Abstract
Abstract Background [18F]flurothymidine (FLT) is proposed as an positron emission tomography (PET) imaging biomarker of proliferation for breast cancer. The aim of this prospective study was to assess the feasibility of FLT PET-CT as a technique for predicting response to neoadjuvant chemotherapy (NAC) in operable breast cancer and to compare baseline FLT to Ki-67. Methods 20 patients with primary breast cancer were recruited into this study and 19 received NAC with FEC (n = 6) or FEC-T (n = 13). A baseline FLT PET-CT scan was performed and repeated before the second cycle of chemotherapy. Expression of Ki-67 in the diagnostic biopsy was quantified after being stained by Dako Ki67 MIB-1 antibody and% positive cells scored. From the FLT PET-CT scans standardized uptake value maximum (SUVmax) were calculated. Results All 20 patients completed the baseline scan and 17 completed the second scan. Baseline Ki-67 results were available for 19 patients. Median age was 52 years (range 32 to 67), 12 patients were ER/ PR +ve, 6 Her-2 +ve and 6 triple negative. Mean baseline SUVmax was 7.3 (range 2.92 to 13.87) and 4.62 (range 1.79 to 14.15) post 1 cycle of NAC (range 7 to 14 days), representing a drop of 2.68 (36.3%). Mean baseline Ki-67 was 32.23 (range 2.3 to 68.4). Pearsons correlation showed a significant correlation between pre-chemotherapy Ki-67 and SUVmax of 0.604 (p = 0.006). 7 out of 17 (41%) patients achieved near pCR or pCR (pathological responders) after NAC and all of these had a reduction in SUVmax with a mean percentage value of –36.5% (range -0.5% to -62.5%). 10 out of 17 (59%) patients were non-responders and 8 of these had a reduction in SUVmax with a mean percentage value of -36.2% (range 11.3% to -70.7). Conclusions Baseline SUVmax measurements of FLT PET-CT were significantly related to Ki-67 suggesting that it is a proliferation biomarker. However, in this series neither the baseline value or the change in SUVmax after one cycle of NAC were able to predict response as most patients had a sizeable SUVmax reduction. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-07.
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