scholarly journals Quantitative multiparametric MRI predicts response to neoadjuvant therapy in the community setting

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
John Virostko ◽  
Anna G. Sorace ◽  
Kalina P. Slavkova ◽  
Anum S. Kazerouni ◽  
Angela M. Jarrett ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Tumor Volume ◽  
Community Care ◽  
Locally Advanced ◽  
Community Setting ◽  
Quantitative Mri ◽  
Vascular Perfusion ◽  
Dce Mri ◽  
Time Points

Abstract Background The purpose of this study was to determine whether advanced quantitative magnetic resonance imaging (MRI) can be deployed outside of large, research-oriented academic hospitals and into community care settings to predict eventual pathological complete response (pCR) to neoadjuvant therapy (NAT) in patients with locally advanced breast cancer. Methods Patients with stage II/III breast cancer (N = 28) were enrolled in a multicenter study performed in community radiology settings. Dynamic contrast-enhanced (DCE) and diffusion-weighted (DW)-MRI data were acquired at four time points during the course of NAT. Estimates of the vascular perfusion and permeability, as assessed by the volume transfer rate (Ktrans) using the Patlak model, were generated from the DCE-MRI data while estimates of cell density, as assessed by the apparent diffusion coefficient (ADC), were calculated from DW-MRI data. Tumor volume was calculated using semi-automatic segmentation and combined with Ktrans and ADC to yield bulk tumor blood flow and cellularity, respectively. The percent change in quantitative parameters at each MRI scan was calculated and compared to pathological response at the time of surgery. The predictive accuracy of each MRI parameter at different time points was quantified using receiver operating characteristic curves. Results Tumor size and quantitative MRI parameters were similar at baseline between groups that achieved pCR (n = 8) and those that did not (n = 20). Patients achieving a pCR had a larger decline in volume and cellularity than those who did not achieve pCR after one cycle of NAT (p < 0.05). At the third and fourth MRI, changes in tumor volume, Ktrans, ADC, cellularity, and bulk tumor flow from baseline (pre-treatment) were all significantly greater (p < 0.05) in the cohort who achieved pCR compared to those patients with non-pCR. Conclusions Quantitative analysis of DCE-MRI and DW-MRI can be implemented in the community care setting to accurately predict the response of breast cancer to NAT. Dissemination of quantitative MRI into the community setting allows for the incorporation of these parameters into the standard of care and increases the number of clinical community sites able to participate in novel drug trials that require quantitative MRI.

Comparison of vascularity measures from PET and MRI for improved breast tumor characterization and therapeutic response evaluation

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 589-589 ◽  
Author(s):  
S. C. Partridge ◽  
P. R. Eby ◽  
R. K. Doot ◽  
S. W. White ◽  
B. F. Kurland ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Blood Flow ◽  
Metabolic Rate ◽  
Fdg Pet ◽  
Tumor Volume ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Novel Therapy ◽  
Dce Mri ◽  
Tumor Characterization

589 Background: Dynamic contrast-enhanced MRI (DCE-MRI) and positron emission tomography (PET) are two imaging modalities previously shown to be predictive of response to neoadjuvant therapy in breast cancer. As the two techniques are functionally very different, the extent of their agreement or discordance for tumor characterization is not well understood. The purpose of this study was therefore to investigate the association between quantitative DCE-MRI enhancement kinetics and 15O-water PET/18F-FDG PET blood flow and metabolic measures of breast tumors. Methods: We retrospectively evaluated exams for 20 patients with locally advanced breast cancer (LABC) who underwent both 15O-water/18F-FDG PET and DCE-MRI. PET measures included 15O-water blood flow, 18F-FDG transport rate constant from blood to tissue (K1), and FDG metabolic rate. DCE-MRI measures included functional tumor volume, initial peak enhancement (PE), and a delayed signal enhancement ratio (SER) assessing washout. Pearson’s correlations and multivariate stepwise regression analyses were performed; p<0.05 was considered significant. Results: PET 15O-water blood flow correlated significantly with DCE-MRI peak SER (r=0.8) and tumor volume (r=0.7). PET K1 measures correlated significantly with DCE-MRI peak PE (r=0.7), peak SER (r=0.6) and tumor volume (r=0.6). By multivariate analysis, SER was the strongest independent MRI correlate of PET blood flow, and PE the strongest MRI correlate for K1. No significant correlations were observed between 18F-FDG PET metabolic rate and the DCE-MRI kinetic parameters. Also, while blood flow and K1 were strongly correlated (r=0.9, p=0.0001), blood flow and metabolic rate were not (r=0.4, p=0.12). Conclusions: The associations between PET and MRI measures may lead to a better understanding of angiogenesis, vascular permeability, and glucose transport in LABC. A lack of correlation of metabolic rate with blood flow and DCE MRI kinetics suggests that 18F-FDG PET provides complimentary metabolic information independent of vascular factors. The combination of MRI and PET may be helpful in understanding tumor pharmacodynamics in response to novel therapy. No significant financial relationships to disclose.

