PET-based estradiol challenge as a predictive biomarker of response to endocrine therapy in women with estrogen-receptor-positive breast cancer

被引:176
作者
Dehdashti, Farrokh [1 ,2 ]
Mortimer, Joanne E. [3 ]
Trinkaus, Kathryn [2 ,4 ]
Naughton, Michael J. [2 ,5 ]
Ellis, Matthew [2 ,5 ]
Katzenellenbogen, John A. [6 ]
Welch, Michael J. [2 ,7 ]
Siegel, Barry A. [1 ,2 ]
机构
[1] Edward Mallinckrodt Inst Radiol, Div Nucl Med, St Louis, MO 63110 USA
[2] Washington Univ, Sch Med, Siteman Canc Ctr, St Louis, MO USA
[3] City Hope Comprehens Canc Ctr, Div Med Oncol & Expt Therapeut, Duarte, CA USA
[4] Washington Univ, Sch Med, Div Biostat, St Louis, MO 63110 USA
[5] Washington Univ, Sch Med, Dept Med, St Louis, MO 63110 USA
[6] Univ Illinois, Dept Chem, Urbana, IL 61801 USA
[7] Edward Mallinckrodt Inst Radiol, Div Radiol Sci, St Louis, MO 63110 USA
关键词
Breast cancer; FDG; FES; Flare reaction; Hormone therapy; Metabolic flare; PET; Positron emission tomography; POSITRON TOMOGRAPHIC ASSESSMENT; POSTMENOPAUSAL WOMEN; PERFORMANCE EVALUATION; METABOLIC FLARE; BONE-SCAN; PHASE-III; TAMOXIFEN; SUPERIOR;
D O I
10.1007/s10549-008-9953-0
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose To determine if response to endocrine therapy of breast cancer can be predicted by either a metabolic "flare reaction" detected by positron emission tomography (PET) with 2-[F-18]-fluoro-2-deoxyglucose (FDG), induced by an estradiol challenge, or by estrogen-receptor (ER) status, determined by PET with the estrogen analog 16 alpha-[F-18]fluoroestradiol-17 beta (FES). Methods Fifty-one post-menopausal women with advanced estrogen-receptor positive breast cancer were studied. Patients underwent FES-PET and FDG-PET at baseline and repeat FDG-PET after 30 mg estradiol. Tracer uptakes was measured as the standardized uptake value (SUV). Patients were subsequently treated with either an aromatase inhibitor or fulvestrant. A prospectively defined cut-off SUV a parts per thousand yen 2 for FES was considered positive for ER expression. A cutoff of a parts per thousand yen12% increase in SUV for FDG, determined by ROC analysis, represented metabolic flare. PET results were correlated with responsiveness to endocrine therapy. Results Seventeen patients responded and 34 patients did not respond to endocrine therapy. Four responders and one non-responder had a clinical flare reaction, while only the responders demonstrated metabolic flare. After estradiol challenge, a significantly higher mean (+/- SD) percent change in SUV for FDG was noted in responders (20.9 +/- A 24.2) compared with non-responders (-4.3 +/- A 11.0, P < 0.0001). On FES-PET, a higher tumor SUV was noted in responders (3.5 +/- A 2.5) compared with non-responders (2.1 +/- A 1.8, P = 0.0049). There was significantly longer overall survival in patients with metabolic flare than in those without flare regardless of type of endocrine therapy (P = 0.0062). Conclusion Baseline tumor FES uptake and metabolic flare after an estradiol challenge are both predictive of responsiveness to endocrine therapy in ER+ breast cancer.
引用
收藏
页码:509 / 517
页数:9
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