Developing a personalized treatment model based on molecular biomarkers and molecular imaging in breast cancer

Abstract

Risk stratification in breast cancer can be done with either bio markers or 18F FDG a marker of glucose metabolism demonstrating tumor aggressiveness. The receptor status also plays an important role in predicting outcome as well as has a significant role in personalizing treatment protocols. In vivo receptor imaging has also made an inroad from the bench to the bed side. Hormone positivity has an impact on both treatment planning and prognosis and therefore imaging the ER receptor plays an important role. 18F-FES PET CT helps in resolving diagnostic dilemma and also planning further management. Estrogen is involved in the growth of both normal and cancerous breast tissues and a uniform expression of receptor is an exception rather than a rule. At the same time the expression in primary tumor and the metastatic sites may be different which may further prompt the need for imaging. FES PET-CT scan in combination with FDG PET-CT scan can be used as a problem solving modality in deciding the regimen. Our results point to this and a common rule of thumb could be well differentiated hormone positive tumor with FDG uptake less than FES uptake is unlikely to benefit from cytotoxic chemotherapy and would be an ideal candidate to be treated with hormone or vice versa. In the coming years and in future we hope that the treatment of breast cancer has a very high potential to be personalized based on PET scan (both FDG and FES) and other molecular bio markers giving early and clear indications to the treating oncologist as to where the disease is heading and how the treatment regimen needs to be modified. In this presentation I will discuss how a combination of conventional FDG PET-CT and FES PET-CT along with the receptor status can help in precision management of breast cancer based on our work and literature.