Prognostic relevance at 5 years of the early monitoring of neoadjuvant chemotherapy using 18F-FDG PET in luminal HER2-negative breast cancer
- 684 Downloads
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).
This prospective study included 61 women with hormone-sensitive HER2-negative breast cancer treated with NAC. 18F-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.
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.
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.
KeywordsBreast cancer Luminal Neoadjuvant chemotherapy Monitoring 18F-FDG PET
We are grateful to Mr. Bastable for his writing services. This study is part of the PharmImage® project.
Conflicts of interest
- 11.Darb-Esfahani S, Loibl S, Müller BM, Roller M, Denkert C, Komor M, et al. Identification of biology-based breast cancer types with distinct predictive and prognostic features: role of steroid hormone and HER2 receptor expression in patients treated with neoadjuvant anthracycline/taxane-based chemotherapy. Breast Cancer Res 2009;11:R69.PubMedCentralPubMedCrossRefGoogle Scholar
- 17.Cortazar P, Zhang L, Untch M, Mehta K, Costantino J, Wolmark N, et al. Meta-analysis results from the Collaborative Trials in Neoadjuvant Breast Cancer (CTNeoBC). Presented at the San Antonio Breast Cancer Symposium, Texas, USA, 4–8 December 2012.Google Scholar
- 23.Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 1991;19:403–10. Histopathology 2002;41:151–2, discussion.Google Scholar
- 25.Zafrani B, Aubriot MH, Mouret E, De Crémoux P, De Rycke Y, Nicolas A, et al. High sensitivity and specificity of immunohistochemistry for the detection of hormone receptors in breast carcinoma: comparison with biochemical determination in a prospective study of 793 cases. Histopathology 2000;37:536–45.PubMedCrossRefGoogle Scholar
- 28.Esserman LJ, Berry DA, Cheang MC, Yau C, Perou CM, Carey L, et al. Chemotherapy response and recurrence-free survival in neoadjuvant breast cancer depends on biomarker profiles: results from the I-SPY 1 TRIAL (CALGB 150007/150012; ACRIN 6657). Breast Cancer Res Treat 2012;132:1049–62.Google Scholar
- 31.Kanstrup IL, Klausen TL, Bojsen-Møller J, Magnusson P, Zerahn B. Variability and reproducibility of hepatic FDG uptake measured as SUV as well as tissue-to-blood background ratio using positron emission tomography in healthy humans. Clin Physiol Funct Imaging 2009;29:108–13.PubMedCrossRefGoogle Scholar
- 35.Alba E, Calvo L, Albanell J, De la Haba JR, Arcusa Lanza A, Chacon JI, et al. Chemotherapy (CT) and hormonotherapy (HT) as neoadjuvant treatment in luminal breast cancer patients: results from the GEICAM/2006-03, a multicenter, randomized, phase-II study. Ann Oncol 2012;23:3069–74.PubMedCrossRefGoogle Scholar