Triple-Negative Breast Cancer: Early Assessment with <sup>18</sup>F-FDG PET/CT During Neoadjuvant Chemotherapy Identifies Patients Who Are Unlikely to Achieve a Pathologic Complete Response and Are at a High Risk of Early Relapse

Groheux, David; Hindié, Elif; Giacchetti, Sylvie; Delord, Marc; Hamy, Anne-Sophie; Roquancourt, Anne de; Vercellino, Laëtitia; Berenger, Nathalie; Marty, M.; Espié, Marc

doi:10.2967/jnumed.111.094045

Cited by 93 publications

(64 citation statements)

References 19 publications

(24 reference statements)

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“…The survival benefit of this switch is more controversial (42,43). In the present study and others (33), the final pathologic response to the sequential regimen strongly depended on the tumor response assessed after the first cycle of FEC or EC and was independent of any further change in the chemotherapy regimen. This suggests that the systematic switch to docetaxel has little benefit.…”

Section: Limitations Of the Studymentioning

confidence: 69%

“…Few studies have evaluated the predictive value of FDG-PET in TNBC treated with NAC. Most of these found a good predictive value of PET in this subtype, after both 1 and 2 cycles of NAC (24,33,34). In the study of Groheux and colleagues, a cutoff of À50% of DSUV max offered the best accuracy in predicting pCR, whereas a À42% cutoff was optimal to predict relapse (24).…”

Section: Biologic Biomarkers Of Tumor Responsementioning

confidence: 99%

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Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Humbert

Riedinger

Charon-Barra

et al. 2015

Clinical Cancer Research

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Purpose: To investigate the value of the metabolic tumor response assessed with 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET), compared with clinicobiologic markers to predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in women with triple-negative breast cancer (TNBC).Experimental Design: Fifty consecutive women with TNBC and an indication for NAC were prospectively included. Different pretreatment clinical, biologic, and pathologic biomarkers, including SBR grade, the Ki-67 proliferation index, androgen receptor expression, EGF receptor (EGFR), and cytokeratin 5/6 staining, were assessed. Tumor glucose metabolism at baseline and its change after the first cycle of NAC (DSUV max ) were assessed using FDG-PET.Results: The pCR rate was 42%. High Ki-67 proliferation index (P ¼ 0.016), negative EGFR status (P ¼ 0.042), and high DSUV max (P ¼ 0.002) were significantly associated with pCR. In multivariate logistic regression, both negative EGFR status (OR, 6.4; P ¼ 0.043) and high DSUV max (OR, 7.1; P ¼ 0.014) were independent predictors of pCR. Using a threshold at À50%, tumor DSUV max predicted pCR with a negative, a positive predictive value, and an accuracy of 79%, 70%, and 75%, respectively. Combining a low DSUV max and positive EGFR status could predict non-pCR with an accuracy of 92%.Conclusions: It is important to define the chemosensitivity of TNBC to NAC early. Combining EGFR status and the metabolic response assessed with FDG-PET can help the physician to early predict the probability of achieving pCR or not. Given these results, the interest of response-guided tailoring of the chemotherapy might be tested in multicenter trials.

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Section: Limitations Of the Studymentioning

confidence: 69%

Section: Biologic Biomarkers Of Tumor Responsementioning

confidence: 99%

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Humbert

Riedinger

Charon-Barra

et al. 2015

Clinical Cancer Research

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“…For example, in the TN phenotype we found a strong correlation between the decrease in the standardized uptake values (SUVs) after 2 courses of NAC, expressed as DSUV, and event-free survival (EFS) (2). However, the predictive value of DSUV could be lower in the ER1/HER2-subtype (3) because this subtype is somewhat less 18 F-FDG-avid at baseline than TN tumors and less responsive to chemotherapy.…”

mentioning

confidence: 79%

Baseline Tumor ¹⁸F-FDG Uptake and Modifications After 2 Cycles of Neoadjuvant Chemotherapy Are Prognostic of Outcome in ER+/HER2− Breast Cancer

