The PLASTIC-3 study is a prospective clinical trial investigating the use of [^18F]FAPI-PET/CT for staging locally advanced gastric cancer. Current standard staging—gastroscopy, contrast-enhanced CT (CECT), and staging laparoscopy—often fails to detect peritoneal or distant metastases, which can lead to overtreatment with neoadjuvant chemotherapy or surgery, increasing patient risk without survival benefit.
Previous studies, including PLASTIC-1, showed that staging laparoscopy significantly reduced unnecessary surgeries by detecting non-operable disease, whereas [^18F]FDG-PET/CT added little value and is no longer recommended in national guidelines.
[^18F]FAPI-PET/CT targets fibroblast activation protein (FAP) expressed in tumor-associated fibroblasts, allowing better visualization of tumors and metastases. Early studies suggest it outperforms [^18F]FDG-PET/CT in detecting both primary gastric tumors and metastases.
The PLASTIC-3 study will enroll approximately 250 patients across several Dutch medical centers. [^18F]FAPI-PET/CT will be compared with CECT and staging laparoscopy, with biopsy and follow-up serving as the gold standard. The main goals are to optimize staging, reduce unnecessary surgeries and toxic systemic treatments, improve patient quality of life, and evaluate cost-effectiveness. Patient perspectives are actively incorporated in study design and outcome measures.
The study may also provide insights into the use of [^18F]FAPI-PET/CT for therapy monitoring and potential theranostic applications, including radionuclide therapy with [^177Lu]FAPI.

July 2025-July-2029

Prof. Dr. Lioe-Fee de Geus-Oei, Drs. Sarah Spruijt, LUMC

LUMC, UMCU, Erasmus MC, AUMC, UMCG, NKI/AvL, ZGT, CZE, Zuyderland MC, Rijnstate, Radboudumc, Frisius MC; Cyclotron Noordwest, University of Twente, SPKS, NFK, DUCG; https://www.plasticstudies.nl/