Chemotherapy Shows a Better Efficacy Than Endocrine Therapy in Metastatic Breast Cancer Patients with a Heterogeneous Estrogen Receptor Expression Assessed by 18F-FES PET

Xie, Yizhao; Du, Xinyue; Zhao, Yannan; Gong, Chengcheng; Hu, Shihui; You, Shuhui; Song, Shaoli; Hu, Xichun; Yang, Zhongyi; Wang, Biyun

doi:10.3390/cancers14143531

Cited by 12 publications

(30 citation statements)

References 30 publications

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“…A retrospective study of 56 patients with known ER+ metastatic breast cancer who underwent FES PET/CT before combined endocrine and palbociclib (cyclin-dependent kinase 4/6-inhibitor) therapy found that patients with only FES-positive lesions had a substantially longer progression-free survival compared to those ER+ breast cancer patients who had at least one FES-negative lesion (23.6 months compared to 2.4 months) [ 45 ]. Similarly, a retrospective study of 75 patients with ER+ metastatic breast cancer found that patients with ER heterogeneity (both FES-positive and FES-negative lesions) responded better to chemotherapy than endocrine therapy, and did not improve with combined chemotherapy and endocrine therapy [ 46 ]. The utility of FES to guide clinical management can be especially useful in patients who have both ER+ breast cancer and at least one other primary malignancy.…”

Section: Estrogen Receptormentioning

confidence: 99%

Nuclear Receptor Imaging In Vivo—Clinical and Research Advances

Parent

Fowler

2022

Journal of the Endocrine Society

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Nuclear receptors are transcription factors that function in normal physiology and play important roles in diseases such as cancer, inflammation, and diabetes. Noninvasive imaging of nuclear receptors can be achieved using radiolabeled ligands and positron emission tomography (PET). This quantitative imaging approach can be viewed as an in vivo equivalent of the classic radioligand binding assay. A main clinical application of nuclear receptor imaging in oncology is to identify metastatic sites expressing nuclear receptors that are targets for approved drug therapies and are capable of binding ligand to improve treatment decision making. Research applications of nuclear receptor imaging include novel synthetic ligand and drug development by quantifying target drug engagement with the receptor for optimal therapeutic drug dosing and for fundamental research into nuclear receptor function in cells and animal models. This Mini-Review provides an overview of PET imaging of nuclear receptors with a focus on radioligands for estrogen receptor, progesterone receptor, and androgen receptor and their use in breast and prostate cancer.

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Section: Estrogen Receptormentioning

confidence: 99%

Nuclear Receptor Imaging In Vivo—Clinical and Research Advances

Parent

Fowler

2022

Journal of the Endocrine Society

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“…All studies were published between 1995 and 2022, 6,7,10-14,18-53 of which 29 (63%) were prospective. 6,7,[10][11][12][13][14][18][19][20][21][23][24][25][26][27][28][29]34,36,[43][44][45][46][47][48][49][50][51] Of the 43 studies, 32 (74%) were on breast cancer, 6,7,[18][19][20][21][22][23][24][25][26]28,31,[33][34][35][37][38][39][40][41][43][44]…”

Section: Results Basic Characteristics Of Included Studies and Patientsmentioning

confidence: 99%

“…Of the 43 included studies, 28 (63%) conducted FES PET imaging to detect ER expression on malignant lesions, 6,7,[10][11][12][20][21][22][23][24][25][27][28][29][31][32][33][34][35][36][37][38][39][40][41]46,52 and 12 (28%) 13,24,39,41,42,[45][46][47][48][49][50][51] and 4 (9%) 14,43,44,53 studies conducted FES PET imaging, respectively, to predict and monitor the treatment response (such as endocrine therapy or chemotherapy), progressionfree survival (PFS), and overall survival (OS) (Table 1).…”

Section: Results Basic Characteristics Of Included Studies and Patientsmentioning

