scholarly journals 18F-fluorodeoxyglucose (FDG) PET or 18F-fluorothymidine (FLT) PET to assess early response to aromatase inhibitors (AI) in women with ER+ operable breast cancer in a window-of-opportunity study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Perrin E. Romine ◽  
Lanell M. Peterson ◽  
Brenda F. Kurland ◽  
Darrin W. Byrd ◽  
Alena Novakova-Jiresova ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Early Stage ◽  
Early Response ◽  
Window Of Opportunity ◽  
Ki 67 ◽  
Flt Pet ◽  
Post Therapy

Abstract Purpose This study evaluated the ability of 18F-Fluorodeoxyglucose (FDG) and 18F-Fluorothymidine (FLT) imaging with positron emission tomography (PET) to measure early response to endocrine therapy from baseline to just prior to surgical resection in estrogen receptor positive (ER+) breast tumors. Methods In two separate studies, women with early stage ER+ breast cancer underwent either paired FDG-PET (n = 22) or FLT-PET (n = 27) scans prior to endocrine therapy and again in the pre-operative setting. Tissue samples for Ki-67 were taken for all patients both prior to treatment and at the time of surgery. Results FDG maximum standardized uptake value (SUVmax) declined in 19 of 22 lesions (mean 17% (range −45 to 28%)). FLT SUVmax declined in 24 of 27 lesions (mean 26% (range −77 to 7%)). The Ki-67 index declined in both studies, from pre-therapy (mean 23% (range 1 to 73%)) to surgery [mean 8% (range < 1 to 41%)]. Pre- and post-therapy PET measures showed strong rank-order agreement with Ki-67 percentages for both tracers; however, the percent change in FDG or FLT SUVmax did not demonstrate a strong correlation with Ki-67 index change or Ki-67 at time of surgery. Conclusions A window-of-opportunity approach using PET imaging to assess early response of breast cancer therapy is feasible. FDG and FLT-PET imaging following a short course of neoadjuvant endocrine therapy demonstrated measurable changes in SUVmax in early stage ER+ positive breast cancers. The percentage change in FDG and FLT-PET uptake did not correlate with changes in Ki-67; post-therapy SUVmax for both tracers was significantly associated with post-therapy Ki-67, an established predictor of endocrine therapy response.

Adjuvant and neoadjuvant therapy of ER+ / HER2– breast cancer

2021 ◽  
Vol 1 (31) ◽  
pp. 7-12
Author(s):  
V. F. Semiglazov ◽  
M. A. Dzhelialova
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Endocrine Therapy ◽  
Kinase Inhibitors ◽  
Early Stage ◽  
Mtor Inhibitors ◽  
Tumor Grade ◽  
Ki 67 ◽  
Her2 Breast Cancer ◽  
Adjuvant And Neoadjuvant Therapy

Even early-stage breast cancer is a heterogeneous disease, so the optimal treatment depends on the pathological characteristics of the tumor. The vast majority of breast tumors (80%) are classified as estrogen receptor positive (ER+) with varying degrees of ER expression. The benefit of endocrine therapy is small with low ER staining (1–10%), occurring in less than 2% of all cases of ER+ breast cancer. Genetic analyzes are valuable for administration of adjuvant chemotherapy prior to endocrine therapy in ER+ / HER2– pN0–pN1c breast cancer. But such tests are not yet widely available. In practical work, when planning adjuvant and neoadjuvant therapy for patients with ER+ / HER2– breast cancer, pathological assessment of the expression of ER, PR, Ki‑67, as well as the tumor grade (G) remains important. The use of drugs to overcome resistance to endocrine therapy: PI3-kinase inhibitors (taselisib), CDK 4/6 inhibitors (palbociclib, abemaciclib, ribociklib), mTOR inhibitors (everolimus) can enhance the effect of neoadjuvant and adjuvant endocrine therapy.

Prognostic relevance at 5 years of the early monitoring of neoadjuvant chemotherapy using FDG PET in luminal HER2-negative breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 11007-11007
Author(s):  
Olivier Humbert ◽  
Alina Berriolo-Riedinger ◽  
Alexandre Cochet ◽  
Mélanie Gauthier ◽  
Celine Charon-Barra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Early Stage ◽  
Breast Cancer Subtype ◽  
Standardized Uptake Value ◽  
Luminal Breast Cancer ◽  
Ki 67

