title: ¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen.
abstract: 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 + cyclophosphamide followed by 4 cycles of docetaxel at conventional doses) and 55 received a dose-intensified, dose-dense concomitant regimen of epirubicin + 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 SUVmax (∆SUVmax) after 2 cycles was more pronounced in patients who achieved pCR (-72% vs. -42%;P< 0.0001). ∆SUVmax was more pronounced under SIM than under EC-D (-68% vs. -35%, P= 0.009), and there was a trend for a higher pCR rate (44% vs. 22%, P= 0.078). Twenty-two patients relapsed and 10 of them died (median follow-up, 34 mo). pCR was associated with EFS (log-rank, P= 0.001). ∆SUVmax was also significantly associated with EFS both in patients receiving SIM (P= 0.028) and in those receiving EC-D (P= 0.021). The optimal ∆SUVmax for predicting pCR and EFS was, however, specific to the treatment regimen. EFS was not associated with tumor grade (P= 0.98), histologic subtype (P= 0.17), or clinical stage (P= 0.097).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Nuclear Medicine, APHP, Saint-Louis Hospital, Paris, France University Paris-Diderot, PRES Paris Cité, INSERM/CNRS UMR944/7212, Paris, France dgroheux@yahoo.fr.
authors.forename: David
authors.initials: D
authors.lastname: Groheux
authors.affiliation: Department of Biostatistics and Information, APHP, Saint-Louis Hospital, Paris, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Biard
authors.affiliation: Department of Medical Oncology, Breast Diseases Center, APHP, Saint-Louis Hospital, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Giacchetti
authors.affiliation: University Paris-Diderot, PRES Paris Cité, INSERM/CNRS UMR944/7212, Paris, France Department of Medical Oncology, Breast Diseases Center, APHP, Saint-Louis Hospital, Paris, France.
authors.forename: Luis
authors.initials: L
authors.lastname: Teixeira
authors.affiliation: Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, France.
authors.forename: Elif
authors.initials: E
authors.lastname: Hindié
authors.affiliation: Department of Medical Oncology, Breast Diseases Center, APHP, Saint-Louis Hospital, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Cuvier
authors.affiliation: Department of Nuclear Medicine, APHP, Saint-Louis Hospital, Paris, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Vercellino
authors.affiliation: Department of Nuclear Medicine, APHP, Saint-Louis Hospital, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Merlet
authors.affiliation: Department of Pathology, APHP, Saint-Louis Hospital, Paris, France; and.
authors.forename: Anne
authors.initials: A
authors.lastname: de Roquancourt
authors.affiliation: University Paris-Diderot, PRES Paris Cité, INSERM/CNRS UMR944/7212, Paris, France Molecular Oncology Unit, APHP, Saint-Louis, Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: de Cremoux
authors.affiliation: Department of Biostatistics and Information, APHP, Saint-Louis Hospital, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Resche-Rigon
authors.affiliation: University Paris-Diderot, PRES Paris Cité, INSERM/CNRS UMR944/7212, Paris, France Department of Medical Oncology, Breast Diseases Center, APHP, Saint-Louis Hospital, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Espié
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*
chemical_list: D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D015251:Epirubicin; D003520:Cyclophosphamide
keywords: 18F-FDG PET/CT; dose-dense chemotherapy; metabolic response; neoadjuvant chemotherapy; prognosis; triple-negative breast cancer