FAPI Therapy

Targeted nuclear medicine therapy, known as FAPI Therapy (fibroblast activation protein inhibitor therapy), is a cutting-edge treatment applied in selective cancer therapies. It is intended to target radiation towards tumour-associated fibroblasts, which are found in the supportive tissue of many solid tumors. Dr. Nikunj Jain and the Nuclear Medicine team at Molecular Diagnostics and Therapy offer patients and their physicians comprehensive guidance and support in molecular imaging assessment and customised treatment planning for advanced targeted TNM therapies.

There are several cancers associated with activated fibroblast cells called cancer-associated fibroblasts (CAFs). These cells contain a protein called Fibroblast Activation Protein (FAP). A molecule is designed to selectively bind to these FAP- expressing cells. In combination with therapeutic radioactive isotopes, FAPI is able to target the radiation to the tumour sites and spare the radiation to surrounding healthy tissues. FAPI Therapy is a new strategy in precision oncology, where treatment is based on the distinct nature of the tumour and not its location and/or size.

What is FAPI Therapy?

FAPI Therapy is a targeted radioligand therapy that involves a therapeutic radionuclide conjugated to a molecule with targeting properties of a Fibroblast Activation Protein (FAP) receptor. The FAPI compound targets and binds to CAFs inside and around tumours. This therapy can treat the following conditions:

• Targeted delivery of radiation to tumour-associated tissues.

• Treatment of selected advanced or metastatic cancers.

• Providing an additional therapeutic option when conventional treatments may be insufficient.

• Supporting personalised cancer management based on molecular characteristics.

• Reducing unnecessary radiation exposure to normal tissues.

Before therapy, a FAPI PET scan may be performed to evaluate FAP expression and determine whether the patient is likely to benefit from treatment.

Why is FAPI Therapy Used?

FAPI Therapy may be considered in selected patients when:

• The tumour shows significant FAP expression on FAPI PET imaging.

• The cancer is advanced or metastatic.

• Standard treatment options have limited effectiveness.

• A targeted molecular therapy approach is required.

• The treating oncology and nuclear medicine team considers the patient suitable.

FAPI Therapy is being investigated and used in several solid tumours, including:

• Pancreatic cancer

• Breast cancer

• Lung cancer

• Colorectal cancer

• Gastric cancer

• Sarcomas

• Head and neck cancers

• Other advanced solid malignancies

The suitability of therapy depends on tumour biology, previous treatments, overall health condition, and imaging findings.

Preparation Before FAPI Therapy

It's crucial to be properly prepared to ensure safe and effective treatment. Before the therapy, the patient's medical history, previous treatments, laboratory reports, and radiological imaging reports are reviewed by the Nuclear Medicine team.

1. Clinical Evaluation

Before treatment, the doctor may review:

• Previous cancer diagnosis and biopsy reports

• PET CT/MRI/CT scan reports

• Previous chemotherapy or radiotherapy history

• Kidney and liver function tests

• Blood counts

• Overall medical condition

2. FAPI PET Imaging Assessment

A diagnostic FAPI PET scan may be performed before therapy to:

• Confirm FAP expression in tumour tissues.

• Evaluate disease distribution.

• Assess whether the radioactive therapy is likely to target tumour sites effectively.

• Plan the appropriate treatment approach.

3. Medication and Medical History Review

Patients should inform the doctor about:

• Current medications

• Allergies

• Supplements or herbal products

• Previous radiation treatments

• Other medical conditions

Your doctor will provide specific instructions according to your condition.

How is FAPI Therapy Administered?

FAPI Therapy is usually administered through an intravenous injection containing the therapeutic radiopharmaceutical. Key points include:

• The prescribed radioactive FAPI compound is administered through a vein.

• The compound travels through the bloodstream and binds to FAP-expressing tumour tissues.

• Radiation is delivered directly to targeted cancer-associated cells.

• The procedure is performed under the supervision of Nuclear Medicine specialists.

• The patient may require monitoring for a short period after administration.

The treatment process is generally well planned and personalised according to the patient's imaging findings and medical condition.

Post-Therapy Safety Instructions

Although FAPI Therapy is designed for targeted radiation delivery, some precautions may be recommended after treatment to reduce radiation exposure to others. Patients may be advised to:

• Drink plenty of fluids to help eliminate excess radioactive material.

• Follow radiation safety instructions provided by the Nuclear Medicine team.

• Maintain appropriate distance from children and pregnant women for the advised duration.

