FDG PET/CT during neoadjuvant chemotherapy may predict response in ER-positive/HER2-negative and triple negative, but not in HER2-positive breast cancer

Koolen, Bas B.; Pengel, Kenneth E.; Wesseling, Jelle; Vogel, Wouter V.; Peeters, Marie‐Jeanne T. F. D. Vrancken; Vincent, Andrew; Gilhuijs, Kenneth G. A.; Rodenhuis, S.; Rutgers, Emiel J.; Olmos, Renato A. Valdés

doi:10.1016/j.breast.2012.12.020

Cited by 79 publications

(63 citation statements)

References 36 publications

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“…Our findings on the prognostic value of PET parameters in ER1/ HER2-BC confirm and extend on previous reports. Koolen et al observed that the change in SUV of the primary tumor early after the beginning of NAC can predict pathologic response in ER1/HER2-BC, but no information was available on the relation between changes of 18 F-FDG uptake and EFS (15). In 31 ER1/HER2-BC patients, Zucchini et al found that the change in SUV max between baseline PET and PET performed after 2 courses of NAC was predictive of disease-free survival (16).…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…The main advantage of metabolic imaging over conventional imaging is its ability to assess response earlier because the tumor metabolic changes occur before the morphologic changes (12). The potential prognostic value of PET gains full power and clinical meaning when each breast cancer phenotype is considered separately (13)(14)(15)(16)(17)(18). Recently, in 142 HER2-positive breast cancer patients, the pCR rate was increased when the neoadjuvant treatment was changed early according to PET information (18).…”

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confidence: 99%

¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

et al. 2015

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Patients with triple-negative breast cancer (TNBC) have poor outcome when pathologic complete response (pCR) is not reached after neoadjuvant chemotherapy. Early prediction would be helpful. We evaluated the association between metabolic response after 2 cycles of neoadjuvant chemotherapy, pCR, and outcome in patients receiving 2 different anthracycline-based regimens (conventional and intensified). Methods: Of 77 consecutive TNBC patients, 23 received EC-D (4 cycles of epirubicin 1 cyclophosphamide followed by 4 cycles of docetaxel at conventional doses) and 55 received a dose-intensified, dose-dense concomitant regimen of epirubicin 1 cyclophosphamide (historically called SIM) for 6 cycles. PET/CT with 18 F-FDG was performed at baseline and after 2 cycles of neoadjuvant chemotherapy. The associations between clinical factors, biologic factors, early metabolic change, pCR, and event-free survival (EFS) were examined (log-rank test). Results: Of the 78 patients, 29 (37%) achieved pCR. The change in SUV max (ΔSUV max ) after 2 cycles was more pronounced in patients who achieved pCR (−72% vs. −42%; P , 0.0001). ΔSUV max was more pronounced under SIM than under EC-D (−68% vs. −35%, P 5 0.009), and there was a trend for a higher pCR rate (44% vs. 22%, P 5 0.078). Twenty-two patients relapsed and 10 of them died (median follow-up, 34 mo). pCR was associated with EFS (log-rank, P 5 0.001). ΔSUV max was also significantly associated with EFS both in patients receiving SIM (P 5 0.028) and in those receiving EC-D (P 5 0.021). The optimal ΔSUV max for predicting pCR and EFS was, however, specific to the treatment regimen. EFS was not associated with tumor grade (P 5 0.98), histologic subtype (P 5 0.17), or clinical stage (P 5 0.097). Conclusion: Early metabolic change during neoadjuvant chemotherapy can predict pathologic response and EFS in TNBC patients under different chemotherapy regimens. However, the metabolic response varies with the type of chemotherapy.

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“…Humbert showed that the change in 18 F-FDG SUVmax after 1 course of treatment may predict clinical response for patients treated with docetaxel, trastuzumab, and carboplatin (n 5 37). In contrast, Koolen et al suggested that changes in 18 F-FDG PET uptake in 25 patients with HER2-positive breast cancer after 6-8 wk of paclitaxel, trastuzumab, and carboplatin were less useful, but the limited numbers of patients in both studies prevents definitive conclusions (7,8).…”

Section: See Page 1862mentioning

confidence: 98%

¹⁸F-FDG PET/CT for Early Prediction of Response to Neoadjuvant Lapatinib, Trastuzumab, and Their Combination in HER2-Positive Breast Cancer: Results from Neo-ALTTO

Kenny

2013

J Nucl Med

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FDG PET/CT during neoadjuvant chemotherapy may predict response in ER-positive/HER2-negative and triple negative, but not in HER2-positive breast cancer

Cited by 79 publications

References 36 publications

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

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

¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

¹⁸F-FDG PET/CT for Early Prediction of Response to Neoadjuvant Lapatinib, Trastuzumab, and Their Combination in HER2-Positive Breast Cancer: Results from Neo-ALTTO

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FDG PET/CT during neoadjuvant chemotherapy may predict response in ER-positive/HER2-negative and triple negative, but not in HER2-positive breast cancer

Cited by 79 publications

References 36 publications

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

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

18F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

18F-FDG PET/CT for Early Prediction of Response to Neoadjuvant Lapatinib, Trastuzumab, and Their Combination in HER2-Positive Breast Cancer: Results from Neo-ALTTO

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

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

¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

¹⁸F-FDG PET/CT for Early Prediction of Response to Neoadjuvant Lapatinib, Trastuzumab, and Their Combination in HER2-Positive Breast Cancer: Results from Neo-ALTTO