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Positron emission tomography of tumour [(18)F]fluoroestradiol uptake in patients with acquired hormone-resistant metastatic breast cancer prior to oestradiol therapy.

van Kruchten M, Glaudemans AW, de Vries EF, Schröder CP, de Vries EG, Hospers GA - Eur. J. Nucl. Med. Mol. Imaging (2015)

Bottom Line: Tumour (18)F-FES-uptake was quantified for a maximum of 20 lesions and expressed as maximum standardised uptake value (SUVmax).Clinical benefit was defined as time to radiologic or clinical progression ≥24 weeks. (18)F-FES uptake, quantified for 255 lesions in 19 patients, varied greatly between lesions (median 2.8; range 0.6-24.3) and between patients (median 2.5; range 1.1-15.5).Seven (37%) patients experienced clinical benefit of oestrogen therapy, eight progressed (PD), and four were non-evaluable due to side effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.

ABSTRACT

Purpose: Whereas anti-oestrogen therapy is widely applied to treat oestrogen receptor (ER) positive breast cancer, paradoxically, oestrogens can also induce tumour regression. Up-regulation of ER expression is a marker for oestrogen hypersensitivity. We, therefore, performed an exploratory study to evaluate positron emission tomography (PET) with the tracer 16α-[(18)F]fluoro-17β-oestradiol ((18)F-FES) as potential marker to select breast cancer patients for oestradiol therapy.

Methods: Eligible patients had acquired endocrine-resistant metastatic breast cancer that progressed after ≥2 lines of endocrine therapy. All patients had prior ER-positive histology. Treatment consisted of oestradiol 2 mg, three times daily, orally. Patients underwent (18)F-FES-PET/CT imaging at baseline. Tumour (18)F-FES-uptake was quantified for a maximum of 20 lesions and expressed as maximum standardised uptake value (SUVmax). CT-scan was repeated every 3 months to evaluate treatment response. Clinical benefit was defined as time to radiologic or clinical progression ≥24 weeks.

Results: (18)F-FES uptake, quantified for 255 lesions in 19 patients, varied greatly between lesions (median 2.8; range 0.6-24.3) and between patients (median 2.5; range 1.1-15.5). Seven (37%) patients experienced clinical benefit of oestrogen therapy, eight progressed (PD), and four were non-evaluable due to side effects. The positive and negative predictive value (PPV/NPV) of (18)F-FES-PET for response to treatment were 60% (95% CI: 31-83%) and 80% (95% CI: 38-96%), respectively, using SUVmax >1.5.

Conclusion: (18)F-FES-PET may aid identification of patients with acquired antihormone resistant breast cancer that are unlikely to benefit from oestradiol therapy.

No MeSH data available.


Related in: MedlinePlus

18F-FES-PET (a), CT (b) and 18F-FES-PET/CT (c) of a patient with bone metastases. Indicated is a rib metastasis (arrow) with SUVmax 3.3
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Fig1: 18F-FES-PET (a), CT (b) and 18F-FES-PET/CT (c) of a patient with bone metastases. Indicated is a rib metastasis (arrow) with SUVmax 3.3

Mentions: 18F-FES was produced and administered to the patient as described earlier [18, 20]. On average 3.4 ± 1.5 GBq 18F-FES was obtained with 100 % radiochemical purity and a 325 ± 274 GBq/μmol specific activity. Patients received approximately 200 MBq 18F-FES intravenously. 18F-FES-PET/CT to evaluate tumour ER-expression was performed at baseline on a hybrid PET/CT camera with a 64-slice CT and high definition and time-of-flight PET (Siemens Medical Systems). Low-dose CT-scan was used for attenuation correction in all patients. Patients were scanned from skull to mid-thigh, 3 min per bed position (usually 7–8 bed positions per patient). In all patients, baseline 18F-FES-PET was combined with a contrast-enhanced diagnostic CT scan. For representative 18F-FES-PET, CT and 18F-FES-PET/CT images see Fig. 1.Fig. 1


