# FAP theranostics as a pan-cancer stromal strategy

Source: https://onco.cc/ideas/idea-fap-theranostics-pancancer/  
OnCo record `idea-fap-theranostics-pancancer` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Instead of finding a different target for each cancer, hit the scaffolding cells that almost all solid tumours share.

## Summary

Rather than finding a different target for each cancer, this idea hits the cancer-associated fibroblasts that almost all solid tumours share. FAP-targeted alpha or beta radioligands such as FAP-2286 would be given to FAPI-PET-avid pancreatic, gastric and sarcoma patients irrespective of tumour-cell genotype, delivering radiation to the stroma with crossfire into adjacent tumour cells and depleting the fibroblasts that exclude T cells. Stroma is genetically stable, so resistance mutations are not expected. The test is phase 2 FAP-2286 cohorts selected by FAPI PET, with paired biopsies and a PD-1 combination in pancreatic cancer. At early-clinical maturity it addresses the bottleneck Cold tumours and the immunosuppressive microenvironment.

## Fields

- Kind: Idea
- Last checked: 2026-09-04
- Hypothesis: FAP-targeted alpha or beta radioligands produce disease control in FAPI-PET-avid pancreatic, gastric, and sarcoma patients irrespective of tumour-cell genotype, and sensitise to immunotherapy by depleting immunosuppressive fibroblasts.
- Rationale: Stroma is genetically stable (no resistance mutations); crossfire range of 177Lu (2 mm) covers adjacent tumour cells; CAF depletion relieves T-cell exclusion.
- Proposed test: Phase 2 FAP-2286 cohorts with FAPI PET selection and paired biopsies for CAF depletion and T-cell infiltration; combination with PD-1 in pancreatic cancer.
- Maturity: early-clinical

## Sources

- Kratochwil et al., 68Ga-FAPI PET/CT: tracer uptake in 28 different kinds of cancer (Journal of Nuclear Medicine 2019): https://doi.org/10.2967/jnumed.119.227967

## Connected records

- cancers: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/)
- technologies: [FAPI PET](https://onco.cc/technologies/fapi-pet/), [Radioligand therapy (beta emitters)](https://onco.cc/technologies/radioligand-therapy/), [Targeted alpha therapy](https://onco.cc/technologies/targeted-alpha-therapy/)
- targets: [FAP](https://onco.cc/targets/fap/)
- drugs: [FAP-2286 (177Lu / 68Ga)](https://onco.cc/drugs/fap-2286/)
- trials: [Study to Evaluate the Diagnostic Performance of GEH300079 (68Ga) Injection PET/CT for Detection of PC in Patients With Colorectal, Gastric, Ovarian, o](https://onco.cc/trials/nct07219238/)
- key papers: [68 Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer](https://onco.cc/key-papers/paper-kratochwil-j-nucl-med/)
- ideas: [A university cyclotron network with shared regulatory files for new tracers](https://onco.cc/ideas/idea-fund-academic-radiopharma-pipeline/), [Reprogramme the stroma rather than remove it: second-generation stromal trials with a stromal biomarker and a survival endpoint](https://onco.cc/ideas/idea-pdac-stromal-reprogramming-not-depletion/)
- bottlenecks: [Cold tumours and the immunosuppressive microenvironment](https://onco.cc/bottlenecks/b-tme-immunosuppression/)

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