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@ARTICLE{Kessler:307575,
      author       = {L. Kessler$^*$ and F. Schwaning$^*$ and M. Metzenmacher$^*$
                      and K. M. Pabst$^*$ and M. Opitz and M. Wiesweg$^*$ and C.
                      Aigner and T. Ploenes$^*$ and S. Boeloekbas and F. Doerr and
                      M. Stuschke and L. Umutlu and M. Nader$^*$ and D. Theegarten
                      and W. E. Eberhardt$^*$ and M. Schuler$^*$ and K.
                      Herrmann$^*$ and W. P. Fendler$^*$ and D. Kersting$^*$ and
                      H. Hautzel$^*$},
      title        = {{P}rognostic {V}alue of {F}ibroblast {A}ctivation
                      {P}rotein-{D}irected {PET} {I}maging in {P}leural
                      {M}esothelioma.},
      journal      = {Journal of nuclear medicine},
      volume       = {nn},
      issn         = {0097-9058},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {DKFZ-2026-00070},
      pages        = {nn},
      year         = {2026},
      note         = {#DKTKZFB9# / #NCTZFB26# / epub},
      abstract     = {High 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.},
      keywords     = {FAPI (Other) / cancer imaging (Other) / fibroblast
                      activation protein (Other) / mesothelioma (Other) /
                      theranostic (Other)},
      cin          = {ED01 / WT01 / DD04},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331 / I:(DE-He78)WT01-20160331 /
                      I:(DE-He78)DD04-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41506801},
      doi          = {10.2967/jnumed.125.270906},
      url          = {https://inrepo02.dkfz.de/record/307575},
}