SNMMI Mars Shot: Pancreatic Cancer

Pancreatic cancer is difficult to diagnose early and, after lung and colon cancers, is currently the third leading cause of cancer deaths. It accounts for about 3% of all newly diagnosed cancers and 7% of all cancer deaths each year. In 2022, it is estimated that about 62,210 people will be diagnosed and 49,830 will die of pancreatic cancer. This form of cancer is so deadly because it can be tough to treat; it does not respond as well as other types of cancer to commonly used cancer therapies. If diagnosed early (which is an unfortunate rarity), the five-year survival rate improves from 10% to 39%, saving and extending thousands of patients’ lives.

Surgery is possible in only less than 20% of patients with pancreatic adenocarcinoma, which accounts for more than 90% of all pancreatic cancers. Patients with pancreatic neuroendocrine tumors often have a better prognosis and a younger median age at diagnosis, but this form of pancreatic cancer is far less common. No early detection test and few effective treatments exist for pancreatic cancer, creating a drastic need for novel therapeutics to treat this devastating disease and for diagnostic markers to aid in earlier detection.


Molecular imaging and radiopharmaceutical therapies may be beneficial in the diagnosis and treatment of pancreatic cancers. Clinical trials are ongoing for a class of agents that would function as a theranostic pair – meaning the agent could be used in diagnostic imaging and, if applicable, in treating the patient. One of the classes of agent is known as fibroblast activation protein or FAP. The ability to see the presence of the drug’s target – on imaging – improves the chances of a positive response to the radiopharmaceutical therapy.


Among the new imaging and treatment methods are radiopharmaceutical drugs such as the fibroblastactivation protein inhibitor, which allows for high image contrast and good tumor delineation and does not require specific patient preparation¹. A theranostic approach (combined therapeutic and diagnostic agents) utilizes radiopharmaceuticals to both image and treat pancreatic adenocarcinoma. Peptide receptor radionuclide therapy targets and treats neuroendocrine tumors. After two decades of rapid development in theranostics, a variety of new targets is available for
further clinical investigation.

Utilizing nuclear medicine and molecular imaging, clinicians are able to assess the stage and impact of the disease and reduce the time that a patient waits for diagnosis and treatment, allowing for better and faster treatment trajectories and prognoses. Improving the efficacy of a modality saves lives and allows for greater research into early detection and more effective therapies.


An important goal of imaging is to provide a high-quality, appropriate test for the right patient at the right time. Appropriate diagnostic care reduces the potential for redundant testing, delays in interventions for the patient, and increased downstream cost. Diagnosed in 2007, one patient traveled to Germany to treat his pancreatic cancer. Three nuclear medicine treatments cut his disease nearly in half and got rid of all his symptoms. At the time, the nuclear medicine treatment was experimental, but in 2018 the Food and Drug Administration approved it for use in the United States. This patient has been living with his cancer for 15 years, an incredible outcome for a disease with such a high mortality rate.

Further research and development of novel radiotracers and radiotherapies will enable patients to receive more effective imaging, improving their care by detecting disease earlier, aiding in diagnosis, and increasing clinical confidence by providing a way to determine which treatments are appropriate. Because of the impact of research on nuclear medicine and molecular imaging,
patients with pancreatic cancer have a greater chance of survival. Years might be added to their lives.