Feasibility study of FDG PET as an indicator of early response to aromatase inhibitors and trastuzumab in a heterogeneous group of breast cancer patients

Persistent Link:
http://hdl.handle.net/10150/610135
Title:
Feasibility study of FDG PET as an indicator of early response to aromatase inhibitors and trastuzumab in a heterogeneous group of breast cancer patients
Author:
Kurland, Brenda; Gadi, Vijayakrishna; Specht, Jennifer; Allison, Kimberly; Livingston, Robert; Rodler, Eve; Peterson, Lanell; Schubert, Erin; Chai, Xiaoyu; Mankoff, David; Linden, Hannah
Affiliation:
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA; Department of Medicine, University of Washington, Seattle, WA, 98195, USA; Department of Pathology, University of Washington, Seattle, WA, 98195, USA; Section of Hematology-Oncology, University of Arizona Cancer Center, Tucson, AZ, 85719, USA; Department of Radiology, University of Washington, Seattle, WA, 98195, USA
Issue Date:
2012
Publisher:
BioMed Central
Citation:
Kurland et al. EJNMMI Research 2012, 2:34 http://www.ejnmmires.com/content/2/1/34
Journal:
EJNMMI Research
Rights:
© 2012 Kurland et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)
Collection Information:
This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.
Abstract:
BACKGROUND:In breast cancer endocrine therapy, post-therapy Ki-67 assay of biopsy material predicts recurrence-free survival but is invasive and prone to sampling error. 18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) has shown an early agonist or 'flare' response to tamoxifen and estradiol, but has not been tested in response to estrogen-lowering aromatase inhibitors (AIs). We hypothesized that decreased agonistic response to AIs would result in early FDG uptake decline. We also measured early response to trastuzumab (T), another targeted agent for breast cancer with differing mechanisms of action. Our study was designed to test for an early decline in FDG uptake in response to AI or T and to examine association with Ki-67 measures of early response.METHODS:Patients with any stage of newly diagnosed or recurrent breast cancer were eligible and enrolled prior to initiation (or resumption) of AI or T therapy. FDG PET and tissue biopsy were planned before and after 2 weeks of AI or T therapy, with pretreatment archival tissue permitted. Cutoffs of greater than or equal to]20% decline in standardized uptake value (SUV) as FDG PET early response and less than or equal to]5% post-treatment expression as Ki-67 early response were defined prior to analysis.RESULTS:Forty-two patients enrolled, and 40 (28 AI, 12 T) completed serial FDG-PET imaging. Twenty-two patients (17 AI, 5 T) had newly diagnosed disease, and 23 (14 AI, 9 T) had metastatic disease (5 newly diagnosed). Post-treatment biopsy was performed in 25 patients (63%) and was either refused or not feasible in 15. Post-treatment biopsy yielded tumor in only 17/25 cases (14 AI, 3 T). Eleven of 14 AI patients with post-therapy tissue showed FDG PET early response, and there was 100% concordance of PET and post-therapy Ki-67 early response. For the T group, 6/12 showed an FDG PET early response, including 2/3 patients with post-therapy biopsy, all with Ki-67 >5%.CONCLUSIONS:Substantial changes in FDG PET SUV occurred over 2 weeks of AI therapy and were associated with low post-therapy proliferation. SUV decline was seen in response to T, but few tissue samples were available to test association with Ki-67. Our results support further investigation of FDG PET as a biomarker for early response to AI therapy.
EISSN:
 2191-219X
DOI:
10.1186/2191-219X-2-34
Keywords:
FDG PET; Ki-67; Breast cancer; Aromatase inhibitor; Trastuzumab; Pharmacodynamic response Early response
Version:
Final published version
Additional Links:
http://www.ejnmmires.com/content/2/1/34

