FAP Expression in Renal Tumors Assessed by [<sup>68</sup>Ga]Ga-FAPI-46 PET Imaging and FAP Immunohistochemistry: A Case Series of Six Patients from the Prospective Exploratory Trial NCT04147494.

Holzgreve, Adrien; Unterrainer, Lena M; Flores, Kimberly; Lam, Ethan C; Mona, Christine E; Czernin, Johannes; Shuch, Brian M; Sisk, Anthony E et al. · J Nucl Med · 2026

case_series · Level IV

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Abstract

Fibroblast activation protein (FAP) has been proposed as a pan-tumor target for PET imaging using FAP-targeted tracers. Here, we explore the potential value of FAP PET in renal tumors. <b>Methods:</b> Six patients with renal tumors (4 with clear cell renal cell carcinoma, 1 with papillary renal cell carcinoma, and 1 with renal oncocytoma) who were included in a prospective imaging study (NCT04147494) underwent [<sup>68</sup>Ga]Ga-FAPI-46 PET before nephrectomy. FAP PET radiotracer uptake and FAP expression by immunohistochemistry were assessed in the tumors and surrounding renal parenchyma. <b>Results:</b> Tumoral FAP radiotracer uptake was highest in clear cell renal cell carcinoma (median SUV<sub>max</sub>, 3.1; range, 2.5-5.3), followed by renal oncocytoma (SUV<sub>max</sub>, 1.9) and papillary renal cell carcinoma (SUV<sub>max</sub>, 1.1). The FAP PET signal strongly correlated with FAP expression by immunohistochemistry (SUV<sub>max</sub>; <i>r</i> = 0.93; <i>P</i> = 0.007). <b>Conclusion:</b> FAP expression in different renal tumors, including renal cell carcinoma, was lower when compared with cancers with known FAP expression, such as sarcoma. Although our data do not favor FAP-based theranostic approaches in renal cell carcinoma, studies in larger cohorts are warranted for conclusive evidence.

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