confidence: 99%

The Application of 18F-FES PET in Clinical Cancer Care

Huang¹,

Chen²,

Chen

et al. 2023

Clin Nucl Med

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Introduction [18F]fluoroestradiol (FES) can be used for the noninvasive visualization and quantification of tumor estrogen receptor (ER) expression and activity and was FDA-approved as a diagnostic agent in May 2022 for detecting ER-positive lesions in patients with recurrent or metastatic breast cancer. PET imaging was also used to detect ER-positive lesions and malignancy among patients with uterine, ovarian, and other ER-positive solid tumors. We conducted a systemic review of the studies on FES PET imaging used among patients with cancer not limited to breast cancer to better understand the application of FES PET imaging. Methods PubMed/MEDLINE and Cochrane Library databases were used to perform a comprehensive and systematic search and were updated until August 15, 2022. Two authors independently reviewed the titles and abstracts of the retrieved articles by using the search algorithm and selected the articles based on the inclusion and exclusion criteria. All statistical analyses were conducted using R statistical software. Results Forty-three studies with 2352 patients were included in the qualitative synthesis, and 23 studies with 1388 patients were included in the quantitative analysis, which estimated the FES-positive detection rate. Thirty-two studies (77%) included breast cancer patients in 43 included studies. The FES SUVmean was higher in patients with endometrial cancer (3.4–5.3) than in those with breast cancer (2.05) and uterine sarcoma (1.1–2.6). The pooled detection rates of FES PET imaging were 0.80 for breast and 0.84 for ovarian cancer patients, both similar to that of 18F-FDG. The FES uptake threshold of 1.1 to 1.82 could detect 11.1% to 45% ER heterogeneity, but the threshold of FES uptake did not have consistent predictive ability for prognosis among patients with breast cancer, unlike uterine cancer. However, FES uptake can effectively predict and monitor treatment response, especially endocrine therapy such as estradiol, ER-blocking agents (fulvestrant and tamifoxen), and aromatase inhibitors (such as letrozole and Z-endoxifen). Conclusions [18F]fluoroestradiol PET is not only a convenient and accurate diagnostic imaging tool for detecting ER-expressing lesions in patients with breast and ovarian cancer but also among patients with uterine cancer. [18F]fluoroestradiol PET is a noninvasive predictive and monitoring tool for treatment response and prognosis.

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“…Furthermore, multiple potential clinical applications for 18 F-FES PET have been proposed, including selecting patients for hormonal therapy, solving clinical dilemmas and systemic staging of tumors with low metabolic activity (10). In terms of prediction of therapeutic response, study had shown that patients with ER heterogeneity or uncertainty tumors on 18 F-FES PET showed better sensitivity to chemotherapy rather than endocrine therapy (29). In another trial evaluating tumor heterogeneity by 18 F-FES PET as a predictive marker in MBC patients receiving palbociclib combined endocrine therapy, nine out of ten patients with an FES-negative site developed PD, with a median PFS of only 2.4 months.…”

Section: Discussionmentioning

confidence: 99%

Case report: 18F-FES PET/CT predicted treatment responses of second-line and third-line CDK4/6 inhibitors after disease progression on first-line CDK4/6 inhibitor in a HR+/HER2- metastatic breast cancer patient

Pan

Hao

et al. 2022

Front. Oncol.

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BackgroundCyclin-dependent kinase 4/6 inhibitor (CDK4/6i) has become the commonest first-line treatment of hormonal receptor positive and human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer (MBC). However, therapy is quite individualized after progression of disease (PD) when CDK4/6i fails. Estrogen receptor (ER) status of metastatic lesions of bone, lung or liver might be different from the primary tumor and biopsy of metastatic lesions was invasive and not always available. Prediction of treatment response after PD of CDK4/6i remains unsolved. 18F-fluoroestradiol (FES) PET/CT could non-invasively reveal ER expression both in primary and metastatic breast cancer and recognize heterogeneity of ER status.Case presentationA 70-year-old woman with Parkinson’s disease, osteoporosis and cardiovascular co-morbidity was diagnosed with HR+/HER2- breast cancer (pT2N2M0, stage IIIa). Three years later, she developed metastases in right lung and pleura with pleural effusion and received palbociclib + letrozole. After 8 months the disease progressed, and 18F-FES PET/CT revealed multiple ER-positive pleural lesions and ER-negative pulmonary nodules after PD and the progression-free survival (PFS) of first-line CDK4/6i was 8 months. Since most of the metastatic lesions were ER-positive, abemaciclib + fulvestrant were chosen as the second-line CDK4/6i treatment and the PFS was 15 months. Another 18F-FES PET/CT showed a new ER-positive pleural mass with multiple ER-negative pulmonary nodules. Since 18F-FES PET/CT revealed that the dominant lesions were still ER-positive, dalpiciclib + exemestane + fulvestrant were prescribed as the third-line CDK4/6i treatment. Currently the patient’s disease had been stable for 2 months.ConclusionThis case demonstrated that 18F-FES PET/CT could show ER heterogeneity non-invasively and reveal the treatment responses a predictive imaging tool of serial second- and third-line of CDK4/6i treatments when first-line CDK4/6i failed in HR+/HER2- MBC. So long as the dominant or newly-developed metastatic lesion was ER-positive on 18F-FES PET after first-line CDK4/6i, the patient might show certain therapeutic response towards endocrine-based treatment including second- and third-line of CDK4/6i, and thus increased the time to chemotherapy (TTC).

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Chemotherapy Shows a Better Efficacy Than Endocrine Therapy in Metastatic Breast Cancer Patients with a Heterogeneous Estrogen Receptor Expression Assessed by 18F-FES PET

Cited by 12 publications

References 30 publications

Nuclear Receptor Imaging In Vivo—Clinical and Research Advances

Nuclear Receptor Imaging In Vivo—Clinical and Research Advances

The Application of 18F-FES PET in Clinical Cancer Care

Case report: 18F-FES PET/CT predicted treatment responses of second-line and third-line CDK4/6 inhibitors after disease progression on first-line CDK4/6 inhibitor in a HR+/HER2- metastatic breast cancer patient

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