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

Abstract

BACKGROUND:

Response monitoring with MRI during neoadjuvant chemotherapy (NAC) in breast cancer is promising, but knowledge of breast cancer subtype is essential. The aim of the present study was to evaluate the relevance of breast cancer subtypes for monitoring of therapy response during NAC with 18F-FDG PET/CT.

METHODS:

Evaluation included 98 women with stages II and III breast cancer. PET/CTs were performed before and after six or eight weeks of NAC. FDG uptake was quantified using maximum standardized uptake values (SUVmax). Tumors were divided into three subtypes: HER2-positive, ER-positive/HER2-negative, and triple negative. Tumor response at surgery was assessed dichotomously (presence or absence of residual disease) and ordinally (breast response index, representing relative change in tumor stage). Multivariate regression and receiver operating characteristic (ROC) analyses were employed to determine associations with pathological response.

RESULTS:

A (near) complete pathological response was seen in 19 (76%) of 25 HER2-positive, 7 (16%) of 45 ER-positive/HER2-negative, and 20 (71%) of 28 triple negative tumors. Multivariate regression of pathological response indicated a significant interaction between change in FDG uptake and breast cancer subtype. The area under the ROC curve was 0.35 (0.12-0.64) for HER2-positive, 0.90 (0.76-1.00) for ER-positive/HER2-negative, and 0.96 (0.86-1.00) for triple negative tumors. We found no association between age, stage, histology, or baseline SUVmax and pathological response.

CONCLUSION:

Response monitoring with PET/CT during NAC in breast cancer seems feasible, but is dependent on the breast cancer subtype. PET/CT may predict response in ER-positive/HER2-negative and triple negative tumors, but seems less accurate in HER2-positive tumors.

• Authors: Bas B Koolen, Kenneth E Pengel, Jelle Wesseling, Wouter V Vogel, Marie-Jeanne T F D Vrancken Peeters, Andrew D Vincent, Kenneth G A Gilhuijs, Sjoerd Rodenhuis, Emiel J Th Rutgers, Renato A Valdés Olmos
• Journal: Breast (Edinburgh, Scotland) (Breast) Vol. 22 Issue 5 Pg. 691-7 (Oct 2013) ISSN: 1532-3080 [Electronic] Netherlands
• PMID: 23414930 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Chemical References

• Radiopharmaceuticals
• Receptors, Estrogen
• Fluorodeoxyglucose F18
• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Area Under Curve
• Carcinoma (chemistry, diagnosis, drug therapy)
• Chemotherapy, Adjuvant
• Female
• Fluorodeoxyglucose F18
• Humans
• Middle Aged
• Multimodal Imaging
• Neoadjuvant Therapy
• Positron-Emission Tomography
• Predictive Value of Tests
• ROC Curve
• Radiopharmaceuticals
• Receptor, ErbB-2 (analysis)
• Receptors, Estrogen (analysis)
• Tomography, X-Ray Computed
• Triple Negative Breast Neoplasms (diagnosis, drug therapy)