Positron emission tomography of tumour [(18)F]fluoroestradiol uptake in patients with acquired hormone-resistant metastatic breast cancer prior to oestradiol therapy.

Abstract

PURPOSE:

Whereas anti-oestrogen therapy is widely applied to treat oestrogen receptor (ER) positive breast cancer, paradoxically, oestrogens can also induce tumour regression. Up-regulation of ER expression is a marker for oestrogen hypersensitivity. We, therefore, performed an exploratory study to evaluate positron emission tomography (PET) with the tracer 16α-[(18)F]fluoro-17β-oestradiol ((18)F-FES) as potential marker to select breast cancer patients for oestradiol therapy.

METHODS:

Eligible patients had acquired endocrine-resistant metastatic breast cancer that progressed after ≥2 lines of endocrine therapy. All patients had prior ER-positive histology. Treatment consisted of oestradiol 2 mg, three times daily, orally. Patients underwent (18)F-FES-PET/CT imaging at baseline. Tumour (18)F-FES-uptake was quantified for a maximum of 20 lesions and expressed as maximum standardised uptake value (SUVmax). CT-scan was repeated every 3 months to evaluate treatment response. Clinical benefit was defined as time to radiologic or clinical progression ≥24 weeks.

RESULTS:

(18)F-FES uptake, quantified for 255 lesions in 19 patients, varied greatly between lesions (median 2.8; range 0.6-24.3) and between patients (median 2.5; range 1.1-15.5). Seven (37%) patients experienced clinical benefit of oestrogen therapy, eight progressed (PD), and four were non-evaluable due to side effects. The positive and negative predictive value (PPV/NPV) of (18)F-FES-PET for response to treatment were 60% (95% CI: 31-83%) and 80% (95% CI: 38-96%), respectively, using SUVmax >1.5.

CONCLUSION:

(18)F-FES-PET may aid identification of patients with acquired antihormone resistant breast cancer that are unlikely to benefit from oestradiol therapy.

• Authors: Michel van Kruchten, Andor W J M Glaudemans, Erik F J de Vries, Carolien P Schröder, Elisabeth G E de Vries, Geke A P Hospers
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 42 Issue 11 Pg. 1674-1681 (Oct 2015) ISSN: 1619-7089 [Electronic] Germany
• PMID: 26091705 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers, Tumor
• Estradiol
• 16-fluoroestradiol

Topics

• Adult
• Aged
• Biological Transport
• Biomarkers, Tumor (metabolism)
• Bone and Bones (metabolism)
• Breast Neoplasms (diagnostic imaging, drug therapy, metabolism)
• Drug Resistance, Neoplasm
• Estradiol (adverse effects, analogs & derivatives, metabolism, therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Positron-Emission Tomography
• Predictive Value of Tests
• Treatment Outcome