In the retrospective study, researchers used PET/CT to image 80 patients with 28 different kinds of cancer, aiming to quantify 68Ga-FAPI uptake in primary, metastatic or recurring cancers. All patients were referred for experimental diagnostics by their treating oncologists because they were facing an unmet diagnostic challenge that could not be solved sufficiently with standard methods. The injected activity for the 68Ga-FAPI examinations was 122-312 MBq, and the PET scans were initiated one hour after injection. Tumor tracer uptake was measured by SUVmean and SUVmax.
Wireless communication. While instant messaging and walkie-talkies aren't new technologies themselves, they have only recently been introduced into the hospital setting, replacing devices like beepers and overhead pagers. "Hospitals are catching up to the 21st century with staff communicating to one another," Mr. Higman says, adding that internal communication advancements in hospitals followed a slower development timeline since they had to account for security and HIPAA concerns.
All patients tolerated the examination well. As the overall SUV mean, median and range of 68Ga-FAPI in primary tumors and metastatic lesions did not differ significantly, researchers analyzed all results in one group.The highest average SUVmax (SUVmax >12) was found in sarcoma, esophageal, breast, cholangiocarcinoma and lung cancer. The lowest 68Ga-FAPI uptake (average SUVmax <6) was observed in pheochromocytoma, renal cell, differentiated thyroid, adenoid cystic and gastric cancers. The average SUVmax of hepatocellular, colorectal, head-neck, ovarian, pancreatic and prostate cancer was intermediate (SUVmax 6-12). In addition, the tumor-to-background ratios were more than three-fold in the intermediate group and more than six-fold in the high-intensity uptake group, resulting in high image contrast and excellent tumor delineation.
"The remarkably high uptake of 68Ga-FAPI makes it useful for many cancer types, especially in cases where traditional 18F-FDG PET/CT faces limitations," said Uwe Haberkorn, MD, professor of nuclear medicine at the University Hospital of Heidelberg and the German Cancer Research Center in Heidelberg, Germany. "For example, low-grade sarcomas generally have a low uptake of 18F-FDG, causing an overlap between benign and malignant lesions. In breast cancer, 18F-FDG PET/CT is commonly used in recurrence, but not generally recommended for initial staging. And for esophageal cancer, 18F-FDG PET/CT often has only a low to moderate sensitivity for lymph node staging."
In contrast to 18F-FDG PET/CT, 68Ga-FAPI PET/CT can be performed without specific patient preparation such as fasting or recline during uptake time. This is a potential operational advantage for 68Ga-FAPI PET/CT, as it stands to improve patient comfort and accelerate work-flow. According to Haberkorn, 68Ga-FAPI offers the possibility of a theranostic approach in the future. "Cancer associated fibroblasts have been described as immunosuppressive and as conferring resistance to chemotherapy, which makes them attractive targets for combination therapies," he said. "Because the 68Ga-FAPI tracers contain the universal DOTA-chelator, it is possible to label them with therapeutic radionuclides whose half-life fits to the tumor retention time of the carrier molecule. Since the tracer has been observed to accumulate in several important tumor entities, there may be a huge field of therapeutic application to be evaluated in the future."
Gamifying behavior change. Adherence and compliance represent crucial issues in improving patients’ health and decreasing the cost of delivering healthcare. Several start-ups have targeted this issue with different solutions such as a pill bottle that glows blue when a medication dose should be taken and red when a dose is missed (winner of the Healthcare Innovation World Cup); or tiny digestible sensors that can be placed in pills and can transmit pill digestion data to physicians and family members. While patients do not like the term adherence as they want to be partners with their caregivers rather than following orders, health insurance companies will use more and more data to check whether the patients comply with their prescriptions to decrease their insurance costs. The wildly popular Pokemon Go motivates people to walk more which might lead to fighting obesity while playing a game.