Abstract
Simple SummaryPancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, mainly due to difficulty in early detection of the disease by current imaging modalities. In this review, we discuss the more specific diagnostic imaging modality that evaluates the presence of specific tumour tracers via positron emission tomography. In addition, we review the available therapeutic applications of these tumour-specific tracers.Pancreatic ductal adenocarcinoma (PDAC) has an inauspicious prognosis, mainly due to difficulty in early detection of the disease by the current imaging modalities. The upcoming development of tumour-specific tracers provides an alternative solution for more accurate diagnostic imaging techniques for staging and therapy response monitoring. The future goal to strive for, in a patient with PDAC, should definitely be first to receive a diagnostic dose of an antibody labelled with a radionuclide and to subsequently receive a therapeutic dose of the same labelled antibody with curative intent. In the first part of this paper, we summarise the available evidence on tumour-targeted diagnostic tracers for molecular positron emission tomography (PET) imaging that have been tested in humans, together with their clinical indications. Tracers such as radiolabelled prostate-specific membrane antigen (PSMA)—in particular, 18F-labelled PSMA—already validated and successfully implemented in clinical practice for prostate cancer, also seem promising for PDAC. In the second part, we discuss the theranostic applications of these tumour-specific tracers. Although targeted radionuclide therapy is still in its infancy, lessons can already be learned from early publications focusing on dose fractioning and adding a radiosensitiser, such as gemcitabine.
Highlights
Licensee MDPI, Basel, Switzerland.Pancreatic ductal adenocarcinoma (PDAC) is the most frequent type of all pancreatic cancers and has an inauspicious prognosis, with a five-year survival rate of less than5% [1,2]
In the first part of this review, we summarise the available evidence on tumourtargeted imaging tracers for molecular positron emission tomography (PET)-CT imaging that have been tested on humans, together with their clinical indications, and in the second part, we discuss the theranostic applications of these tumour-specific tracers
Röhrich et al showed in a small study including 19 PDAC patients that 68 Ga-FAPI PET-CT led to restaging in half of the patients with PDAC and, in most patients with recurrent disease compared to standard of care imaging
Summary
The upcoming development of tumour-specific tracers provides an alternative solution for more accurate diagnostic techniques, staging, and therapy response monitoring Targeted radionuclides such as radiolabelled peptides, which bind to the receptors overexpressed by cancer cells, and radiolabelled antibodies to tumour-specific antigens can provide a more specific diagnosis [5,6,7]. This development offers new possibilities to maximally capitalise on the theranostic applicability, i.e., the possibility to use the tracer both for imaging purposes as well as a targeting binder for radionuclide therapy. Our search strategy for both the diagnostic and therapeutic sections consisted of a general search of diagnostic and therapeutic tracers in pancreatic cancer, followed by a search of specific tracers and, reviewing the papers for leads to other—not yet included—tracers
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