Will FAPI PET/CT Replace FDG PET/CT in the Next Decade? Point-An Important Diagnostic, Phenotypic, and Biomarker Role

FAP is a highly promising target for cancer imaging and therapy. FAPI PET images document a high TBR as a prerequisite for its use as a theranostic pair. Although clinical exploration and exploitation are still in early stages, it is likely that FAP-targeted radiolabeled probes will contribute to the treatment of cancer patients. FAPI can play a role in the diagnostic imaging of some cancers for which FDG is known to have limited value. More important, FAPI PET/CT will be most attractively applied as a predictive biomarker of therapeutic responses to FAP-targeted treatments. Finally, FAPI, but not FDG, can be labeled with therapeutic radionuclides. The biomarker and theranostic use of FAPI PET can have high value in cancer therapeutics and will drive clinical adoption of the agent. In summary, over the coming decade FAPI PET/CT will add important complementary diagnostic, phenotypic, and biomarker information to FDG PET/CT, and radiologists must be aware of this information. © 2021 American Roentgen Ray Society. All rights reserved.