Molecular imaging to identify patients with metastatic breast cancer who benefit from endocrine treatment combined with cyclin-dependent kinase inhibition

Boers, Jorianne; Venema, Clasina M; Vries, Erik F. J. de; Glaudemans, Andor W J M; Kwee, Thomas C.; Schuuring, Ed; Martens, John W.M.; Elias, Sjoerd G.; Hospers, Geke A.P.; Schröder, Carolina P.

doi:10.1016/j.ejca.2019.10.024

Cited by 45 publications

(86 citation statements)

References 35 publications

(47 reference statements)

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“…Several studies have examined 18 F-FES PET as a predictor of response to endocrine monotherapy [18,23,38,40,44,45,49,50] and in combination with other agents, including the CDK inhibitor palbociclib [51][52][53]. Therefore, ER status by 18 F-FES PET has potential for assisting with therapy selection decisions for patients with ER+ MBC.…”

Section: Clinical Applications For 18 F-fes Petmentioning

confidence: 99%

Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16α-18F-Fluoro-17β-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications

Kurland

Wiggins²,

Coche³

et al. 2020

The Oncologist

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Estrogen receptor (ER) status by immunohistochemistry (IHC) of cancer tissue is currently used to direct endocrine therapy in breast cancer. Positron emission tomography (PET) with 16α-18F-fluoro-17β-estradiol (18 F-FES) noninvasively characterizes ER ligand-binding function of breast cancer lesions. Concordance of imaging and tissue assays should be established for 18 F-FES PET to be an alternative or complement to tissue biopsy for metastatic lesions. We conducted a metaanalysis of published results comparing 18 F-FES PET and tissue assays of ER status in patients with breast cancer. PubMed and EMBASE were searched for English-language manuscripts with at least 10 patients and low overall risk of bias. Thresholds for imaging and tissue classification could differ between studies but had to be clearly stated. We used hierarchical summary receiver-operating characteristic curve models for the meta-analysis. The primary analysis included 113 nonbreast lesions from 4 studies; an expanded analysis included 327 total lesions from 11 studies. Treating IHC results as the reference standard, sensitivity was 0.78 (95% confidence region 0.65-0.88) and specificity 0.98 (0.65-1.00) for the primary analysis of nonbreast lesions. In the expanded analysis including non-IHC tissue assays and all lesion sites, sensitivity was 0.81 (0.73-0.87) and specificity 0.86 (0.68-0.94). These results suggest that 18 F-FES PET is useful for characterization of ER status of metastatic breast cancer lesions. We also review current best practices for conducting 18 F-FES PET scans. This imaging assay has potential to improve clinically relevant outcomes for patients with (historically) ER-positive metastatic breast cancer, including those with brain metastases and/or lobular histology.

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Section: Clinical Applications For 18 F-fes Petmentioning

confidence: 99%

Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16α-18F-Fluoro-17β-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications

Kurland

Wiggins²,

Coche³

et al. 2020

The Oncologist

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“…Moreover, cell proliferation can be detected by [ 18 F]-fluorothymidine ([ 18 F]-FLT)-PET, and postneoadjuvant chemotherapy [ 18 F]-FLT uptake may be correlated with the proliferation marker Ki-67 measured by IHC in primary BC patients [92]. In light of the current developments in BC immunotherapy, assessment of the programmed death-ligand 1 (PD-L1) with [ 89 [48,54,94]. This could help to select the best therapeutic strategy.…”

Section: Other Pet Tracers For Molecular Imaging In Bcmentioning

confidence: 99%

“…Currently, one recruiting [ 89 Zr]-atezolizumab-PET study is available for lobular BC ( NCT04222426 ). Furthermore, a combination of molecular imaging techniques, such as [ 18 F]-FES-PET, [ 89 Zr]-trastuzumab-PET with [ 18 F]-FDG-PET, may be useful in identifying disease heterogeneity or differentiating between indolent and aggressive disease [ 48 , 54 , 94 ]. This could help to select the best therapeutic strategy.…”

