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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 8/2014

01-08-2014 | Original Article

HER2-positive breast cancer: 18F-FDG PET for early prediction of response to trastuzumab plus taxane-based neoadjuvant chemotherapy

Authors: Olivier Humbert, Alexandre Cochet, Jean-Marc Riedinger, Alina Berriolo-Riedinger, Laurent Arnould, Bruno Coudert, Isabelle Desmoulins, Michel Toubeau, Inna Dygai-Cochet, Séverine Guiu, Charles Coutant, Pierre Fumoleau, François Brunotte

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2014

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Abstract

Purpose

To investigate the value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) to predict a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer.

Material and methods

Fifty-seven consecutive women with HER2-positive breast cancer, treated with trastuzumab plus taxane-based NAC, were prospectively included. Maximum Standardized Uptake Value of the primary tumor and axillary nodes were measured at baseline (PET1.SUVmax) and after the first course of NAC (PET2.SUVmax). Tumor metabolic volumes were assessed to determine Total Lesion Glycolysis (TLG). The tumor metabolic response (ΔSUVmax and ΔTLG) was calculated.

Results

In univariate analysis, negative hormonal receptor status (p = 0.04), high tumor grade (p = 0.03), and low tumor PET 2 .SUVmax (p = 0.001) were predictive of pCR. Tumor ΔSUVmax correlated with pCR (p = 0.03), provided that tumors with low metabolic activity at baseline were excluded. ΔTLG did not correlate with pCR. In multivariate analysis, tumor PET2.SUVmax < 2.1 was the best independent predictive factor (Odds ratio =14.3; p = 0.004) with both negative and positive predictive values of 76 %. Although the metabolic features of the primary tumor did not depend on hormonal receptor status, both the baseline metabolism and early response of axillary nodes were higher if estrogen receptors were not expressed (p = 0.01 and p = 0.03, respectively).

Conclusion

In HER2-positive breast cancer, very low tumor residual metabolism after the first cycle of NAC (SUVmax < 2.1) was the main predictor of pCR. These results should be further explored in multicenter studies and incorporated into the design of clinical trials.
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Metadata
Title
HER2-positive breast cancer: 18F-FDG PET for early prediction of response to trastuzumab plus taxane-based neoadjuvant chemotherapy
Authors
Olivier Humbert
Alexandre Cochet
Jean-Marc Riedinger
Alina Berriolo-Riedinger
Laurent Arnould
Bruno Coudert
Isabelle Desmoulins
Michel Toubeau
Inna Dygai-Cochet
Séverine Guiu
Charles Coutant
Pierre Fumoleau
François Brunotte
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 8/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-014-2739-1

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