Full metadata record

DC FieldValue Language
dc.contributor.authorKurland, Brendaen
dc.contributor.authorGadi, Vijayakrishnaen
dc.contributor.authorSpecht, Jenniferen
dc.contributor.authorAllison, Kimberlyen
dc.contributor.authorLivingston, Roberten
dc.contributor.authorRodler, Eveen
dc.contributor.authorPeterson, Lanellen
dc.contributor.authorSchubert, Erinen
dc.contributor.authorChai, Xiaoyuen
dc.contributor.authorMankoff, Daviden
dc.contributor.authorLinden, Hannahen
dc.date.accessioned2016-05-20T08:59:21Z-
dc.date.available2016-05-20T08:59:21Z-
dc.date.issued2012en
dc.identifier.citationKurland et al. EJNMMI Research 2012, 2:34 http://www.ejnmmires.com/content/2/1/34en
dc.identifier.doi10.1186/2191-219X-2-34en
dc.identifier.urihttp://hdl.handle.net/10150/610135-
dc.description.abstractBACKGROUND:In breast cancer endocrine therapy, post-therapy Ki-67 assay of biopsy material predicts recurrence-free survival but is invasive and prone to sampling error. 18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) has shown an early agonist or 'flare' response to tamoxifen and estradiol, but has not been tested in response to estrogen-lowering aromatase inhibitors (AIs). We hypothesized that decreased agonistic response to AIs would result in early FDG uptake decline. We also measured early response to trastuzumab (T), another targeted agent for breast cancer with differing mechanisms of action. Our study was designed to test for an early decline in FDG uptake in response to AI or T and to examine association with Ki-67 measures of early response.METHODS:Patients with any stage of newly diagnosed or recurrent breast cancer were eligible and enrolled prior to initiation (or resumption) of AI or T therapy. FDG PET and tissue biopsy were planned before and after 2 weeks of AI or T therapy, with pretreatment archival tissue permitted. Cutoffs of greater than or equal to]20% decline in standardized uptake value (SUV) as FDG PET early response and less than or equal to]5% post-treatment expression as Ki-67 early response were defined prior to analysis.RESULTS:Forty-two patients enrolled, and 40 (28 AI, 12 T) completed serial FDG-PET imaging. Twenty-two patients (17 AI, 5 T) had newly diagnosed disease, and 23 (14 AI, 9 T) had metastatic disease (5 newly diagnosed). Post-treatment biopsy was performed in 25 patients (63%) and was either refused or not feasible in 15. Post-treatment biopsy yielded tumor in only 17/25 cases (14 AI, 3 T). Eleven of 14 AI patients with post-therapy tissue showed FDG PET early response, and there was 100% concordance of PET and post-therapy Ki-67 early response. For the T group, 6/12 showed an FDG PET early response, including 2/3 patients with post-therapy biopsy, all with Ki-67 >5%.CONCLUSIONS:Substantial changes in FDG PET SUV occurred over 2 weeks of AI therapy and were associated with low post-therapy proliferation. SUV decline was seen in response to T, but few tissue samples were available to test association with Ki-67. Our results support further investigation of FDG PET as a biomarker for early response to AI therapy.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urlhttp://www.ejnmmires.com/content/2/1/34en
dc.rights© 2012 Kurland et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)en
dc.subjectFDG PETen
dc.subjectKi-67en
dc.subjectBreast canceren
dc.subjectAromatase inhibitoren
dc.subjectTrastuzumaben
dc.subjectPharmacodynamic response Early responseen
dc.titleFeasibility study of FDG PET as an indicator of early response to aromatase inhibitors and trastuzumab in a heterogeneous group of breast cancer patientsen
dc.typeArticleen
dc.identifier.eissn 2191-219Xen
dc.contributor.departmentClinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USAen
dc.contributor.departmentDepartment of Medicine, University of Washington, Seattle, WA, 98195, USAen
dc.contributor.departmentDepartment of Pathology, University of Washington, Seattle, WA, 98195, USAen
dc.contributor.departmentSection of Hematology-Oncology, University of Arizona Cancer Center, Tucson, AZ, 85719, USAen
dc.contributor.departmentDepartment of Radiology, University of Washington, Seattle, WA, 98195, USAen
dc.identifier.journalEJNMMI Researchen
dc.description.collectioninformationThis item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.en
dc.eprint.versionFinal published versionen
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