Section: Other Pet Tracers For Molecular Imaging In Bcmentioning

confidence: 99%

Application of PET Tracers in Molecular Imaging for Breast Cancer

et al. 2020

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Purpose of Review Molecular imaging with positron emission tomography (PET) is a powerful tool to visualize breast cancer characteristics. Nonetheless, implementation of PET imaging into cancer care is challenging, and essential steps have been outlined in the international "imaging biomarker roadmap." In this review, we identify hurdles and provide recommendations for implementation of PET biomarkers in breast cancer care, focusing on the PET tracers 2-[ 18 F]-fluoro-2-deoxyglucose ([ 18 F]-FDG), sodium [ 18 F]-fluoride ([ 18 F]-NaF), 16α-[ 18 F]-fluoroestradiol ([ 18 F]-FES), and [ 89 Zr]-trastuzumab. Recent Findings Technical validity of [ 18 F]-FDG, [ 18 F]-NaF, and [ 18 F]-FES is established and supported by international guidelines. However, support for clinical validity and utility is still pending for these PET tracers in breast cancer, due to variable endpoints and procedures in clinical studies. Summary Assessment of clinical validity and utility is essential towards implementation; however, these steps are still lacking for PET biomarkers in breast cancer. This could be solved by adding PET biomarkers to randomized trials, development of imaging data warehouses, and harmonization of endpoints and procedures.

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“…On the other hand, fasting (at least 4 h before imaging) has also been suggested to reduce bowel accumulation due to reduced elimination of [ 18 F]-FES from the gall bladder [ 11 ]. Nowadays, different patient preparation instructions are used for [ 18 F]-FES-PET imaging, such as fasting, oral hydration with water, and non-fasting [ 11 , 12 , 13 ]. The first recommendation paper about [ 18 F]-FES-PET concluded that no specific patient preparation instructions are necessary, except when the PET scan is acquired in combination with a diagnostic (contrast-enhanced) computed tomography (CT)-scan [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Image Quality and Interpretation of [18F]-FES-PET: Is There any Effect of Food Intake?

et al. 2020

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Background: High physiological 16α-[18F]-fluoro-17β-estradiol ([18F]-FES) uptake in the abdomen is a limitation of this positron emission tomography (PET) tracer. Therefore, we investigated the effect of food intake prior to PET acquisition on abdominal background activity in [18F]-FES-PET scans. Methods: Breast cancer patients referred for [18F]-FES-PET were included. Three groups were designed: (1) patients who consumed a chocolate bar (fatty meal) between tracer injection and imaging (n = 20), (2) patients who fasted before imaging (n = 20), and (3) patients without diet restrictions (control group, n = 20). We compared the physiological [18F]-FES uptake, expressed as mean standardized uptake value (SUVmean), in the abdomen between groups. Results: A significant difference in [18F]-FES uptake in the gall bladder and stomach lumen was observed between groups, with the lowest values for the chocolate group and highest for the fasting group (p = 0.015 and p = 0.011, respectively). Post hoc analysis showed significant differences in the SUVmean of these organs between the chocolate and fasting groups, but not between the chocolate and control groups. Conclusion: This exploratory study showed that, compared to fasting, eating chocolate decreases physiological gall bladder and stomach [18F]-FES uptake; further reduction through a normal diet was not seen. A prospective study is warranted to confirm this finding.

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Molecular imaging to identify patients with metastatic breast cancer who benefit from endocrine treatment combined with cyclin-dependent kinase inhibition

Abstract: List of where and when the study has been presented in part elsewhere: Part of the data was presented at the San Antonio Breast Cancer Symposium 2017.Clinical trial information: NCT02806050.

Cited by 45 publications

References 35 publications

Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16α-18F-Fluoro-17β-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications

Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16α-18F-Fluoro-17β-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications

Application of PET Tracers in Molecular Imaging for Breast Cancer

Image Quality and Interpretation of [18F]-FES-PET: Is There any Effect of Food Intake?

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