HER2-positive breast cancer: 18F-FDG PET for early prediction of response to trastuzumab plus taxane-based neoadjuvant chemotherapy

  • Olivier HumbertEmail author
  • Alexandre Cochet
  • Jean-Marc Riedinger
  • Alina Berriolo-Riedinger
  • Laurent Arnould
  • Bruno Coudert
  • Isabelle Desmoulins
  • Michel Toubeau
  • Inna Dygai-Cochet
  • Séverine Guiu
  • Charles Coutant
  • Pierre Fumoleau
  • François Brunotte
Original Article



To investigate the value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) to predict a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer.

Material and methods

Fifty-seven consecutive women with HER2-positive breast cancer, treated with trastuzumab plus taxane-based NAC, were prospectively included. Maximum Standardized Uptake Value of the primary tumor and axillary nodes were measured at baseline (PET1.SUVmax) and after the first course of NAC (PET2.SUVmax). Tumor metabolic volumes were assessed to determine Total Lesion Glycolysis (TLG). The tumor metabolic response (ΔSUVmax and ΔTLG) was calculated.


In univariate analysis, negative hormonal receptor status (p = 0.04), high tumor grade (p = 0.03), and low tumor PET 2 .SUVmax (p = 0.001) were predictive of pCR. Tumor ΔSUVmax correlated with pCR (p = 0.03), provided that tumors with low metabolic activity at baseline were excluded. ΔTLG did not correlate with pCR. In multivariate analysis, tumor PET2.SUVmax < 2.1 was the best independent predictive factor (Odds ratio =14.3; p = 0.004) with both negative and positive predictive values of 76 %. Although the metabolic features of the primary tumor did not depend on hormonal receptor status, both the baseline metabolism and early response of axillary nodes were higher if estrogen receptors were not expressed (p = 0.01 and p = 0.03, respectively).


In HER2-positive breast cancer, very low tumor residual metabolism after the first cycle of NAC (SUVmax < 2.1) was the main predictor of pCR. These results should be further explored in multicenter studies and incorporated into the design of clinical trials.


Breast cancer Neoadjuvant chemotherapy PET HER2 Response monitoring 



This study is part of the PharmImage® project. We thank Mr Bastable for proof-reading the text.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Olivier Humbert
    • 1
    • 5
    • 6
    Email author
  • Alexandre Cochet
    • 1
    • 6
  • Jean-Marc Riedinger
    • 1
    • 2
  • Alina Berriolo-Riedinger
    • 1
  • Laurent Arnould
    • 2
  • Bruno Coudert
    • 3
  • Isabelle Desmoulins
    • 3
  • Michel Toubeau
    • 1
  • Inna Dygai-Cochet
    • 1
  • Séverine Guiu
    • 3
  • Charles Coutant
    • 4
  • Pierre Fumoleau
    • 3
  • François Brunotte
    • 1
    • 5
    • 6
  1. 1.Department of Nuclear MedicineCentre GF LeclercDijonFrance
  2. 2.Department of Biology and PathologyCentre GF LeclercDijonFrance
  3. 3.Department of Medical OncologyCentre GF LeclercDijonFrance
  4. 4.Department of SurgeryCentre GF LeclercDijonFrance
  5. 5.Imaging DepartmentCHU Le BocageDijonFrance
  6. 6.Université de Bourgogne, UMR CNRS 5158DijonFrance

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