<sup>18</sup>F-FDG PET/CT for the Evaluation of Therapy Response in                     Hormone Receptor–Positive Bone-Dominant Metastatic Breast                     Cancer

Makhlin, Igor; Korhonen, Katrina; Martin, Melissa L.; Gillman, Jennifer; Schubert, Erin K.; Pantel, Austin R.; Mankoff, David A.; Clark, Amy S.

doi:10.1148/rycan.220032

Cited by 13 publications

(10 citation statements)

References 14 publications

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“…Numerous investigations have demonstrated a strong correlation between alterations in FDG uptake and clinical as well as tumour marker responses, serving as predictive indicators for the duration until progression and skeletal-related events 24 . Within this study, the pre-and post-therapy serum tumour biomarkers (CEA and CA153) and serum ALP concentrations prior to treatment held diagnostic value for discerning treatment e cacy.…”

Section: Discussionmentioning

confidence: 99%

FDG PET/CT, Precise Positioning of the Criminal Focus in the Osteogenic Region of Breast Cancer Bone Metastases after Therapy

Lin,

Lv,

et al. 2023

Preprint

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Purpose The present study endeavours to investigate the utility and indispensability of FDG PET/CT in appraising the post-treatment efficacy of bone metastasis in cases of breast cancer. Method A cohort of 11 patients diagnosed with breast cancer and suffering from bone metastases was enrolled for this investigation. These patients underwent repeated FDG PET/CT evaluations, with comprehensive clinical records and sufficient follow-up duration available. Division of patients and bone metastases ensued into three distinct groups - amelioration, stability, and progression - predicated upon the response exhibited by each bone metastatic site subsequent to treatment. The ensuing analysis and juxtaposition encompassed PET and CT image alterations, levels of serum tumour biomarkers (CEA, CA153), as well as biochemical indicators (ALP, Ca), within each group across the identical time frame. Furthermore, the inquiry scrutinized disparities between immunohistochemical outcomes of primary breast cancer and bone metastases displaying escalated FDG uptake as discerned through PET/CT post-treatment. Results Discernible disparities in serological indices (CEA, CA153, ALP, and Ca) were absent among patients classified under distinct efficacy categories (p > 0.05). Nonetheless, diminished expression of Her-2 engendered an elevated likelihood of suboptimal efficacy (p < 0.05). Appraisal of efficacy, guided by individual bone metastases, unveiled notable fluctuations in FDG uptake through PET (SUVmax) amid the three groups (p < 0.05), while density variations in CT scans did not reach statistical significance (p = 0.243). Variances surfaced in FDG uptake, alterations in CT density, and levels of CEA and CA153 within patient sera before and after treatment (p < 0.05). Of these indicators, paramount diagnostic efficacy was ascribed to FDG PET metrics: alterations in FDG uptake (AUC 0.972) and post-therapy SUVmax (AUC 0.949). Immunohistochemical examination of bone metastases within the progressive group diverged from primary lesions. Conclusions FDG PET/CT confers precise assessment of the post-treatment efficacy pertaining to each bone metastatic site in breast cancer cases. The modality facilitates identification of eluding foci following extant therapies, localization for pathological assessment, and bears substantive significance in evaluating therapeutic efficacy, refining treatment stratagems, and prognosticating the trajectory for breast cancer patients contending with bone metastases.

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Section: Discussionmentioning

confidence: 99%

FDG PET/CT, Precise Positioning of the Criminal Focus in the Osteogenic Region of Breast Cancer Bone Metastases after Therapy

Lin,

Lv,

et al. 2023

Preprint

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“…For example, NCT04316117 aims to evaluate the performance of [ 18 F]FDG PET/CT in bone-predominant metastatic breast cancer response to systemic therapies as a predictor of progression-free survival (PFS). 53 In breast cancer, estrogen receptor-positive metastases can be detected with [ 18 F]fluoroestradiol (FES) with studies documenting intertumoral heterogeneity between metastases within an individual patient. [54][55][56][57] In a study using both [ 18 F]FDG and [ 18 F]FES in patients treated with systemic endocrine therapy, [ 18 F]FDG predicted PFS, but the ratio of tumor burden between [ 18 F]FDG and [ 18 F]FES, as a measure of heterogeneity, predicted overall survival (OS).…”

Section: Pet Imaging: Diagnosis and Response Assessmentmentioning

confidence: 99%

“…Ongoing collaborative prospective studies of [ 18 F]FDG PET/CT in breast cancer are aiming to provide more robust data to fill some of the current evidence gaps. For example, NCT04316117 aims to evaluate the performance of [ 18 F]FDG PET/CT in bone-predominant metastatic breast cancer response to systemic therapies as a predictor of progression-free survival (PFS) 53 …”

Section: Pathophysiology Of Bone Metastases Related To Molecular Imag...mentioning

confidence: 99%

Bone Metastases

Cook,

Thorpe

2024

Cancer J

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Bone metastases occur frequently in common malignancies such as breast and prostate cancer. They are responsible for considerable morbidity and skeletal-related events. Fortunately, there are now several systemic, focal, and targeted therapies that can improve quality and length of life, including radionuclide therapies. It is therefore important that bone metastases can be detected as early as possible and that treatment can be accurately and sensitively monitored. Several bone-specific and tumor-specific single-photon emission computed tomography and positron emission tomography molecular imaging agents are available, for detection and monitoring response to systemic therapeutics, as well as theranostic agents to confirm target expression and predict response to radionuclide therapies.

