A preliminary study of 18F-FES PET/CT in predicting metastatic breast cancer in patients receiving docetaxel or fulvestrant with docetaxel

Abstract

The present explorative study was initiated to evaluate the clinical value of 18F-FES PET/CT in monitoring the change of estrogen receptor (ER) expression and potential predictive value in metastatic breast cancer patients. Twenty-two pathology-confirmed breast cancer patients were prospectively enrolled and randomly divided into two groups (T: docetaxel, n = 14 and TF: docetaxel + fulvestrant, n = 8). The percentage of patients without disease progression after 12 months (PFS > 12 months) was 62.5% in group TF compared with 21.4% in group T (P = 0.08). According to 18F-FES PET/CT scans, the SUVmax (maximum standard uptake value) of all the metastatic lesions decreased in group TF after 2 cycles of treatment (6 weeks ± 3 days). However, 6 of 9 patients in group T had at least one lesion with higher post-treatment SUVmax. There was a significant difference in the reduction of ER expression between these two groups (P = 0.028). In group TF, the patients with PFS > 12 months had significantly greater SUVmax changes of 18F-FES than those with PFS < 12 months (PFS > 12 months: 91.0 ± 12.0% versus PFS < 12 months: 20.7 ± 16.2%; t = −4.64, P = 0.01). Our preliminary study showed that 18F-FES PET/CT, as a noninvasive method to monitor ER expression, could be utilized to predict prognosis based on changes in SUVmax.

The Predictive Value of Early Changes in 18F-Fluoroestradiol Positron Emission Tomography/Computed Tomography During Fulvestrant 500 mg Therapy in Patients with Estrogen Receptor-Positive Metastatic Breast Cancer

“…Several studies have validated the novel tracer 16a‐ 18 F‐fluoro‐17β‐estradiol ( 18 F‐FES) as a unique approach to quantify and visualize molecular information about ER expression in all metastatic lesions [15,16,17]. Studies at our center and others have shown that 18 F‐FES uptake correlates with ER expression measured by immunohistochemistry staining, indicating the important role of 18 F‐FES PET in the prediction of treatment response to endocrine therapy [15,18,19,20,21,22].…”

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

“…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 ].…”

“…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 ].…”

The Potential of In Vivo Imaging for Optimization of Molecular and Cellular Anti-cancer Immunotherapies

“…For such application, in vivo imaging has competition from other potential biomarkers that provide off-the-shelf and high-throughput solutions like analyses of circulating tumor cells or tumor DNA, which for these reasons receive interest from the industry. We foresee that in vivo imaging will play a limited role in this domain, although implementation of in vivo imaging to support clinical decision making is being reported, for example, [ 18 F]fluoroestradiol PET imaging in metastatic breast cancer [ 94 , 95 ].…”