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[18F]FDG PET/CT for predicting triple-negative breast cancer outcomes after neoadjuvant chemotherapy with or without pembrolizumab

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine if pretreatment [18F]FDG PET/CT could contribute to predicting complete pathological complete response (pCR) in patients with early-stage triple-negative breast cancer (TNBC) undergoing neoadjuvant chemotherapy with or without pembrolizumab.

Methods

In this retrospective bicentric study, we included TNBC patients who underwent [18F]FDG PET/CT before neoadjuvant chemotherapy (NAC) or chemo-immunotherapy (NACI) between March 2017 and August 2022. Clinical, biological, and pathological data were collected. Tumor SUVmax and total metabolic tumor volume (TMTV) were measured from the PET images. Cut-off values were determined using ROC curves and a multivariable model was developed using logistic regression to predict pCR.

Results

N = 191 patients were included. pCR rates were 53 and 70% in patients treated with NAC (N = 91) and NACI (N = 100), respectively (p < 0.01). In univariable analysis, high Ki67, high tumor SUVmax (> 12.3), and low TMTV (≤ 3.0 cm3) were predictors of pCR in the NAC cohort while tumor staging classification (< T3), BRCA1/2 germline mutation, high tumor SUVmax (> 17.2), and low TMTV (≤ 7.3 cm3) correlated with pCR in the NACI cohort. In multivariable analysis, only high tumor SUVmax (NAC: OR 8.8, p < 0.01; NACI: OR 3.7, p = 0.02) and low TMTV (NAC: OR 6.6, p < 0.01; NACI: OR 3.5, p = 0.03) were independent factors for pCR in both cohorts, albeit at different thresholds.

Conclusion

High tumor metabolism (SUVmax) and low tumor burden (TMTV) could predict pCR after NAC regardless of the addition of pembrolizumab. Further studies are warranted to validate such findings and determine how these biomarkers could be used to guide neoadjuvant therapy in TNBC patients.

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Data Availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France

    Romain-David Seban, Segolene Hescot, Arnaud Berenbaum & Laurence Champion

  2. Laboratoire d’Imagerie Translationnelle en Oncologie, Inserm U1288, Institut Curie, PSL University, Paris Saclay University, 91400, Orsay, France

    Romain-David Seban, Laurence Champion & Irene Buvat

  3. Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France

    Emilie Arnaud, Delphine Loirat, Luc Cabel & Paul Cottu

  4. Department of Pathology, Institut Curie, 75005, Paris, France

    Lounes Djerroudi

  5. Department of Radiation Oncology, Institut Curie, 92210, Saint-Cloud, France

    Pierre Loap

  6. Inserm U900, Institut Curie, 35, rue Dailly, 92210, Saint-Cloud, France

    Claire Bonneau

  7. Department of Surgery, Institut Curie, 92210, Saint-Cloud, France

    Claire Bonneau

  8. Department of Medical Oncology, Institut Curie, UVSQ/Paris-Saclay University, 92210, Saint-Cloud, France

    Francois-Clement Bidard

  9. Circulating Tumor Biomarkers Laboratory, Institut Curie, SiRIC, PSL Research University, Paris, France

    Francois-Clement Bidard

  10. Department of Nuclear Medicine, Institut Curie, 75005, Paris, France

    Virginie Huchet & Nina Jehanno

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  1. Romain-David Seban
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Contributions

All authors made substantial contributions to the design of the work; or the acquisition, analysis, or interpretation of data; all authors revised it critically for important intellectual content; all authors approved the version to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Material preparation, data collection, and analysis were performed by R-D. Seban, E. Arnaud, D. Loirat, L. Djerroudi, F–C Bidard, A Berenbaum, L. Champion, and I. Buvat. The first draft of the manuscript was written by R-D Seban, E. Arnaud, D. Loirat, F–C Bidard, L. Champion, and I. Buvat. All authors commented on previous versions of the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Romain-David Seban.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration.

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For this type of study (retrospective), formal consent is not required.

Conflict of interest

Financial interests: Dr. Delphine LOIRAT and Dr. Segolene HESCOT have received speaker and consultant honoraria from MSD. All other authors declare that they have no conflict of interest.

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Seban, RD., Arnaud, E., Loirat, D. et al. [18F]FDG PET/CT for predicting triple-negative breast cancer outcomes after neoadjuvant chemotherapy with or without pembrolizumab. Eur J Nucl Med Mol Imaging 50, 4024–4035 (2023). https://doi.org/10.1007/s00259-023-06394-y

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