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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-uptake (SUVmax) in bone lesions (a) and non-bone lesions (b) in all individual patients. The dashed line indicates the 1.5 (SUVmax) threshold
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Fig3: 18F-FES-uptake (SUVmax) in bone lesions (a) and non-bone lesions (b) in all individual patients. The dashed line indicates the 1.5 (SUVmax) threshold

Mentions: 18F-FES uptake in tumour lesions was quantified for a total of 255 lesions (214 bone, 24 lung, 12 lymph nodes, one breast, one soft-tissue, and one brain lesion) out of which 42 (16 %) were 18F-FES-negative (SUVmax <1.5). Twelve out of 19 patients (63 %) had only 18F-FES-positive lesions, six (32 %) had both FES-positive and FES-negative lesions, and one had only FES-negative lesions. Absolute 18F-FES-uptake (SUVmax) varied widely between lesions (median 2.8; range 0.6–24.3) and patients (median 2.5; range 1.1–15.5), as is depicted in Fig. 3a and b. ROC analysis indicated that the most optimum threshold to differentiate between patients with clinical benefit and patients with PD was a median SUVmax of >1.5. For patients with response assessment available (n = 15 patients), this threshold produced a PPV of 60 % (95 % CI: 31–83 %) and an NPV of 80 % (95 % CI: 38–96 %) (Fig. 4a), with an area under curve of 0.62.Fig. 3


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-uptake (SUVmax) in bone lesions (a) and non-bone lesions (b) in all individual patients. The dashed line indicates the 1.5 (SUVmax) threshold
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554736&req=5

Fig3: 18F-FES-uptake (SUVmax) in bone lesions (a) and non-bone lesions (b) in all individual patients. The dashed line indicates the 1.5 (SUVmax) threshold
Mentions: 18F-FES uptake in tumour lesions was quantified for a total of 255 lesions (214 bone, 24 lung, 12 lymph nodes, one breast, one soft-tissue, and one brain lesion) out of which 42 (16 %) were 18F-FES-negative (SUVmax <1.5). Twelve out of 19 patients (63 %) had only 18F-FES-positive lesions, six (32 %) had both FES-positive and FES-negative lesions, and one had only FES-negative lesions. Absolute 18F-FES-uptake (SUVmax) varied widely between lesions (median 2.8; range 0.6–24.3) and patients (median 2.5; range 1.1–15.5), as is depicted in Fig. 3a and b. ROC analysis indicated that the most optimum threshold to differentiate between patients with clinical benefit and patients with PD was a median SUVmax of >1.5. For patients with response assessment available (n = 15 patients), this threshold produced a PPV of 60 % (95 % CI: 31–83 %) and an NPV of 80 % (95 % CI: 38–96 %) (Fig. 4a), with an area under curve of 0.62.Fig. 3

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