Albumin Binder–Conjugated Fibroblast Activation Protein Inhibitor Radiopharmaceuticals for Cancer Therapy

Fibroblast activation protein (FAP) has become an attractive target for diagnosis and therapy, and a series of FAP inhibitor (FAPI)–based radiotracers has been developed and had excellent performance for diagnosis outcomes in clinical applications. Yet, their fast clearance and insufficient tumor retention have hampered their further clinical application in cancer treatment. In this study, we developed 2 albumin binder–conjugated FAPI radiotracers, TEFAPI-06 and TEFAPI-07. They were derived from FAPI-04 and were optimized by conjugating 2 types of well-studied albumin binders, 4-(p-iodophenyl) butyric acid moiety (TEFAPI-06) and truncated Evans blue moiety (TEFAPI-07), to try to overcome the above limitations at the expense of prolonging the blood circulation. Methods: TEFAPI-06 and TEFAPI-07 were synthesized and labeled with (68)Ga, (86)Y, and (177)Lu successfully. A series of cell assays was performed to identify the binding affinity and FAP specificity in vitro. PET imaging, SPECT imaging, and biodistribution studies were performed to evaluate the pharmacokinetics in pancreatic cancer patient–derived xenograft (PDX) animal models. The cancer treatment efficacy of (177)Lu-TEFAPI-06 and (177)Lu-TEFAPI-07 were evaluated in pancreatic cancer PDX–bearing mice. Results: The binding affinities (dissociation constants) to FAP of (68)Ga-TEFAPI-06 and (68)Ga-TEFAPI-07 were 10.16 ± 2.56 nM and 7.81 ± 2.28 nM, respectively, which were comparable with that of (68)Ga-FAPI-04. Comparative PET imaging of HT-1080-FAP and HT-1080 tumor–bearing mice and a blocking study showed the FAP-targeting ability in vivo of these 2 tracers. Compared with (177)Lu-FAPI-04, PET imaging, SPECT imaging, and biodistribution studies of TEFAPI-06 and TEFAPI-07 demonstrated their remarkably enhanced tumor accumulation and retention, respectively. Notable tumor growth inhibition by (177)Lu-TEFAPI-06 and (177)Lu-TEFAPI-07 were observed, whereas the control group and the group treated by (177)Lu-FAPI-04 showed a slight therapeutic effect. Conclusion: Two albumin binder–conjugated FAPI radiopharmaceuticals have been developed and evaluated in vitro and in vivo. Significantly improved tumor uptake and retention were observed, compared with the original FAPI tracer. Both (177)Lu-TEFAPI-06 and (177)Lu-TEFAPI-07 showed remarkable growth inhibition of PDX tumors, whereas the side effects were almost negligible, demonstrating that these radiopharmaceuticals are promising for further clinical translational studies.