A groundbreaking advancement in the imaging of invasive lobular carcinoma (ILC), a challenging subtype of breast cancer, has been announced through a prestigious $100,000 research fellowship supported by the SNMMI Mars Shot Research Fund in partnership with the Lobular Breast Cancer Alliance (LBCA). Dr. Randy Yeh, a distinguished radiologist and nuclear medicine physician affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai in New York, is spearheading this pioneering effort to improve detection and consequent clinical outcomes for patients afflicted with metastatic ILC via an innovative imaging modality known as FAPI PET.
Invasive lobular carcinoma represents nearly 15% of all breast cancer diagnoses in the United States, translating to an estimated 45,000 new cases each year. Unlike the more frequently occurring invasive ductal carcinoma, ILC infiltrates tissue in a dispersed, single-file manner which evades easy palpation and conventional mammographic detection. This unique histological pattern results in delayed diagnosis, often when tumors have grown substantially larger or spread to advanced stages, complicating treatment and reducing survival odds. Current imaging techniques, including CT scans, bone scintigraphy, and standard FDG PET scans, frequently fall short in adequately visualizing these elusive lesions.
The problem posed by ILC’s diffuse growth pattern underscores the pressing need for specialized imaging tools tailored for this cancer subtype. The LBCA’s Chief Operating Officer, Mason Mitchell-Daniels, underscores this point, emphasizing the scarcity of research dedicated specifically to ILC detection and treatment, and the critical importance of developing imaging technologies that genuinely address its diagnostic challenges. This fellowship represents a strategic collaboration aiming to fill this unmet clinical need through sophisticated molecular imaging that targets the tumor microenvironment rather than the cancer cells alone.
Central to Dr. Yeh’s approach is the utilization of ^18F-FAPI PET/CT imaging—a technique that harnesses fibroblast activation protein inhibitor (FAPI), a radiolabeled ligand binding with high specificity to fibroblast activation protein expressed on cancer-associated fibroblasts abundant in ILC’s stromal matrix. This molecular target differentiates itself from FDG, which images glucose metabolism broadly but may inadequately highlight the infiltrative, low-cellularity nature of ILC tumors. By illuminating the tumor-supportive fibroblasts, FAPI PET promises enhanced sensitivity and superior tumor delineation in these notoriously hard-to-image cancers.
Dr. Yeh’s upcoming study is designed as a direct comparative evaluation of FAPI PET versus FDG PET to objectively quantify differences in lesion detectability, image resolution, and radiotracer uptake intensity among patients with metastatic ILC. Beyond imaging metrics, the research will incorporate patient and physician questionnaires to assess FAPI PET’s impact on clinical decision-making and patients’ comprehension of their disease burden. This patient-centered outcome measure aims to elucidate whether improved visualization translates into more informed treatment pathways and potentially better prognoses.
Advancing from detection to therapy, Dr. Yeh envisions FAPI not only as a diagnostic agent but also as a vehicle for delivering targeted radiopharmaceutical therapy. The conjugation of FAPI to therapeutic radioisotopes opens a promising avenue for precision medicine in ILC, as these agents could selectively irradiate tumor-associated fibroblasts, disrupting the supportive tumor microenvironment that facilitates cancer growth and resistance.
Dr. Yeh’s expertise bridges cancer biology and cutting-edge molecular imaging, enabling a translational approach that merges fundamental science with clinical innovation. Having completed substantial training at the University of Texas Health Science Center and Columbia University Medical Center, he is uniquely equipped to navigate this interdisciplinary frontier. His board certifications in diagnostic radiology and nuclear medicine further reflect his commitment to advancing imaging methodologies with tangible patient benefits.
The broader nuclear medicine community, led by thought leaders such as Richard Wahl, MD, founder and chair of the Mars Shot initiative, enthusiastically supports the exploration of FAPI PET in breast cancer and ILC specifically. Although FAPI has demonstrated remarkable utility in multiple malignancies, its application to ILC remains scarcely investigated, representing a critical knowledge gap this research seeks to address. The Mars Shot Research Fund’s investment reflects optimism that FAPI imaging could revolutionize not only the diagnostic landscape but also therapeutic strategies targeting the stromal components integral to tumor survival.
The collaboration between SNMMI and the LBCA exemplifies a synergistic alliance bridging patient advocacy and high-impact scientific exploration. The LBCA, as the only dedicated U.S. organization addressing lobular breast cancer, plays a pivotal role in directing funding and awareness to this often-underrepresented cancer subtype. Their partnership with the Mars Shot initiative underscores the importance of aligning research funding with patient-centric priorities to accelerate advances that matter most to those affected.
Established in 2023, the SNMMI Mars Shot Research Fund represents a visionary framework supporting transformative projects in nuclear medicine and molecular imaging. Its mission is to fast-track the journey from innovative research concepts to clinical tools and treatments, striving to improve patient outcomes through personalized diagnostic and therapeutic modalities. Dr. Yeh’s fellowship epitomizes this mission by tackling a long-standing clinical challenge with next-generation radiopharmaceutical technology.
This research initiative promises to set a new benchmark for imaging lobular breast cancer, potentially influencing screening protocols, staging accuracy, and treatment customization. If FAPI PET imaging demonstrates clear superiority, it could catalyze widespread adoption and stimulate further development of FAPI-based radiotherapeutic agents. Such a leap forward would address a critical unmet need in breast oncology, improving survival rates and quality of life for thousands of patients annually.
The scientific community and patient advocates eagerly anticipate the outcomes of this rigorous study, which promises to shed light on the intricate tumor microenvironment of ILC and enhance the precision of nuclear medicine in oncology. Through this innovative work, nuclear medicine could revolutionize breast cancer care by establishing new paradigms for imaging and treatment, especially in difficult-to-detect cancers like invasive lobular carcinoma.
As evidence accrues validating the role of FAPI PET in ILC, this modality has the potential to be integrated into clinical trials, diagnostic algorithms, and therapeutic regimens worldwide. Dr. Yeh’s research therefore not only carries significance for individual patients but also embodies a broader evolution in molecular imaging—where personalized, targeted approaches redefine cancer management through deeper biological insight and highly specific technological innovations.
Subject of Research: Imaging and treatment of metastatic invasive lobular breast cancer using ^18F-FAPI PET imaging
Article Title: Novel FAPI PET Imaging Promises Breakthrough in Detection and Management of Invasive Lobular Breast Cancer
News Publication Date: Information not provided
Web References:
https://lobularbreastcancer.org
https://www.snmmi.org
Keywords: invasive lobular carcinoma, lobular breast cancer, FAPI PET, molecular imaging, nuclear medicine, radiopharmaceutical therapy, cancer detection, breast cancer imaging, fibroblast activation protein, metastatic breast cancer
