Estrogen receptor‐positive/human epidermal growth factor receptor 2‐negative breast tumors

Abstract

BACKGROUND:The objective of this prospective study was to evaluate the ability of 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) to predict chemosensitivity in patients with estrogen receptor (ER)-positive/ human epidermal growth factor receptor 2 (HER2)-negative breast cancer. METHODS: Sixty-four consecutive patients underwent 18 F-FDG PET/CT scanning at baseline and after the second course of neoadjuvant chemotherapy (NAC). The evolution (D) between the 2 scans of image parameters (maximum standardized uptake value [SUV max ], SUV mean , metabolic tumor volume, and total lesion glycolysis [TLG]) was measured. Correlations between early changes in PET-derived parameters and pathologic response observed in surgical specimens after the completion of 8 courses of NAC were estimated with Mann-Whitney U tests. Response prediction on the basis of clinical data, histologic type, or molecular markers also was assessed (Fisher exact test). Receiver operating characteristic (ROC) analysis was used to compare the area under the curve (AUC) of each parameter. RESULTS: The best prediction of chemosensitivity was obtained with DTLG (À49% AE 31% in nonresponders vs À73% AE 25% in responders; P <.0001). Among the biologic parameters, only negative progesterone receptor status (57% responders vs 31% nonresponders; P ¼.04) and luminal B subtype (63% responders vs 22% nonresponders; P ¼.02) were predictive of a pathologic response. ROC analysis resulted in an AUC of 0.81, 0.73, 0.71, and 0.63 for DTLG, DSUV max , luminal subtype, and progesterone receptor status, respectively. CONCLUSIONS: When patients responded to NAC, the majority of ER-positive/HER2 negative tumors exhibited partial tumor shrinkage; and the PET parameters that combined volume and activity measurements, such as TLG, offered better accuracy for early prediction than the SUV max . Negative progesterone receptor status and luminal B subtype had weaker predictive power than PET-derived parameters. Cancer KEYWORDS: 18 F-fluorodeoxyglucose, positron emission tomography/computed tomography, maximum standardized uptake value, total lesion glycolysis, estrogen receptor-positive/human epidermal growth factor receptor 2 negative breast cancer, luminal tumor, neoadjuvant chemotherapy, metabolic response, pathologic response, chemosensitivity. INTRODUCTIONNeoadjuvant chemotherapy (NAC) is commonly offered to patients with locally advanced breast cancer and to women with primary operable but large breast cancer. This strategy allows more patients to undergo breast-conserving surgery and provides information on the efficacy of chemotherapy. Breast carcinoma is a heterogeneous class of tumors, and gene-expression profiling has led to the identification of 5 different subtypes with clinical implications (ie, luminal A, luminal B, basal-like, human epidermal growth factor receptor 2 [HER2]-like, and normal-like subtypes). 1 To some degree, these molecular subtypes can be distinguished using immunohistochemistry. 2 Estrogen receptor...

Whole-body total lesion glycolysis measured on fluorodeoxyglucose positron emission tomography/computed tomography as a prognostic variable in metastatic breast cancer

“…These indices have been considered to be potentially reliable parameters for providing more details about the status of diseases in various types of cancers, especially lung tumors, oro/nasopharyngeal, and rectal cancers [15-18]. Most recently, some authors have reported that TLG was superior to SUVmax as a predictor of prognosis in malignancies [19,20]. Our results showed that the WTLG of MBC in the initial presentation (group A) was correlated with OS not only in the univariate analysis but also in the multivariate analysis after adjustments for tumor phenotype and HSUVmax.…”

Imaging Considerations and Interprofessional Opportunities in the Care of Breast Cancer Patients in the Neoadjuvant Setting

“…48,84 18 F-FDG-PET (combined with x-ray computed tomography (CT) for anatomical imaging) is commonly used in the staging of breast cancer patients and evaluation of metastatic disease. 47,48,84 Alterations in tumor metabolic activity, as quantified by 18 F-FDG uptake, has been identified as a potential predictive biomarker for NAT response in breast cancer patients.…”

“…48,84 18 F-FDG-PET (combined with x-ray computed tomography (CT) for anatomical imaging) is commonly used in the staging of breast cancer patients and evaluation of metastatic disease. 47,48,84 Alterations in tumor metabolic activity, as quantified by 18 F-FDG uptake, has been identified as a potential predictive biomarker for NAT response in breast cancer patients. 48–53 A meta-analysis pooling results of 19 breast cancer patient studies demonstrated that 18 F-FDG-PET had a sensitivity of 84% and specificity of 66% in predicting histopathological response to NAT, 85 a finding consistent with other meta-analyses.…”

“…47,48,84 Alterations in tumor metabolic activity, as quantified by 18 F-FDG uptake, has been identified as a potential predictive biomarker for NAT response in breast cancer patients. 48–53 A meta-analysis pooling results of 19 breast cancer patient studies demonstrated that 18 F-FDG-PET had a sensitivity of 84% and specificity of 66% in predicting histopathological response to NAT, 85 a finding consistent with other meta-analyses. 86,87 In a prospective study investigating the early prediction of NAT response in breast cancer patients using 18 F-FDG-PET, Hatt et al found that the change in maximum standard uptake value (ΔSUV max ) and total lesion glycolysis (ΔTLG) after two cycles of NAT showed a significant difference between pathological non-responders and responders, with an area under the AUC curve of 0.82 for ΔSUV max and 0.91 for ΔTLG.…”

“…47,49,88 18 F-FDG-PET/CT evaluation of NAT response has yet to gain wide acceptance due to limited accuracy and specificity of the technique; these limitations have been attributed to significant differences in 18 F-FDG uptake between breast cancer subtypes, both at baseline and after treatment. 48–50,88 While the ability of 18 F-FDG-PET/CT to predict NAT response may be receptor status dependent and requires further investigation, the technique shows promise for early evaluation and prediction of response to NAT prior to downstream alterations in tumor size. Figure 2 reveals how quantitatively assessing treatment response with 18 F-FDG-PET imaging during NAT can provide indications of response.…”