A Randomized Feasibility Study of18F-Fluoroestradiol PET to Predict Pathologic Response to Neoadjuvant Therapy in Estrogen Receptor-Rich Postmenopausal Breast Cancer.
The aim of this study was to explore the ability of18F-fluoroestradiol (18F-FES) PET/CT imaging to predict pathologic response to neoadjuvant therapy in postmenopausal women with estrogen receptor (ER)-rich breast cancer.Methods:This was a prospective, single-center study conducted as a substudy of the neoadjuvant study of chemotherapy versus endocrine therapy in postmenopausal patients with primary breast cancer (NEOCENT) trial. Patients with ER-rich breast cancer were randomized to neoadjuvant chemotherapy (NC) or neoadjuvant endocrine therapy (NET). The baseline SUVmaxof18F-FES PET/CT was measured. The pathologic response was assessed by the Miller-Payne system as nonresponse (grades 1 and 2) and response (grades 3-5).Results:Twenty-six patients were enrolled, with pathologic response achieved in 25 (NC, 12; NET, 13). Two patients achieved pathologic complete response after NC, but the remaining 23 patients had residual disease after NC or NET. Eight of 12 patients responded to NC, and 4 of 13 to NET; the difference was marginally significant (P= 0.07). In the NC group, the 2 patients with18F-FES-negative tumors and none of the 10 patients with18F-FES-avid tumors achieved pathologic complete response (P= 0.02). No difference in the SUVmaxbetween responders and nonresponders was observed in either group. However, 5 of 7 NC patients with a baseline SUVmaxof less than 7.3 achieved pathologic response, whereas none of the 5 NET patients with an SUVmaxof less than 7.3 were responders (P= 0.03). The SUVmaxvalues of the NC group were negatively correlated with percentage reduction of tumor cellularity (r= -0.63,P= 0.03), whereas those of the NET group showed positive correlation (r= 0.62,P= 0.02). During the median follow-up of 74 mo (range, 44-85 mo), recurrence occurred in only 4 NET patients. In patients with an SUVmaxof less than 7.3, recurrence occurred in none of the 8 NC patients and 2 of the 5 NET patients (P= 0.13).Conclusion:Postmenopausal women who are ER-positive, but18F-FES-negative, may benefit from NC rather than NET.18F-FES PET/CT has the potential to predict response to neoadjuvant therapy in postmenopausal women with ER-rich breast cancer.
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sun Young
SY
Chae
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sung-Bae
SB
Kim
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sei Hyun
SH
Ahn
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Hye Ok
HO
Kim
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Dok Hyun
DH
Yoon
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Jin-Hee
JH
Ahn
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Kyung Hae
KH
Jung
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sangwon
S
Han
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Seung Jun
SJ
Oh
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sang Ju
SJ
Lee
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Hee Jeong
HJ
Kim
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Byung Ho
BH
Son
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and.
Gyungyub
G
Gong
Department of Nuclear Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
Hyo Sang
HS
Lee
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea dhmoon@amc.seoul.kr.
Dae Hyuk
DH
Moon
D000368:Aged; D001692:Biological Transport; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D004958:Estradiol / Q000031:analogs & derivatives* / Q000378:metabolism; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D000072078:Positron Emission Tomography Computed Tomography; D017698:Postmenopause; D011960:Receptors, Estrogen / Q000378:metabolism*; D016019:Survival Analysis; D016896:Treatment Outcome
D011960:Receptors, Estrogen; D004958:Estradiol; C043436:16-fluoroestradiol
18F-FES; breast cancer; estrogen receptor-positive; neoadjuvant therapy; positron emission tomography