Complete Metabolic Response on Interim 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography to Predict Long-Term Survival in Patients with Breast Cancer Undergoing Neoadjuvant Chemotherapy

Chen, Suyun; Ibrahim, Nuhad K.; Yan, Yuanqing; Wong, Stephen T.C.; Wang, Hui; Wong, Franklin

doi:10.1634/theoncologist.2016-0334

Cited by 15 publications

(14 citation statements)

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“…Imaging modalities that show promise in the assessment of chemotherapy response include ultrasound of both breast and axilla [ 24 ], dynamic contrast-enhanced magnetic resonance imaging (MRI) [ 29 ], MRI texture analysis [ 25 ], and trimodal imaging (ultrasound, mammography, and MRI) [ 30 , 31 ]. Shear-wave elastography of tumor stiffness before the start of chemotherapy has been associated with tumor response [ 26 ], and 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has also been studied [ 32 ]. The latter work correlated metabolic response by PET/CT during NACT after as few as two cycles of chemotherapy to improved survival at 71-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

Effect of neoadjuvant chemotherapy regimen on relapse-free survival among patients with breast cancer achieving a pathologic complete response: an early step in the de-escalation of neoadjuvant chemotherapy

et al. 2018

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BackgroundPatients with breast cancer who have a pathologic complete response (pCR) to neoadjuvant chemotherapy (NACT) have improved survival. We hypothesize that once pCR has been achieved, there is no difference in subsequent postsurgical recurrence-free survival (RFS), whichever NACT regimen is used.MethodsData from patients with breast cancer who achieved pCR after NACT between 1996 and 2011 were reviewed. RFS was estimated by the Kaplan-Meier method, and differences between groups were assessed using log-rank testing. Cox proportional hazards regression analysis adjusted for age, menopausal status, stage, grade, tumor subtype, and adjuvant endocrine HER2-targeted radiation treatment.ResultsAmong 721 patients who achieved pCR after NACT, 157 (21.8%) were hormone receptor-positive (HR), 310 (43.3%) were HER2-amplified, and 236 (32.7%) were triple-negative; 292 (40.5%) were stage IIA, 153 (21.2%) were stage IIB, 78 (10.8%) were stage IIIA, 66 (9.2%) were stage IIIB, and 132 (18.3%) were stage IIIC. Most patients (367 [50.9%]) had been treated with adriamycin-based chemotherapy plus taxane (A + T), 56 (7.8%) without taxane (A no T), 227 (31.5%) with HER2-targeted therapy, and 71 (9.8%) provider choice. Median follow-up was 7.1 years. Adjuvant chemotherapy was employed in 196 (27%) patients, adjuvant endocrine in 261 (36%), and adjuvant radiation in the majority (559 [77.5%]). There was no statistically significant difference in RFS by NACT group. Adjusted RFS hazard ratios, comparing each treatment with the reference group A + T, were 1.25 (95% CI 0.47–3.35) for A no T, 0.90 (95% CI 0.37–2.20) for HER2-targeted therapy, and 1.28 (95% CI 0.55–2.98) for provider choice.ConclusionsThese data suggest that postsurgical RFS is not significantly influenced by the choice of NACT or cancer subtype among patients achieving pCR.Electronic supplementary materialThe online version of this article (10.1186/s13058-018-0945-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Effect of neoadjuvant chemotherapy regimen on relapse-free survival among patients with breast cancer achieving a pathologic complete response: an early step in the de-escalation of neoadjuvant chemotherapy

et al. 2018

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“…All studies were rated as having a low risk of attrition bias. For prognostic factor measurement, nine studies had a high risk of bias due to the use of data-dependent cut-off values [ 12 – 14 , 18 , 20 , 24 , 27 , 31 , 32 ]. Regarding outcome measurements, fifteen studies had a moderate risk of bias because the definition or methods for measuring disease recurrence were unclear [ 12 – 16 , 22 – 24 , 26 – 32 ].…”

