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Purpose <p>The increasing use of PET/CT with radiolabelled fibroblast activation protein inhibitors (FAPI) as diagnostic imaging across various malignancies has prompted growing interest to predict treatment response and prognosis, particularly in the immunotherapy setting. In this context, its ability to detect inflammatory-related FAPI uptake also enables early identification of immune-related adverse events. This short review aims to evaluate, in oncological patients undergoing immunotherapy, the potential role of FAPI PET imaging in predicting treatment response and prognosis, as well as in detecting immune-related adverse events.</p> Methods <p>A literature search was performed using PubMed and Scopus databases (last update: June 2025), employing keywords related to fibroblast activation protein (FAP), FAP inhibitors (FAPI), PET, immunotherapy and immune-related adverse events. Clinical studies investigating the role of FAPI PET imaging in predicting tumour response to immunotherapy and prognosis, as well as reporting incidental detection of immuno-related adverse events, were selected.</p> Results <p>From a total of 81 articles initially retrieved, 11 studies were finally included: four addressing the predictive role of FAPI PET imaging in immunotherapy response and prognosis, and seven reporting its utility in detecting immune-related adverse events.</p> Conclusions <p>In oncological patients treated with immunotherapy, FAPI PET imaging emerges as a promising tool for predicting both tumour response and prognosis, outperforming [¹⁸F]FDG PET/CT in selected studies. Furthermore, it shows potential in the early detection of immuno-related adverse events, particularly myocarditis, thyroiditis, arthritis and retroperitoneal fibrosis. Larger prospective clinical trials are warranted to validate its utility as a non-invasive tool for identifying patients most likely benefiting from immunotherapy.</p>

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Radiolabelled FAPI PET imaging in the era of immunotherapy: potential role in predicting tumour response and prognosis, and detecting immune-related adverse events – a short review

  • 期刊论文

  • 发表日期：

    2026年2月24日

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  • Elisabetta Perrone,
  • Silvia Taralli,
  • Maria Lucia Calcagni,
  • Lucia Leccisotti

摘要

Purpose

The increasing use of PET/CT with radiolabelled fibroblast activation protein inhibitors (FAPI) as diagnostic imaging across various malignancies has prompted growing interest to predict treatment response and prognosis, particularly in the immunotherapy setting. In this context, its ability to detect inflammatory-related FAPI uptake also enables early identification of immune-related adverse events. This short review aims to evaluate, in oncological patients undergoing immunotherapy, the potential role of FAPI PET imaging in predicting treatment response and prognosis, as well as in detecting immune-related adverse events.

Methods

A literature search was performed using PubMed and Scopus databases (last update: June 2025), employing keywords related to fibroblast activation protein (FAP), FAP inhibitors (FAPI), PET, immunotherapy and immune-related adverse events. Clinical studies investigating the role of FAPI PET imaging in predicting tumour response to immunotherapy and prognosis, as well as reporting incidental detection of immuno-related adverse events, were selected.

Results

From a total of 81 articles initially retrieved, 11 studies were finally included: four addressing the predictive role of FAPI PET imaging in immunotherapy response and prognosis, and seven reporting its utility in detecting immune-related adverse events.

Conclusions

In oncological patients treated with immunotherapy, FAPI PET imaging emerges as a promising tool for predicting both tumour response and prognosis, outperforming [¹⁸F]FDG PET/CT in selected studies. Furthermore, it shows potential in the early detection of immuno-related adverse events, particularly myocarditis, thyroiditis, arthritis and retroperitoneal fibrosis. Larger prospective clinical trials are warranted to validate its utility as a non-invasive tool for identifying patients most likely benefiting from immunotherapy.