New procedure standard/practice guideline released for fibroblast activation protein PET

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the European Association of Nuclear Medicine (EANM) have issued a new procedure standard/practice guideline for the use of fibroblast activation protein (FAP) PET. Published in the January issue of The Journal of Nuclear Medicine, the procedure standard/practice guideline was developed to assist providers in recommending and performing FAP PET, as well as interpreting and reporting results of the imaging studies.

FAP is a transmembrane protein expressed on both cancer-associated fibroblasts and on normal activated fibroblasts involved in wound healing and tissue repair. FAP has long been a target for cancer therapy, but the development of FAP targeted radioligands has led to an increased interest in imaging FAP for assessment of cancer and other diseases.

 "FAP PET imaging can be used for initial staging, re-staging, therapy response evaluation, and whole-body target expression assessment for therapy selection," noted the authors. "This procedure standard/practice guideline provides referring physicians with the best available evidence to help them to deliver the best possible diagnostic efficacy and study quality for their patients."

 The procedure standard/practice guideline outlines several oncologic indications for FAP PET imaging, including gastro-intestinal adenocarcinoma, pancreatic ductal adenocarcinoma, esophageal, head and neck cancer, thyroid, lung, ovarian and breast cancers, as well as non-oncologic indications such as inflammation and fibrosis. In addition, it reviews the qualifications and responsibilities of imaging personnel, and presents standardized quality control/quality assurance procedures and imaging procedures for FAP PET. 

 "FAP PET is in its early days, and there will be significant changes to our understanding of its role as we learn more," the authors said. "Moving forward, it is essential to establish well-designed prospective clinical trials to help elucidate the clinical role of FAP PET and lead to regulatory approval of these imaging agents. There will also be a need to better understand the clinical impact of more accurate disease detection and treatment response assessment. FAP PET is an incredibly promising imaging agent, and we look forward to its broad future in clinical practice."