A preliminary study of 18F-FES PET/CT in predicting metastatic breast cancer in patients receiving docetaxel or fulvestrant with docetaxel

Chengcheng Gong,Yongping Zhang,Yingjian Zhang,Biyun Wang,Chunlei Zheng,Zhifeng Yao,Zhongyi Yang,Herong Pan,Leiping Wang,Jian Zhang,Jing Xue,Yifei Sun

doi:10.1038/s41598-017-06903-8

Abstract

The present explorative study was initiated to evaluate the clinical value of 18F-FES PET/CT in monitoring the change of estrogen receptor (ER) expression and potential predictive value in metastatic breast cancer patients. Twenty-two pathology-confirmed breast cancer patients were prospectively enrolled and randomly divided into two groups (T: docetaxel, n = 14 and TF: docetaxel + fulvestrant, n = 8). The percentage of patients without disease progression after 12 months (PFS > 12 months) was 62.5% in group TF compared with 21.4% in group T (P = 0.08). According to 18F-FES PET/CT scans, the SUVmax (maximum standard uptake value) of all the metastatic lesions decreased in group TF after 2 cycles of treatment (6 weeks ± 3 days). However, 6 of 9 patients in group T had at least one lesion with higher post-treatment SUVmax. There was a significant difference in the reduction of ER expression between these two groups (P = 0.028). In group TF, the patients with PFS > 12 months had significantly greater SUVmax changes of 18F-FES than those with PFS < 12 months (PFS > 12 months: 91.0 ± 12.0% versus PFS < 12 months: 20.7 ± 16.2%; t = −4.64, P = 0.01). Our preliminary study showed that 18F-FES PET/CT, as a noninvasive method to monitor ER expression, could be utilized to predict prognosis based on changes in SUVmax.

Highlights

Breast cancer, as one of the most common cancers in women, was estimated to account for 15% of newly diagnosed cancers in China in the year of 20151
With the advent of molecular imaging, positron emission tomography (PET) with estrogen receptor (ER)-targeting radiopharmaceuticals has emerged as a noninvasive method for simultaneously measuring the in vivo delivery and binding of estrogen, and of ER expression, at multiple sites
The inclusion criteria were: women between 18 and 70 years old with histologically confirmed hormone receptor (HR)-positive, HER2-negative metastatic breast cancer; an Eastern Cooperative Oncology Group performance status

Summary

Introduction

As one of the most common cancers in women, was estimated to account for 15% of newly diagnosed cancers in China in the year of 20151. Preclinical evidence and clinical evidence have both suggested that ER + breast cancers are less responsive to chemotherapy than ER-negative (ER−) tumors, indicating that ER might interfere with factors determining the sensitivity to chemotherapy[4,5,6,7]. Preclinical evidence has proved that fulvestrant can dramatically reverse resistance to various cytotoxic agents (doxorubicin, paclitaxel, docetaxel, vinorelbine, and 5-fluorouracil), especially with docetaxel, suggesting a novel strategy for reversing ER-mediated chemoresistance[12, 19,20,21,22]. With a response rate of 30–40%, is considered one of the most effective single agent chemotherapies for breast cancer and was shown to have synergistic effects on inhibiting tumor growth when combined with fulvestrant in vivo[22]. We hypothesized that we could use 18F-FES PET to monitor the change in ER during combination treatment, with the potential to predict prognosis

Methods

Results

Conclusion