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

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

Abstract

Purpose

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.

Results

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).

Conclusion

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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Nuclear Medicine, Centre GF Leclerc, 1 rue du Pr Marion, 21000, Dijon, France

    Olivier Humbert, Alexandre Cochet, Jean-Marc Riedinger, Alina Berriolo-Riedinger, Michel Toubeau, Inna Dygai-Cochet & François Brunotte

  2. Department of Biology and Pathology, Centre GF Leclerc, Dijon, France

    Jean-Marc Riedinger & Laurent Arnould

  3. Department of Medical Oncology, Centre GF Leclerc, Dijon, France

    Bruno Coudert, Isabelle Desmoulins, Séverine Guiu & Pierre Fumoleau

  4. Department of Surgery, Centre GF Leclerc, Dijon, France

    Charles Coutant

  5. Imaging Department, CHU Le Bocage, Dijon, France

    Olivier Humbert & François Brunotte

  6. Université de Bourgogne, UMR CNRS 5158, Dijon, France

    Olivier Humbert, Alexandre Cochet & François Brunotte

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  1. Olivier Humbert
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Correspondence to Olivier Humbert.

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Humbert, O., Cochet, A., Riedinger, JM. et al. HER2-positive breast cancer: 18F-FDG PET for early prediction of response to trastuzumab plus taxane-based neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging 41, 1525–1533 (2014). https://doi.org/10.1007/s00259-014-2739-1

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