FAP-targeted Radio-ligand Therapy in Pancreatic Neuroendocrine Tumor

A 47-year-old man presented with a grade II well-differentiated metastatic neuroendocrine tumor originating from the pancreas. Initial treatment included trans-arterial embolization, long-acting octreotide, followed by chemotherapy. Despite these interventions, progressive disease was noted, prompting evaluation for peptide receptor radionuclide therapy using 68 Ga-DOTATATE PET/CT; however, this imaging revealed nonavid lesions. Subsequently, a 99m Tc-FAPI-46 scan was conducted, demonstrating favorable uptake in both the liver metastases and the primary tumor, leading to the administration of 177 Lu-FAPI-2286 therapy. This case highlights the potential of FAPI as a novel imaging and therapeutic strategy in the management of neuroendocrine tumors.