FDG PET/CT for prognostic stratification of patients with metastatic breast cancer treated with first line systemic therapy: Comparison of EORTC criteria and PERCIST.

Edouard Depardon,Olivier Humbert,Aurélie Bertaut,Pierre Fumoleau,Jean-Marc Riedinger,Alina Berriolo-Riedinger,Ilan Tal,Michel Toubeau,François Brunotte,Salim Kanoun,Jean-Marc Vrigneaud,Alexandre Cochet,Maud Lasserre,Inna Dygai-Cochet

doi:10.1371/journal.pone.0199529

Abstract

AimEvaluate response and predict prognosis of patients with newly diagnosed metastatic breast cancer treated with first line systemic therapy using European Organization for Research and Treatment of Cancer (EORTC) criteria and PET Response Criteria in solid Tumours (PERCIST).MethodsFrom December 2006 to August 2013, 57 women with newly diagnosed metastatic breast cancer were retrospectively evaluated. FDG-PET/CT was performed within one month before treatment and repeated after at least 3 cycles of treatment. Metabolic response evaluation was evaluated by two readers according to both EORTC criteria and PERCIST, classifying the patients into 4 response groups: complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD).ResultsWith EORTC criteria, 22 patients had CMR, 17 PMR, 6 SMD and 12 PMD. With PERCIST, 20 patients had CMR, 15 PMR, 10 SMD and 12 PMD. There was agreement between EORTC and PERCIST in 84% of the patients. By log-rank analysis, metabolic response evaluated with both EORTC criteria and PERCIST was able to predict overall survival (p = 0.028 and 0.002 respectively). CMR patient group had longer median OS than patients in the combined PMR+SMD+PMD group (60 vs 26 months both with EORTC and PERCIST; p = 0.009 and 0.006 respectively). By multivariate analysis, CMR either with EORTC or PERCIST remained an independent predictor of survival.ConclusionMetabolic response evaluation with EORTC criteria and PERCIST gave similar prognostic stratification for metastatic breast cancer treated with a first line of systemic therapy.

Highlights

Metastatic breast cancer is an incurable disease in 25% of breast cancer patients, which makes it a major therapeutic challenge
By log-rank analysis, metabolic response evaluated with both EORTC criteria and PET Response Criteria in solid Tumours (PERCIST) was able to predict overall survival (p = 0.028 and 0.002 respectively)
Metabolic response evaluation with EORTC criteria and PERCIST gave similar prognostic stratification for metastatic breast cancer treated with a first line of systemic therapy

Summary

Introduction

Metastatic breast cancer is an incurable disease in 25% of breast cancer patients, which makes it a major therapeutic challenge. Non-curative treatment is used for prolonging life and reducing symptoms in order to improve quality of life [1]. For that purpose proper assessment of treatment response and prognostic stratification is essential in order to propose optimal and personalized therapeutic strategies [2]. Metabolic changes assessed with 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography/Computerized Tomography (PET/CT) has gained increasing interest for monitoring response to therapy in breast cancer, in both neoadjuvant and metastatic settings [3]. Several studies have shown FDG-PET/CT effectiveness in assessing response to systemic therapy in metastatic breast cancer [2,4,5,6,7]. Generalization of the use of FDG PET/CT in this indication requires standardization of the response quantification methodology [8,9]

Methods

Results

Conclusion