2025/10/09 by William McGahan, Alexa Chadwick, Karen Lindsay +7
Biochemistry, Genetics and Molecular Biology · Medicine · #Pancreatic and Hepatic Oncology Research #Peptidase Inhibition and Analysis #Protease and Inhibitor Mechanisms
paper · doi:10.2967/jnumed.125.270510
openalex publication_date 2025/10/09 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/29
PET/CT using <sup>68</sup>Ga-labeled fibroblast activation protein inhibitor (<sup>68</sup>Ga-FAPI) may detect occult metastases and identify aggressive tumor biology in patients with pancreatic ductal adenocarcinoma (PDAC). We evaluated the impact of <sup>68</sup>Ga-FAPI PET/CT on surgical treatment in this patient population. <b>Methods:</b> Patients with PDAC who were deemed operative candidates after standard CT underwent pretreatment <sup>68</sup>Ga-FAPI PET/CT and were followed until confirmation of treatment intent. Lymph node ratio in resected tumors was used as a surrogate marker for tumor biology and correlated with the SUV<sub>max</sub> of the primary tumor using linear regression. <b>Results:</b> Of 16 eligible participants, 5 (31%) had metastases that were not visible on CT scans but were detected with <sup>68</sup>Ga-FAPI PET/CT, and surgery was prevented. No additional investigations were prompted by <sup>68</sup>Ga-FAPI PET/CT unless they changed treatment intent. Two participants without metastases on <sup>68</sup>Ga-FAPI PET/CT did not have surgery because of local progression after neoadjuvant therapy. The SUV<sub>max</sub> of the primary tumor at 60 min correlated with the lymph node ratio in resected PDAC (<i>P</i> = 0.04). <b>Conclusion:</b><sup>68</sup>Ga-FAPI PET/CT may enhance treatment selection in PDAC. Comparative trials are the next step to confirm role in the clinical setting.