scholarly journals Abstract 3043: Quantitative MRI during neoadjuvant therapy for predicting breast cancer response in the community setting

2018 ◽  
Author(s):  
Anna Sorace ◽  
Jack Virostko ◽  
Chengyue Wu ◽  
Angela M. Jarrett ◽  
Stephanie L. Barnes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Community Setting ◽  
Quantitative Mri

scholarly journals Role of Post-Neoadjuvant therapy with trastuzumab emtansine in HER2-positive breast cancer

2021 ◽  
pp. 68-74
Author(s):  
E. V. Lubennikova ◽  
Ya. V. Vishnevskaya
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Locally Advanced ◽  
Residual Tumor ◽  
Long Term Results ◽  
Trastuzumab Emtansine ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

The widespread introduction of anti-HER2 agents has changed the natural course of Her2-positive breast cancer. The use of trastuzumab, and later dual anti-HER2 blockade with pertuzumab, in neoadjuvant regimens significantly increased the chances of complete cure. However, among patients with early and locally advanced forms of Her2-positive cancer, there is a cohort with an extremely unfavorable prognosis – tumors that have not achieved complete pathomorphological regression after neoadjuvant chemotherapy.The presence of a residual tumor in Her2-positive breast cancer has long been only a prognostically unfavorable factor without the potential to influence disease outcome. The results of the international phase III study KATHERINE, which demonstrated the high efficacy of post-adjuvant therapy with trastuzumab emtansine (T-DM1) in this patient cohort, have established a new standard of care. Due to T-DM1 adjuvant therapy, the possibility to significantly improve long-term results determined the predictive characteristics of the morphological response to the choice of treatment tactics, which became an important argument in favor of neoadjuvant therapy in patients with not only locally advanced but also primarily resectable Her2-positive breast cancer, followed by personalization of therapy.This article presents our own experience with post-neoadjuvant therapy with trastuzumab emtansine in a young patient with a residual tumor. The data of the main studies in early Her2-positive breast cancer are summarized.

5063 POSTER Improvement of Neoadjuvant Therapy Response by Using 4FE100C Vs 6FE100C in Locally Advanced Breast Cancer

2011 ◽  
Vol 47 ◽  
pp. S349
Author(s):  
N. Ramirez-Torres ◽  
A. Perez-Puente ◽  
J. Asbun-Bojalil ◽  
E. Ruiz-Garcia ◽  
L.A. Valenzuela-Martinez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Therapy Response ◽  
Advanced Breast

Phase II Study of Neoadjuvant Docetaxel, Vinorelbine, and Trastuzumab Followed by Surgery and Adjuvant Doxorubicin Plus Cyclophosphamide in Women With Human Epidermal Growth Factor Receptor 2–Overexpressing Locally Advanced Breast Cancer

2007 ◽  
Vol 25 (10) ◽  
pp. 1232-1238 ◽  
Author(s):  
Steven A. Limentani ◽  
Adam M. Brufsky ◽  
John K. Erban ◽  
Mohammed Jahanzeb ◽  
Deborah Lewis
Keyword(s):  
Breast Cancer ◽  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Febrile Neutropenia ◽  
Neoadjuvant Therapy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Growth Factor Receptor ◽  
Epidermal Growth

Purpose To evaluate the combination of docetaxel, vinorelbine, and trastuzumab as neoadjuvant therapy for human epidermal growth factor receptor 2 (HER2) –overexpressing breast cancer. Patients and Methods Patients with stage IIB or III breast cancer, including inflammatory disease, and HER2 overexpression (determined by fluorescent in situ hybridization) were treated with six cycles of docetaxel 60 mg/m2 and vinorelbine 45 mg/m2 administered every 14 days with granulocyte colony-stimulating factor and quinolone prophylaxis. Trastuzumab was administered as a 4 mg/kg loading dose followed by 2 mg/kg weekly for 12 weeks. The primary efficacy end point was pathologic complete response (pCR) in the breast. Results Of 31 enrolled patients, 68% had T3 or T4 tumors and 90% were clinically node positive. Twelve patients (39%; 95% CI, 21.6% to 55.9%) achieved pCR in the breast and lymph nodes and 14 patients (45%; 95% CI, 27.6% to 62.7%) achieved pCR in the breast alone, and 19 patients (61%; 95% CI, 44.1% to 78.4%) were node negative after neoadjuvant therapy. Clinical response was documented in 29 patients (94%; 95% CI, 78.6% to 99.2%) with 26 complete responses (84%; 95% CI, 70.9% to 96.8%). The most commonly reported grade 3/4 toxicities were neutropenia (97%), febrile neutropenia (22%), anemia (6%), mucositis/stomatitis (6%), constipation (6%), and skin rash (6%). Conclusion With clinical response and pCR rates of 94% and 39%, respectively, docetaxel, vinorelbine, and trastuzumab is a highly active neoadjuvant therapy for HER2-overexpressing locally advanced breast cancer. Although well tolerated overall, significant febrile neutropenia was observed despite prophylactic measures; therefore, evaluating a similar regimen using lower docetaxel and/or vinorelbine doses is warranted.

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