title: Prognostic relevance at 5 years of the early monitoring of neoadjuvant chemotherapy using (18)F-FDG PET in luminal HER2-negative breast cancer.
abstract: OBJECTIVE
  The objective of this study was to evaluate, in the luminal human epidermal growth factor receptor 2 (HER2)-negative breast cancer subtype, the prognostic value of tumour glucose metabolism at baseline and of its early changes during neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  This prospective study included 61 women with hormone-sensitive HER2-negative breast cancer treated with NAC. (18)F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) was performed at baseline. Hepatic activity was used as a reference to distinguish between low metabolic and hypermetabolic tumours. In hypermetabolic tumours, a PET exam was repeated after the first course of NAC. The relative change in the maximum standardized uptake value of the tumour (∆SUV) was calculated.
  
  
  RESULTS
  Nineteen women had low metabolic luminal breast cancers at baseline, correlated with low proliferation indexes. Forty-two women had hypermetabolic tumours, corresponding to more proliferative breast cancers with higher Ki-67 expression (p = 0.017) and higher grade (p = 0.04). The median follow-up period was 64.2 months (range 11.5-93.2). Thirteen women developed recurrent disease, nine of whom died. Worse overall survival was associated with larger tumour size [>5 cm, hazard ratio (HR) = 6.52, p = 0.009] and with hypermetabolic tumours achieving a low metabolic response after one cycle of NAC (ΔSUV < 16%, HR = 10.63, p = 0.004). Five-year overall survival in these poor responder patients was 49.2%. Overall survival in women with low metabolic tumours or hypermetabolic/good response tumours was 100 and 96.15%, respectively.
  
  
  CONCLUSIONS
  In luminal HER2-negative breast tumours, tumour metabolism at baseline and changes after the first course of NAC are early surrogate markers of patients' survival. A subgroup of women with hypermetabolic/poorly responding tumours, correlated with poor prognosis at 5 years, can be identified early. These results may guide future studies by tailoring the NAC regimen to the metabolic response.
authors.affiliation: Department of Nuclear Medicine, Centre GF Leclerc, 1 rue du Pr Marion, 21000, Dijon, France, ohumbert@cgfl.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Humbert
authors.forename: Alina
authors.initials: A
authors.lastname: Berriolo-Riedinger
authors.forename: Alexandre
authors.initials: A
authors.lastname: Cochet
authors.forename: Mélanie
authors.initials: M
authors.lastname: Gauthier
authors.forename: Céline
authors.initials: C
authors.lastname: Charon-Barra
authors.forename: Séverine
authors.initials: S
authors.lastname: Guiu
authors.forename: Isabelle
authors.initials: I
authors.lastname: Desmoulins
authors.forename: Michel
authors.initials: M
authors.lastname: Toubeau
authors.forename: Inna
authors.initials: I
authors.lastname: Dygai-Cochet
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
authors.forename: Pierre
authors.initials: P
authors.lastname: Fumoleau
authors.forename: François
authors.initials: F
authors.lastname: Brunotte
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000628:therapy; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D019394:Ki-67 Antigen / Q000235:genetics / Q000378:metabolism; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18; D019394:Ki-67 Antigen; D019275:Radiopharmaceuticals; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human