OnCo
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FAP theranostics as a pan-cancer stromal strategy

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

FAP is expressed on cancer-associated fibroblasts in >90% of epithelial cancers. FAPI PET already images them; FAP radioligands (FAP-2286, 225Ac-FAPI) deliver radiation to the stroma, with crossfire into tumour cells.

Confidence
25%–50%likelyOnCo editors (initial estimate), 2026-09-07 · Imaging is convincing; therapeutic dosimetry to stroma is the unknown.
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.
What would test it
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

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cancers

3
Gastric & gastro-oesophageal junction cancerPancreatic ductal adenocarcinomaSarcomas (soft tissue, bone, GIST)

technologies

3
FAPI PETRadioligand therapy (beta emitters)Targeted alpha therapy

targets

1
FAP

drugs

1
Phase 2Theranostic pair (peptide radioligand)
FAP-2286 (177Lu / 68Ga)

ideas

1
A university cyclotron network with shared regulatory files for new tracers

bottlenecks

1
Cold tumours and the immunosuppressive microenvironment