Positron emission tomography of tumour [(18)F]fluoroestradiol uptake in patients with acquired hormone-resistant metastatic breast cancer prior to oestradiol therapy.

van Kruchten M, Glaudemans AW, de Vries EF, Schröder CP, de Vries EG, Hospers GA - Eur. J. Nucl. Med. Mol. Imaging (2015)

18F-FES-PET (a), CT (b) and 18F-FES-PET/CT (c) of a patient with bone metastases. Indicated is a rib metastasis (arrow) with SUVmax 3.3
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4554736&req=5

Fig1: 18F-FES-PET (a), CT (b) and 18F-FES-PET/CT (c) of a patient with bone metastases. Indicated is a rib metastasis (arrow) with SUVmax 3.3
Mentions: 18F-FES was produced and administered to the patient as described earlier [18, 20]. On average 3.4 ± 1.5 GBq 18F-FES was obtained with 100 % radiochemical purity and a 325 ± 274 GBq/μmol specific activity. Patients received approximately 200 MBq 18F-FES intravenously. 18F-FES-PET/CT to evaluate tumour ER-expression was performed at baseline on a hybrid PET/CT camera with a 64-slice CT and high definition and time-of-flight PET (Siemens Medical Systems). Low-dose CT-scan was used for attenuation correction in all patients. Patients were scanned from skull to mid-thigh, 3 min per bed position (usually 7–8 bed positions per patient). In all patients, baseline 18F-FES-PET was combined with a contrast-enhanced diagnostic CT scan. For representative 18F-FES-PET, CT and 18F-FES-PET/CT images see Fig. 1.Fig. 1

Bottom Line: Tumour (18)F-FES-uptake was quantified for a maximum of 20 lesions and expressed as maximum standardised uptake value (SUVmax).Clinical benefit was defined as time to radiologic or clinical progression ≥24 weeks. (18)F-FES uptake, quantified for 255 lesions in 19 patients, varied greatly between lesions (median 2.8; range 0.6-24.3) and between patients (median 2.5; range 1.1-15.5).Seven (37%) patients experienced clinical benefit of oestrogen therapy, eight progressed (PD), and four were non-evaluable due to side effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.

ABSTRACT

Purpose: Whereas anti-oestrogen therapy is widely applied to treat oestrogen receptor (ER) positive breast cancer, paradoxically, oestrogens can also induce tumour regression. Up-regulation of ER expression is a marker for oestrogen hypersensitivity. We, therefore, performed an exploratory study to evaluate positron emission tomography (PET) with the tracer 16α-[(18)F]fluoro-17β-oestradiol ((18)F-FES) as potential marker to select breast cancer patients for oestradiol therapy.

Methods: Eligible patients had acquired endocrine-resistant metastatic breast cancer that progressed after ≥2 lines of endocrine therapy. All patients had prior ER-positive histology. Treatment consisted of oestradiol 2 mg, three times daily, orally. Patients underwent (18)F-FES-PET/CT imaging at baseline. Tumour (18)F-FES-uptake was quantified for a maximum of 20 lesions and expressed as maximum standardised uptake value (SUVmax). CT-scan was repeated every 3 months to evaluate treatment response. Clinical benefit was defined as time to radiologic or clinical progression ≥24 weeks.

Results: (18)F-FES uptake, quantified for 255 lesions in 19 patients, varied greatly between lesions (median 2.8; range 0.6-24.3) and between patients (median 2.5; range 1.1-15.5). Seven (37%) patients experienced clinical benefit of oestrogen therapy, eight progressed (PD), and four were non-evaluable due to side effects. The positive and negative predictive value (PPV/NPV) of (18)F-FES-PET for response to treatment were 60% (95% CI: 31-83%) and 80% (95% CI: 38-96%), respectively, using SUVmax >1.5.

Conclusion: (18)F-FES-PET may aid identification of patients with acquired antihormone resistant breast cancer that are unlikely to benefit from oestradiol therapy.

No MeSH data available.


Related in: MedlinePlus