FAP-targeted radioligand therapy Lu-177–FAPI for Tumors | Theranostics Section of TUM University Hospital Rechts der Isar

FAP-targeted theranostics at the Theranostics Section of TUM University Hospital Rechts der Isar combine molecular imaging and targeted radionuclide therapy into a single coordinated package. Using FAP PET/CT with a FAPI tracer, the team visualizes fibroblast activation protein (FAP) expression in tumor-associated tissue to support precise staging and to confirm whether a FAP-directed approach is a meaningful option for an individual case, with care delivered through a specialized theranostics unit that supports both outpatient evaluation and inpatient therapy when needed. If imaging confirms relevant target expression, Lu-177–FAPI radioligand therapy delivers tumor-focused radiation via a ligand that binds to FAP, aiming to concentrate the therapeutic dose in FAP-positive disease while limiting exposure to non-target tissues. Because Lu-177–FAPI is an emerging strategy across multiple solid tumor settings, treatment is typically planned on an individualized basis within a high-expertise theranostics environment that is also active in translating and implementing newer theranostic procedures. The application will be possible for the following tumors (but not limited):Pancreatic cancer: FAP PET/CT is frequently explored in pancreatic ductal adenocarcinoma because many cases show strong FAPI uptake, and FAP-targeted radioligand therapy is most often discussed in the literature for advanced, treatment-refractory pancreatic disease when target uptake is confirmed on FAP imaging. Hepatobiliary tumors: FAPI PET/CT has shown particularly high uptake in cholangiocarcinoma and is also increasingly reported across other hepatobiliary malignancies (including hepatocellular carcinoma), where it can complement standard imaging, especially when FDG PET/CT underperforms in certain cases. Upper GI cancers: FAPI PET/CT is repeatedly highlighted in gastroesophageal cancers (notably esophageal and gastric malignancies) as a tumor group where FAP imaging can improve lesion conspicuity and support theranostic selection if uptake is sufficiently high. Sarcomas: Among solid tumors, sarcomas are consistently reported to have some of the highest FAPI tracer uptake, and published overviews cite sarcoma as one of the settings with the most encouraging early clinical experience for FAP-targeted radioligand therapy in advanced disease. Breast cancer: FAPI PET/CT has been used to visualize disease in breast cancer, and early “theranostic” reports and broader reviews frequently reference breast cancer as a tumor type where FAP-targeted radioligand therapy has shown promising preliminary clinical signals in selected advanced cases. Lung cancer: FAPI PET/CT is commonly discussed for lung cancer (including lung adenocarcinoma) as another entity where FAP imaging can be highly informative in selected scenarios and may support patient selection for FAP-directed approaches if target expression is demonstrated. Thyroid cancer: FAP-targeted radioligand therapy has been reported in radioiodine-refractory differentiated thyroid cancer in early clinical work (first-in-human/dose-escalation contexts), with FAP PET/CT used to confirm targetability. Head & neck tumors and other solid cancers: Across the wider oncology landscape, FAPI PET/CT has been applied to head and neck cancers and many other solid tumors, but eligibility for Lu-177–FAPI therapy is generally described as case-by-case and target-uptake dependent, often within early-phase clinical study or individualized treatment settings.