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“…Patients in which metabolic change was observed after 4 weeks had a longer PFS (14.2 months versus 6.3; p = 0.53) and OS (44.0 months versus 29.7 months; p = 0.47) in this study. 40 There seems to be a role for [ 18 Concluding, the addition of [ 18 F]FDG-PET to CE-CT for response assessment might improve the quality of current treatment assessment because of earlier detection of progressive metastatic breast cancer, especially in patients with bone-only or bone-dominant disease. However, this needs to be further evaluated in a prospective setting.…”

Section: [ 18 F]fdg-pet In Metastatic Breast Cancermentioning

confidence: 99%

“…Patients in which metabolic change was observed after 4 weeks had a longer PFS (14.2 months versus 6.3; p = 0.53) and OS (44.0 months versu s 29.7 months; p = 0.47) in this study. 40 There seems to be a role for [ 18 F]FDG-PET in response prediction and assessment in bone-only and bone-dominant disease; however, the currently available evidence is limited. Prospective studies evaluating the role of [ 18 F]FDG-PET in this specific setting will have to be conducted to clarify its exact value.…”

Section: [ 18 F]fdg-pet In Metastatic Breast Cancermentioning

confidence: 99%

Molecular imaging as biomarker for treatment response and outcome in breast cancer

et al. 2023

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Molecular imaging, such as positron emission tomography (PET), is increasingly used as biomarker to predict and assess treatment response in breast cancer. The number of biomarkers is expanding with specific tracers for tumour characteristics throughout the body and this information can be used to aid the decision-making process. These measurements include metabolic activity using [18F]fluorodeoxyglucose PET ([18F]FDG-PET), oestrogen receptor (ER) expression using 16α-[18F]Fluoro-17β-oestradiol ([18F]FES)-PET and human epidermal growth factor receptor 2 (HER2) expression using PET with radiolabelled trastuzumab (HER2-PET). In early breast cancer, baseline [18F]FDG-PET is frequently used for staging, but limited subtype-specific data reduce its usefulness as biomarker for treatment response or outcome. Early metabolic change on serial [18F]FDG-PET is increasingly used in the neo-adjuvant setting as dynamic biomarker to predict pathological complete response to systemic therapy, potentially allowing de-intensification or step-up intensification of treatment. In the metastatic setting, baseline [18F]FDG-PET and [18F]FES-PET can be used as biomarker to predict treatment response, in triple-negative and ER-positive breast cancer, respectively. Metabolic progression on repeated [18F]FDG-PET appears to precede progressive disease on standard evaluation imaging; however, subtype-specific studies are limited and more prospective data are needed before implementation in clinical practice. Even though (repeated) [18F]FDG-PET, [18F]FES-PET and HER2-PEt all show promising results as biomarkers to predict therapy response and outcome, for eventual integration into clinical practice, future studies will have to clarify at what timepoint this integration has to optimally take place.

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¹⁸F-FDG PET/CT for the Evaluation of Therapy Response in Hormone Receptor–Positive Bone-Dominant Metastatic Breast Cancer

Cited by 13 publications

References 14 publications

FDG PET/CT, Precise Positioning of the Criminal Focus in the Osteogenic Region of Breast Cancer Bone Metastases after Therapy

FDG PET/CT, Precise Positioning of the Criminal Focus in the Osteogenic Region of Breast Cancer Bone Metastases after Therapy

Bone Metastases

Molecular imaging as biomarker for treatment response and outcome in breast cancer

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18F-FDG PET/CT for the Evaluation of Therapy Response in Hormone Receptor–Positive Bone-Dominant Metastatic Breast Cancer

Cited by 13 publications

References 14 publications

FDG PET/CT, Precise Positioning of the Criminal Focus in the Osteogenic Region of Breast Cancer Bone Metastases after Therapy

FDG PET/CT, Precise Positioning of the Criminal Focus in the Osteogenic Region of Breast Cancer Bone Metastases after Therapy

Bone Metastases

Molecular imaging as biomarker for treatment response and outcome in breast cancer

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Product

Resources

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¹⁸F-FDG PET/CT for the Evaluation of Therapy Response in Hormone Receptor–Positive Bone-Dominant Metastatic Breast Cancer