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FDG PET/CT during neoadjuvant chemotherapy may predict response in ER-positive/HER2-negative and triple negative, but not in HER2-positive breast cancer.
Breast. 2013 Oct; 22(5):691-7.B

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+Show Affiliations

Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23414930

Citation

Koolen, Bas B., et al. "FDG PET/CT During Neoadjuvant Chemotherapy May Predict Response in ER-positive/HER2-negative and Triple Negative, but Not in HER2-positive Breast Cancer." Breast (Edinburgh, Scotland), vol. 22, no. 5, 2013, pp. 691-7.
Koolen BB, Pengel KE, Wesseling J, et al. FDG PET/CT during neoadjuvant chemotherapy may predict response in ER-positive/HER2-negative and triple negative, but not in HER2-positive breast cancer. Breast. 2013;22(5):691-7.
Koolen, B. B., Pengel, K. E., Wesseling, J., Vogel, W. V., Vrancken Peeters, M. J., Vincent, A. D., Gilhuijs, K. G., Rodenhuis, S., Rutgers, E. J., & Valdés Olmos, R. A. (2013). FDG PET/CT during neoadjuvant chemotherapy may predict response in ER-positive/HER2-negative and triple negative, but not in HER2-positive breast cancer. Breast (Edinburgh, Scotland), 22(5), 691-7. https://doi.org/10.1016/j.breast.2012.12.020
Koolen BB, et al. FDG PET/CT During Neoadjuvant Chemotherapy May Predict Response in ER-positive/HER2-negative and Triple Negative, but Not in HER2-positive Breast Cancer. Breast. 2013;22(5):691-7. PubMed PMID: 23414930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - FDG PET/CT during neoadjuvant chemotherapy may predict response in ER-positive/HER2-negative and triple negative, but not in HER2-positive breast cancer. AU - Koolen,Bas B, AU - Pengel,Kenneth E, AU - Wesseling,Jelle, AU - Vogel,Wouter V, AU - Vrancken Peeters,Marie-Jeanne T F D, AU - Vincent,Andrew D, AU - Gilhuijs,Kenneth G A, AU - Rodenhuis,Sjoerd, AU - Rutgers,Emiel J Th, AU - Valdés Olmos,Renato A, Y1 - 2013/02/12/ PY - 2012/07/23/received PY - 2012/09/18/revised PY - 2012/12/17/accepted PY - 2013/2/19/entrez PY - 2013/2/19/pubmed PY - 2014/5/16/medline KW - Breast cancer KW - Neoadjuvant chemotherapy KW - PET/CT KW - Response monitoring KW - Subtype SP - 691 EP - 7 JF - Breast (Edinburgh, Scotland) JO - Breast VL - 22 IS - 5 N2 - 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. SN - 1532-3080 UR - https://www.unboundmedicine.com/medline/citation/23414930/FDG_PET/CT_during_neoadjuvant_chemotherapy_may_predict_response_in_ER_positive/HER2_negative_and_triple_negative_but_not_in_HER2_positive_breast_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0960-9776(13)00002-7 DB - PRIME DP - Unbound Medicine ER -