survival analyses were performed with univariate and multivariate Cox regression and with Kaplan-Meier curves for clinical and imaging parameters, stratified by median. Results: Univariate analysis showed significant survival differences for all volumetric parameters for 68Ga-FAPI-46 and 18F-FDG (e.g., 68Ga-FAPI-46 MTV, 262 d vs. 737 d; P = 0.008 vs. 18F-FDG MTV, 336 d vs. 760 d; P = 0.012). Multivariate analysis revealed that MTV was an independent prognostic marker for 68Ga-FAPI-46 (hazard ratio, 4.44; 95% CI, 1.20-16.43; P = 0.025) and 18F-FDG (hazard ratio, 7.01; 95% CI, 1.29-38.2; P = 0.024). Kaplan-Meier analysis of the FAP IRS found that a higher IRS was associated with poorer survival (438 d with an IRS of 0-3 vs. 1,076 d with an IRS of 4-12; P = 0.04), but no significant difference was observed in univariate and multivariate analyses. Conclusion: In this modest exploratory cohort of patients with malignant pleural mesothelioma, MTV determined by 68Ga-FAPI-46 and 18F-FDG PET/CT had similar prognostic value, and high MTV was an independent risk factor. 68Ga-FAPI-46 not only complements a diagnostic work-up but also provides prognostic value and could offer alternative theranostic strategies for these patients.
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000307575 650_7 $$2Other$$aFAPI
000307575 650_7 $$2Other$$acancer imaging
000307575 650_7 $$2Other$$afibroblast activation protein
000307575 650_7 $$2Other$$amesothelioma
000307575 650_7 $$2Other$$atheranostic
000307575 7001_ $$0P:(DE-HGF)0$$aSchwaning, Felix$$b1
000307575 7001_ $$0P:(DE-HGF)0$$aMetzenmacher, Martin$$b2
000307575 7001_ $$0P:(DE-HGF)0$$aPabst, Kim M$$b3
000307575 7001_ $$aOpitz, Marcel$$b4
000307575 7001_ $$0P:(DE-HGF)0$$aWiesweg, Marcel$$b5
000307575 7001_ $$aAigner, Clemens$$b6
000307575 7001_ $$0P:(DE-HGF)0$$aPloenes, Till$$b7
000307575 7001_ $$aBoeloekbas, Servet$$b8
000307575 7001_ $$aDoerr, Fabian$$b9
000307575 7001_ $$aStuschke, Martin$$b10
000307575 7001_ $$aUmutlu, Lale$$b11
000307575 7001_ $$0P:(DE-HGF)0$$aNader, Michael$$b12
000307575 7001_ $$aTheegarten, Dirk$$b13
000307575 7001_ $$0P:(DE-HGF)0$$aEberhardt, Wilfried E$$b14
000307575 7001_ $$0P:(DE-HGF)0$$aSchuler, Martin$$b15
000307575 7001_ $$0P:(DE-HGF)0$$aHerrmann, Ken$$b16
000307575 7001_ $$0P:(DE-HGF)0$$aFendler, Wolfgang P$$b17
000307575 7001_ $$0P:(DE-HGF)0$$aKersting, David$$b18
000307575 7001_ $$0P:(DE-HGF)0$$aHautzel, Hubertus$$b19
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