Fibroblast Activation Protein Inhibitor-PET Imaging in Colorectal Cancer

Fibroblast activation protein inhibitor (FAPI)-PET imaging holds great promise for improving the clinical management of colorectal cancer. High fibroblast activation protein expression is particularly observed in lymph node metastases, in the aggressive Consensus Molecular Subtype 4, in peritoneal metastases, and in tumors that respond poorly to immunotherapy. We have defined six clinical dilemmas in the diagnosis and treatment of colorectal cancer, which FAPI-PET may help solve. Future clinical trials should include patients undergoing tumor resection, allowing correlation of FAPI-PET signals with in-depth histopathological, cellular, and molecular tissue analyses.