11007 Background: To evaluate, in the luminal breast cancer subtype, the prognostic value of tumor glucose metabolism at baseline and of its changes after one cycle of neoadjuvant chemotherapy (NAC). Methods: This prospective study included 61 women with immunophenotypically defined luminal HER2-negative breast cancer treated with NAC. 18F-FDG PET was performed at baseline. Hepatic activity was used as a reference to distinguish between low-metabolic and hypermetabolic tumors. In hypermetabolic tumors, a PET exam was repeated after the first course of NAC. The relative change in the maximal Standardized Uptake Value of the tumor (ΔSUV), corresponding to the metabolic response, was calculated. Results: Forty-two women had hypermetabolic tumors at baseline, corresponding to more proliferative breast cancers with higher Ki-67 expression (p=0.017) and higher grade (p=0.04). Nineteen women had low-metabolic tumors with lower proliferation indexes. Worse overall survival was associated with larger tumor size (>5cm, HR=6.52, P=0.009) and with hypermetabolic tumors achieving a low metabolic response after one cycle of NAC (ΔSUV<16%, HR=10.63, P=0.004). Five-year overall survival in these poor-response patients was 49.22% (95% CI=[14.76%-76.90%]). In contrast, overall survival in women with low-metabolic tumors or hypermetabolic/good-response tumors (ΔSUV≥16%) was good, 100% and 96.15%, respectively (95% CI=[75.69%-99.45%]). Conclusions: In luminal HER2-negative breast tumors, tumor metabolism at baseline and changes after the first course of NAC are surrogate markers of patients’ survival. A subgroup of women with hypermetabolic/bad-responding tumors correlated with poor prognosis can be identified. These results may create the ability to tailor the NAC regimen to the metabolic response at an early stage.

scholarly journals Clinical, Radiometabolic and Immunologic Effects of Olaparib in Locally Advanced Triple Negative Breast Cancer: The OLTRE Window of Opportunity Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Francesco Schettini ◽  
Silvia Paola Corona ◽  
Fabiola Giudici ◽  
Carla Strina ◽  
Marianna Sirico ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Early Stage ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Tumor Infiltrating Lymphocytes ◽  
Early Response ◽  
Window Of Opportunity ◽  
Immune Biomarkers

IntroductionOlaparib is effective in metastatic triple negative breast cancer (TNBC) carrying germline mutations in DNA damage repair (DDR) genes BRCA1/2 (gBRCA-mut). The OLTRE window-of-opportunity trial preliminarily investigated potential pathologic, radiometabolic and immune biomarkers of early-response to olaparib in gBRCA-wild-type (wt) TNBC and, as proof-of-concept in gBRCA-mut HER2-negative BC.MethodsPatients received olaparib for 3 weeks (3w) before standard neoadjuvant chemotherapy and underwent multiple FDG18-PET/CT scan (basal, after olaparib), clinical assessments (basal, every 3w), tumor biopsies and blood samplings (baseline, after olaparib). Clinical and radiometabolic responses were evaluated according to RECIST1.1 and PERCIST criteria.Results27 patients with gBRCA-wt TNBC and 8 with gBRCA-mut BC (6 TNBC, 2 HR+/HER2-negative) were enrolled. Three (11.1%) patients showed mutations in non-BRCA1/2 DDR genes and 4 (14.8%) in other genes. 3w olaparib induced 16/35 and 15/27 partial clinical and radiometabolic responses, including in 40.7% and 50.0% gBRCA-wt patients. gBRCA-mut tumors presented numerically higher tumor-infiltrating lymphocytes (TILs) levels and PD-L1 positive tumors. Clinical responders experienced a reduction in T-regs/T-eff ratio (p=0.05), B and NK lymphocytes (p=0.003 both), with an average increase in T-helpers rate (p&lt;0.001) and CD4/CD8 ratio (p=0.02). Ki67% and TILs did not vary significantly (p=0.67 and p=0.77). A numerical increase in PD-L1 positive cases after olaparib was observed, though non-significant (p=0.134). No differences were observed according to gBRCA status and type of response.ConclusionsEarly-stage TNBC might be a target population for olaparib, irrespective of gBRCA mutations. Future trials should combine TILs, PD-L1 and gBRCA status to better identify candidates for escalated/de-escalated treatment strategies including olaparib.

scholarly journals Beliefs about medicines and adherence in women with breast cancer on adjuvant endocrine therapy

2021 ◽  
pp. 135910532199077
Author(s):  
Eng Hooi Tan ◽  
Andrea Li Ann Wong ◽  
Chuan Chien Tan ◽  
Patrick Wong ◽  
Sing Huang Tan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Factor Analysis ◽  
Medication Adherence ◽  
Endocrine Therapy ◽  
Internal Consistency ◽  
Early Stage ◽  
Adjuvant Endocrine Therapy ◽  
Beliefs About Medicines ◽  
Good Internal Consistency ◽  
English Speaking

The Beliefs about Medicines Questionnaire (BMQ) and Adherence Starts with Knowledge (ASK-12) questionnaire were originally developed and validated in Western populations to assess beliefs and barriers to medication adherence. The study aim is to validate the BMQ and ASK-12 questionnaire for use in a Singapore population with early stage breast cancer. English-speaking women on adjuvant endocrine therapy ( n = 157) were recruited. The BMQ-Specific showed good internal consistency with structural validity. The internal consistency of BMQ-General and ASK-12 Behaviour scale improved with the new factor structure obtained from exploratory factor analysis. Further studies are needed to confirm these factor structures.

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