Section: Resultsmentioning

confidence: 99%

Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

Han

Choi

2020

Breast Cancer Res

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Background We performed a systematic review and meta-analysis to evaluate the prognostic significance of 18F-FDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods We searched PubMed, Embase, and the Cochrane Library databases until June 2020 to identify studies that assessed the prognostic value of 18F-FDG PET scans during or after NAC with regard to overall (OS) and disease-free survival (DFS). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled meta-analytically using a random-effects model. Results Twenty-one studies consisting of 1630 patients were included in the qualitative synthesis. Twelve studies investigated the use of PET scans for interim response evaluation (during NAC) and 10 studies assessed post-treatment PET evaluation (after NAC). The most widely evaluated parameter distinguishing metabolic responders from poor responders on interim or post-treatment PET scans was %ΔSUVmax, defined as the percent reduction of SUVmax compared to baseline PET, followed by SUVmax and complete metabolic response (CMR). For the 17 studies included in the meta-analysis, the pooled HR of metabolic responses on DFS was 0.21 (95% confidence interval [CI], 0.14–0.32) for interim PET scans and 0.31 (95% CI, 0.21–0.46) for post-treatment PET scans. Regarding the influence of metabolic responses on OS, the pooled HRs for interim and post-treatment PET scans were 0.20 (95% CI, 0.09–0.44) and 0.26 (95% CI, 0.14–0.51), respectively. Conclusions The currently available literature suggests that the use of 18F-FDG PET or PET/CT for evaluation of response to NAC provides significant predictive value for disease recurrence and survival in breast cancer patients and might allow risk stratification and guide rational management.

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“…However, other PET variables such as SUVpeak have also been used as predictors of neoadjuvant chemotherapy response and prognosis in breast cancer. At 6year follow-up, SUVmax on early PET was shown to independently correlate with OS in patients with breast cancer receiving neoadjuvant chemotherapy [32]. In patients with operable HER2-positive and triple negative breast cancer, the SUVmax determined by PET after neoadjuvant chemotherapy predicted pCR and significantly correlated with recurrence-free survival and recurrence [6].…”

Section: Discussionmentioning

confidence: 96%

Long-term outcomes in patients with PET-predicted poor-responsive HER2-positive breast cancer treated with neoadjuvant bevacizumab added to trastuzumab and docetaxel: 5-year follow-up of the randomised Avataxher study

et al. 2020

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Background: The open-label, randomised Phase 2 AVATAXHER study (NCT01142778) demonstrated that early PET assessment identified HER2-positive breast cancer patients who responded poorly to neoadjuvant docetaxel plus trastuzumab. Adding neoadjuvant bevacizumab for PET-predicted poor-responders improved pathological complete response (pCR) rates (43.8% vs 24.0%). We investigated long-term study outcomes. Methods: Patients were treated in three groups. All patients initially received two cycles of standard neoadjuvant therapy with [ 1 ⁸F]-FDG PET conducted before each cycle. Those with 70% change in the maximum standardised uptake value (ΔSUVmax) received four further cycles of standard neoadjuvant therapy (PET responders). PET-predicted poor-responders (ΔSUVmax <70%) were randomised (2:1) to neoadjuvant therapy with (Group A) or without (Group B) bevacizumab for cycles 3À6. All patients received one further cycle of trastuzumab before surgery plus adjuvant trastuzumab (11 cycles). Findings: 142 patients were randomized and treated (PET responders, n = 69; Group A, n = 48; Group B, n = 25). 5-year disease-free survival rates were 90.5% (95% CI: 80.0À95.6%) in PET responders, 90.2% (95% CI: 75.9À96.2%) in Group A, and 76.0% (95% CI: 54.2À88.4%) in Group B. However, no difference was observed between randomised arms in a sensitivity analysis. During adjuvant therapy, the incidence of Grade 3 (Group A: 25.6%; Group B 12.5%) and serious adverse events (Group A: 18.6%; Group B 12.5%) was higher in Group A vs Group B, but with no apparent effect on cardiac events. Interpretation: In patients with HER2-positive breast cancer, an intervention based on early PET assessment and improvement of pCR does not modify disease-free survival.

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Complete Metabolic Response on Interim 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography to Predict Long-Term Survival in Patients with Breast Cancer Undergoing Neoadjuvant Chemotherapy

Cited by 15 publications

References 28 publications

Effect of neoadjuvant chemotherapy regimen on relapse-free survival among patients with breast cancer achieving a pathologic complete response: an early step in the de-escalation of neoadjuvant chemotherapy

Effect of neoadjuvant chemotherapy regimen on relapse-free survival among patients with breast cancer achieving a pathologic complete response: an early step in the de-escalation of neoadjuvant chemotherapy

Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

Long-term outcomes in patients with PET-predicted poor-responsive HER2-positive breast cancer treated with neoadjuvant bevacizumab added to trastuzumab and docetaxel: 5-year follow-up of the randomised Avataxher study

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