Iranian Journal of Nuclear Medicine

Iranian Journal of Nuclear Medicine

Head-to-head comparison of [68Ga]Ga-FAP-2286 and [18F]FDG PET/CT in inoperable lung cancer: A prospective pilot study

Articles in Press

Document Type : Original Article

Authors
Masumeh Pourghayoomi 1, 2
Saeed Farzanehfar 1
Niloofar Tabatabaeian 1
Mohammad Reza Ghasri 1
Hamidreza Abtahi 2
Nasim Vahidfar 1
Mehrshad Abbasi 1
1 Department of Nuclear Medicine, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
10.22034/irjnm.2026.130605.1774
Abstract
Introduction: Fibroblast activation protein inhibitor (FAPI) radiotracers have demonstrated high tumor uptake across various malignancies. Comparative data with [18F]FDG in lung cancer are limited. This study evaluates uptake characteristics of [68Ga]Ga-FAP-2286versus [18F]FDG in inoperable lung cancer and explores implications for future FAP-targeted radioligand therapy.
Methods: This prospective pilot study included seven patients with histologically confirmed inoperable lung cancer who underwent standard [18F]FDG PET/CT followed by [68Ga]Ga-FAP-2286 PET/CT within one month. SUVmax and standardized uptake (lesion-to-blood-pool ratio) were measured for primary tumors, lymph nodes, liver, bone, and adrenal metastases. Physiologic biodistribution was also assessed.
Results: Six patients had measurable residual primary tumors. [68Ga]Ga-FAP-2286 showed numerically higher uptake in primary tumors compared with [18F]FDG (SUVmax 5.7±2.2 vs. 5.2±0.9; standardized uptake 4.3±2.3 vs. 2.5±0.9). Mediastinal nodal uptake differences were not statistically significant. All metastatic lesions exhibited uptake above background, indicating robust targeting. [68Ga]Ga-FAP-2286 biodistribution revealed high renal uptake, mild hepatic uptake, and minimal bone-marrow activity, supporting the feasibility of future therapeutic labeling.
Conclusion: In this small prospective pilot study, [68Ga]Ga-FAP-2286 demonstrated favorable uptake in primary and metastatic lung-cancer lesions with low background activity in several normal tissues. These findings are preliminary and hypothesis-generating. Larger prospective studies incorporating lesion-level analysis, standardized imaging methodology, and formal dosimetry are required before definitive conclusions can be drawn regarding diagnostic superiority or therapeutic applicability.
Keywords
Lung noplasms
Positron emission tomography computed tomography
Fibroblast activation protein
Standardized uptake value
Subjects
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Iranian Journal of Nuclear Medicine

Articles in Press, Accepted Manuscript
Available Online from 02 November 2026