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Title of Journal: Breast Cancer Res Treat

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Abbravation: Breast Cancer Research and Treatment

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Springer US

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DOI

10.1016/0026-0657(92)90202-p

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ISSN

1573-7217

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PETbased estradiol challenge as a predictive biom

Authors: Farrokh Dehdashti Joanne E Mortimer Kathryn Trinkaus Michael J Naughton Matthew Ellis John A Katzenellenbogen Michael J Welch Barry A Siegel
Publish Date: 2008/03/09
Volume: 113, Issue: 3, Pages: 509-517
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Abstract

Purpose To determine if response to endocrine therapy of breast cancer can be predicted by either a metabolic “flare reaction” detected by positron emission tomography PET with 218Ffluoro2deoxyglucose FDG induced by an estradiol challenge or by estrogenreceptor ER status determined by PET with the estrogen analog 16α18Ffluoroestradiol17β FES Methods Fiftyone postmenopausal women with advanced estrogenreceptor positive breast cancer were studied Patients underwent FESPET and FDGPET at baseline and repeat FDGPET after 30 mg estradiol Tracer uptakes was measured as the standardized uptake value SUV Patients were subsequently treated with either an aromatase inhibitor or fulvestrant A prospectively defined cutoff SUV ≥ 2 for FES was considered positive for ER expression A cutoff of ≥12 increase in SUV for FDG determined by ROC analysis represented metabolic flare PET results were correlated with responsiveness to endocrine therapy Results Seventeen patients responded and 34 patients did not respond to endocrine therapy Four responders and one nonresponder had a clinical flare reaction while only the responders demonstrated metabolic flare After estradiol challenge a significantly higher mean ±SD percent change in SUV for FDG was noted in responders 209 ± 242 compared with nonresponders −43 ± 110 P  00001 On FESPET a higher tumor SUV was noted in responders 35 ± 25 compared with nonresponders 21 ± 18 P = 00049 There was significantly longer overall survival in patients with metabolic flare than in those without flare regardless of type of endocrine therapy P = 00062 Conclusion Baseline tumor FES uptake and metabolic flare after an estradiol challenge are both predictive of responsiveness to endocrine therapy in ER+ breast cancer

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