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. 2021 Aug 10;21(1):908.
doi: 10.1186/s12885-021-08649-z.

Prospective comparison of early interim 18F-FDG-PET with 18F-FLT-PET for predicting treatment response and survival in metastatic breast cancer

Tzu-Pei Su #  1 , Jen-Seng Huang #  2 , Pei-Hung Chang  2 , Kar-Wai Lui  3 , Jason Chia-Hsun Hsieh  4 , Shu-Hang Ng  3 , Sheng-Chieh Chan  5   6
Affiliations

Prospective comparison of early interim 18F-FDG-PET with 18F-FLT-PET for predicting treatment response and survival in metastatic breast cancer

Tzu-Pei Su et al. BMC Cancer. .

Abstract

Background: To compare the value of interim 18F-FLT-PET and 18F-FDG-PET for predicting treatment outcomes in patients with metastatic breast cancer after salvage therapy.

Methods: Patients with metastatic breast cancer received PET/CT using 18F-FLT and 18F-FDG at baseline, after the 1st and 2nd cycle of systemic chemotherapy. The clinical response was classified according to Response Evaluation Criteria in Solid Tumors 1.1 based on contrast-enhanced CT after 3 months of systemic chemotherapy. The metabolic response on PET was assessed according to European Organization for Research and Treatment of Cancer criteria or PET Response Criteria in Solid Tumors (PERCIST) and was correlated to the clinical response, overall survival (OS), and progression-free survival (PFS).

Results: Twenty-five patients entered final analysis. On 18F-FDG-PET, clinical responders after 2 chemotherapy cycles (post-2c) had a significantly greater reduction of maximal standardized uptake value (SUV) and the peak SUV corrected for lean body mass (SULpeak) of the tumor than non-responders (P = 0.030 and 0.003). Metabolic response determined by PERCIST on post-2c 18F-FDG-PET showed a high area under the receiver operating characteristics curve of 0.801 in predicting clinical response (P = 0.011). Patients who were metabolic responders by PERCIST on post-2c 18F-FDG-PET had a significantly longer PFS (53.8% vs. 16.7%, P = 0.014) and OS (100% vs. 47.6%, P = 0.046) than non-responders. Survival differences between responders and non-responders in the interim 18F-FLT-PET were not significant.

Conclusions: 18F-FLT-PET failed to show an advantage over 18F-FDG-PET in predicting the treatment response and survival in patients with metastatic breast cancer. Assessment of treatment outcome by interim 18F-FDG-PET may aid treatment.

Trial registration: The study was retrospectively registered on 02/06/2020 on Clinicaltrials.gov (identifier NCT04411966 ).

Keywords: 18F-FDG; 18F-FLT; Breast cancer; Positron-emission tomography; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of SUV and SUL changes between clinical responders and non-responders in patients with metastatic carcinoma. Clinical responders showed significant larger SUV and SUL changes on post-2c 18F-FDG-PET (P = 0.030 and 0.003) than non-responders
Fig. 2
Fig. 2
A case with metastatic breast cancer at the sternum. (A) 18F-FDG-PET, (B) 18F-FLT-PET. The lesion was clearly demarcated in 18F-FDG-PET. In 18F-FLT-PET, the margin of the lesion could not be well defined due to physiological 18F-FLT uptake in the adjacent bone marrow
Fig. 3
Fig. 3
Areas under the receiver operating characteristic curves (AUCs) for post-1c or post-2c 18F-FDG-PET and 18F-FLT-PET for predicting clinical response based on EORTC criteria or PERCIST. The post-2c 18F-FDG-PET had a higher AUC value (P = 0.011)
Fig. 4
Fig. 4
A case of a 51-year-old female presenting with metastatic breast cancer at the right lower lung and liver. (A, B) baseline 18F-FDG-PET, (C, D) post-2c 18F-FDG-PET, (E, F) baseline 18F-FLT-PET, and (G, H) post-2c 18F-FLT-PET
Fig. 5
Fig. 5
The Kaplan–Meier curves for the progression-free survival rate of metastatic breast cancer patients stratified by the response on 18F-FLT-PET or 18F-FDG-PET after one or two cycles of chemotherapy. The metabolic responders on post-2c 18F-FDG-PET based on PERCIST showed a significantly higher survival rate than metabolic non-responders
Fig. 6
Fig. 6
The Kaplan–Meier curves for the overall survival rate of metastatic breast cancer patients stratified by the response on 18F-FLT-PET or 18F-FDG-PET after one or two cycles of chemotherapy. The metabolic response on post-2c 18F-FDG-PET based on PERCIST significantly predicted the overall survival rate in these patients
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References

    1. Waks AG, Winer EP. Breast Cancer treatment: a review. JAMA. 2019;321(3):288–300. doi: 10.1001/jama.2018.19323. - DOI - PubMed
    1. Burzykowski T, Buyse M, Piccart-Gebhart MJ, Sledge G, Carmichael J, Luck HJ, et al. Evaluation of tumor response, disease control, progression-free survival, and time to progression as potential surrogate end points in metastatic breast cancer. J Clin Oncol. 2008;26(12):1987–1992. doi: 10.1200/JCO.2007.10.8407. - DOI - PubMed
    1. Campiglio M, Bufalino R, Sandri M, Ferri E, Aiello RA, De Matteis A, et al. Increased overall survival independent of RECIST response in metastatic breast cancer patients continuing trastuzumab treatment: evidence from a retrospective study. Breast Cancer Res Treat. 2011;128(1):147–154. doi: 10.1007/s10549-011-1484-4. - DOI - PubMed
    1. Groheux D, Giacchetti S, Delord M, de Roquancourt A, Merlet P, Hamy AS, Espié M, Hindié E. Prognostic impact of 18F-FDG PET/CT staging and of pathological response to neoadjuvant chemotherapy in triple-negative breast cancer. Eur J Nucl Med Mol Imaging. 2015;42(3):377–385. doi: 10.1007/s00259-014-2941-1. - DOI - PubMed
    1. Rousseau C, Devillers A, Sagan C, Ferrer L, Bridji B, Campion L, Ricaud M, Bourbouloux E, Doutriaux I, Clouet M, Berton-Rigaud D, Bouriel C, Delecroix V, Garin E, Rouquette S, Resche I, Kerbrat P, Chatal JF, Campone M. Monitoring of early response to neoadjuvant chemotherapy in stage II and III breast cancer by [18F] fluorodeoxyglucose positron emission tomography. J Clin Oncol. 2006;24(34):5366–5372. doi: 10.1200/JCO.2006.05.7406. - DOI - PubMed

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