et al. 2015

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This study investigated whether 18 F-FDG PET/CT performed at baseline and during neoadjuvant chemotherapy (NAC) was able to early depict estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER1/HER2−) breast cancer patients with poor clinical outcome. Methods: The NAC regimen consisted of 4 cycles of epirubicin plus cyclophosphamide, followed by 4 courses of docetaxel. The patients underwent 18 F-FDG PET/CT at baseline and after 2 cycles of chemotherapy. After completion of NAC, all patients had breast surgery with axillary lymph node dissection. We assessed the impact of 2 PET parameters, maximum standardized uptake values (SUV max ) and total lesion glycolysis, on event-free survival (EFS). Results: Ninety-eight consecutive patients with clinical stage II or III ER1/HER2− breast cancer were included. 18 F-FDG PET/CT revealed distant metastases in 14 patients (14%). Overall survival was significantly shorter in these patients than in the 84 patients classified as M0 at baseline 18 F-FDG PET/CT (P , 0.001). In M0 patients, a high SUV max at baseline was associated with shorter EFS (P , 0.001). Twelve patients had a tumor SUV max of 10 or greater and a 3-y EFS of 49% (vs. 92% in patients with baseline SUV max , 10). A low change in SUV max between 18 F-FDG PET/CT examination before starting NAC and after the second cycle of chemotherapy was also associated with recurrence (P 5 0.033), as was a low change in total lesion glycolysis (P , 0.001). Contrarily to PET-based prediction, the extent of pathologic response after completion of NAC (partial/complete vs. nonresponders) was poorly correlated to the risk of relapse. Conclusion: Baseline tumor 18 F-FDG uptake and modifications after 2 cycles of NAC are prognostic of outcome in patients with ER1/ HER2− breast cancer.

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“…DCE MR imaging has high sensitivity for cases of TN breast cancer that are occult at mammographic imaging or US, and certain features of DCE MR imaging have high specificity for TN breast cancer compared with cancers that are estrogen receptorpositive, progesterone receptor-positive, and HER2-negative (11,12). TN breast cancer demonstrates higher SUV max than other subtypes, and PET/ CT can help identify TN breast cancer patients at increased risk of early relapse (13,14).…”

Section: Patients and Study Protocolmentioning

confidence: 99%

Triple-Negative and Non–Triple-Negative Invasive Breast Cancer: Association between MR and Fluorine 18 Fluorodeoxyglucose PET Imaging

Bolouri

Elias²,

Wisner³

et al. 2013

Radiology

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Purpose:To assess the relationship between parameters measured on dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in primary invasive breast cancer. Materials and Methods:This HIPAA-compliant study was a retrospective review of medical records and therefore approved by the institutional review board without the requirement for informed consent. Patients with a diagnosis of invasive breast cancer from January 2005 through December 2009 who underwent both DCE MR imaging and FDG PET/CT before treatment initiation were retrospectively identified. Fractional volumes were measured for ranges of signal enhancement ratio (SER) values from DCE MR imaging data and compared with maximum standardized uptake values (SUV max ) from FDG PET/CT data. Linear regression analysis was performed to clarify the relationship between SER and SUV max , adjusting for tumor size, pathologic grade, and receptor status. Results:Analyzed were 117 invasive breast cancers in 117 patients. Overall, a higher percentage of high washout kinetics was positively associated with SUV max (1.57% increase in SUV max per 1% increase in high washout; P = .020), and a higher percentage of low plateau kinetics was negatively associated with SUV max (1.19% decrease in SUV max per 1% increase in low plateau; P = .003). These relationships were strongest among triple-negative (TN) tumors (4.34% increase in SUV max per 1% increase in high washout and 2.65% decrease in SUV max per 1% increase in low plateau; P = .018 and .004, respectively). Conclusion:In invasive breast carcinoma, there is a positive relationship between the percentage of high washout and SUV max and a negative relationship between the percentage of low plateau and SUV max . These results are stronger in TN tumors.q RSNA, 2013 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Triple-Negative Breast Cancer: Early Assessment with ¹⁸F-FDG PET/CT During Neoadjuvant Chemotherapy Identifies Patients Who Are Unlikely to Achieve a Pathologic Complete Response and Are at a High Risk of Early Relapse

Cited by 93 publications

References 19 publications

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Baseline Tumor ¹⁸F-FDG Uptake and Modifications After 2 Cycles of Neoadjuvant Chemotherapy Are Prognostic of Outcome in ER+/HER2− Breast Cancer

Triple-Negative and Non–Triple-Negative Invasive Breast Cancer: Association between MR and Fluorine 18 Fluorodeoxyglucose PET Imaging

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Triple-Negative Breast Cancer: Early Assessment with 18F-FDG PET/CT During Neoadjuvant Chemotherapy Identifies Patients Who Are Unlikely to Achieve a Pathologic Complete Response and Are at a High Risk of Early Relapse

Cited by 93 publications

References 19 publications

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Baseline Tumor 18F-FDG Uptake and Modifications After 2 Cycles of Neoadjuvant Chemotherapy Are Prognostic of Outcome in ER+/HER2− Breast Cancer

Triple-Negative and Non–Triple-Negative Invasive Breast Cancer: Association between MR and Fluorine 18 Fluorodeoxyglucose PET Imaging

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Triple-Negative Breast Cancer: Early Assessment with ¹⁸F-FDG PET/CT During Neoadjuvant Chemotherapy Identifies Patients Who Are Unlikely to Achieve a Pathologic Complete Response and Are at a High Risk of Early Relapse

Baseline Tumor ¹⁸F-FDG Uptake and Modifications After 2 Cycles of Neoadjuvant Chemotherapy Are Prognostic of Outcome in ER+/HER2− Breast Cancer