• Maintain good personal hygiene.

• Follow toilet and hygiene precautions as instructed.

• Avoid prolonged close contact with others if advised.

The Nuclear Medicine team provides personalised safety instructions based on the administered activity and patient condition.

Follow-Up After FAPI Therapy

Follow-up evaluation is important to assess treatment response and disease status. Follow-up may include:

• Clinical assessment by the treating doctor.

• Blood investigations as required.

• Follow-up FAPI PET CT or other imaging studies.

• Evaluation of tumour response.

• Monitoring of symptoms and treatment effects.

The follow-up schedule depends on the type of cancer, treatment response, and doctor's recommendation.

Benefits of FAPI Therapy

• Targeted molecular treatment approach.

• Delivers radiation directly to tumour-associated fibroblasts.

• May provide a treatment option for selected advanced cancers.

• Helps personalise cancer therapy based on tumour biology.

• Potentially reduces radiation exposure to normal tissues.

• Can be considered in patients with limited treatment options.

• Combines advanced molecular imaging with targeted therapy.

Possible Side Effects

Side effects of FAPI Therapy are generally monitored carefully and may vary depending on the radioactive isotope used, administered dose, and the patient's condition. Possible effects may include:

• Fatigue

• Mild nausea

• Temporary weakness

• Mild changes in blood counts

• Temporary reduction in blood cell levels

• Rare effects on organs receiving radiation exposure

Your Nuclear Medicine specialist will explain possible risks and expected benefits before treatment.

Conclusion

FAPI Therapy is an advanced treatment strategy in targeted radionuclide therapy that relies on molecular target binding and targeting of tumor-associated fibroblasts by radiation. The therapy detects the cells in a tumour that express FAP and offers a targeted therapy to certain patients with advanced solid tumours.

FAPI Therapy is successful and appropriate if the patient is also selected properly, molecular imaging is evaluated, and the treatment is planned expertly. Dr. Nikunj Jain at Molecular Diagnostics and Therapy specialises in evaluating and giving individualized instructions at each phase of FAPI diagnosis and therapy.

Instructions

• Carry all previous medical records, including biopsy reports, PET CT/MRI/CT reports, treatment history, and laboratory investigations.

• Inform your doctor about all medications, supplements, and previous treatments.

• Complete recommended blood tests before therapy.

• Inform your doctor if you are pregnant, planning pregnancy, or breastfeeding.

• Follow all radiation safety instructions provided by the Nuclear Medicine team.

• Maintain adequate hydration after therapy as advised.

• Arrive at the centre before the scheduled appointment time for registration and preparation.

निर्देश

• अपनी सभी पुरानी मेडिकल रिपोर्ट जैसे बायोप्सी रिपोर्ट, PET CT/MRI/CT रिपोर्ट, इलाज का इतिहास और ब्लड टेस्ट रिपोर्ट साथ लेकर आएं।

• डॉक्टर को अपनी सभी दवाइयों, सप्लीमेंट्स और पहले किए गए उपचारों की जानकारी दें।

• उपचार से पहले आवश्यक ब्लड टेस्ट डॉक्टर की सलाह के अनुसार करवाएं।

• यदि आप गर्भवती हैं, गर्भधारण की योजना बना रही हैं या स्तनपान करा रही हैं, तो डॉक्टर को अवश्य बताएं।

• न्यूक्लियर मेडिसिन टीम द्वारा दिए गए रेडिएशन सुरक्षा निर्देशों का पालन करें।

• उपचार के बाद डॉक्टर की सलाह के अनुसार पर्याप्त मात्रा में पानी पिएं।

• पंजीकरण और तैयारी के लिए निर्धारित समय से पहले केंद्र पर पहुंचें।

Procedure

• Before FAPI Therapy, the Nuclear Medicine team reviews the patient's medical history, imaging reports, laboratory results, and treatment suitability.

• The recommended therapeutic FAPI radiopharmaceutical is administered intravenously under specialist supervision.

• The radioactive compound circulates through the body and selectively binds to tumour tissues expressing Fibroblast Activation Protein.

• The therapy delivers targeted radiation to tumour-associated fibroblasts while limiting exposure to surrounding normal tissues.

• After administration, the patient receives personalised radiation safety instructions regarding hydration, hygiene, family contact, and precautions.

• Follow-up imaging and clinical evaluation are planned according to the patient's condition and treatment response.

• The Nuclear Medicine and oncology team continues monitoring the patient throughout the treatment journey.