CAIX-targeted PET/CT in Solid Tumors

A hallmark of solid tumors is their intrinsic hypoxic microenvironment, which is not only closely associated with tumor metabolic reprogramming, angiogenesis, invasion, and metastasis, but also represents a key factor contributing to resistance to radiotherapy, chemotherapy, as well as certain targeted and immunotherapeutic approaches. Therefore, achieving precise, non-invasive imaging of tumor hypoxia has become a cutting-edge and prominent focus in current cancer research. Among hypoxia-related molecules, carbonic anhydrase IX (CAIX) is the most representative target for research. As a key downstream target gene of the hypoxia-inducible factor-1 (HIF-1) pathway, CAIX expression levels are closely correlated with the hypoxic state and play an important role in regulating extracellular acidification in tumor cells as well as maintaining intracellular acid-base homeostasis; CAIX is intimately involved in the survival, proliferation, invasion, and metastasis of cancer cells. Studies have demonstrated that high CAIX expression is often associated with greater tumor invasiveness, an increased risk of metastasis, and a worse patient prognosis. Compared to other hypoxia-related molecules, CAIX expression is relatively limited in normal tissues-primarily observed in a small number of tissues such as certain gastrointestinal epithelial cells-but it exhibits abnormally high expression in various malignant tumors, including clear cell renal cell carcinoma, non-small cell lung cancer, colorectal cancer, breast cancer, and brain tumors. Therefore, CAIX is considered a highly promising diagnostic and therapeutic target for solid tumors.

CAIX-targeted molecular imaging probes can be classified into three major categories based on their molecular structure: antibody-based probes, small molecule-based probes, and peptide-based probes. Several CAIX-targeted probes (e.g., 68Ga-DPI-4452, 68Ga-NY104, and 18F-AlF-NYM005) have currently entered the clinical translation phase and demonstrated promising diagnostic potential for the detection of clear cell renal cell carcinoma; however, their clinical value in the diagnosis of other solid tumors remains unclear. Therefore, this study aims to further evaluate the diagnostic value of CAIX-targeted PET/CT imaging in various solid tumors (including renal cell carcinoma, non-small cell lung cancer, colorectal cancer, breast cancer, etc.) and to explore the correlation between tumor uptake and tissue CAIX expression, thereby providing a scientific basis for its subsequent routine clinical application.

Inclusion criteria

• Participants with suspected malignant solid tumors or patients with newly diagnosed or recurrent/metastatic malignant solid tumors confirmed by histopathology;
• Age of 18 years and above, both male and female are eligible;
• The ECOG PS score for physical condition in the Eastern Cancer Collaboration Group is 0-1 points;
• Research participants voluntarily sign informed consent forms or have their parents/children/legal guardians sign informed consent forms, and are able to complete the trial according to the requirements of the research protocol.

Exclusion criteria

• Participants with severe liver and kidney dysfunction and cardiac dysfunction;
• Participants with severe obesity, claustrophobia, or other reasons who are unable to undergo PET scans;
• Pregnant or lactating women;
• Other situations that researchers believe should be excluded and documented.