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Research ArticleClinical Investigations

TBCRC 008: Early Change in 18F-FDG Uptake on PET Predicts Response to Preoperative Systemic Therapy in Human Epidermal Growth Factor Receptor 2–Negative Primary Operable Breast Cancer

Roisin M. Connolly, Jeffrey P. Leal, Matthew P. Goetz, Zhe Zhang, Xian C. Zhou, Lisa K. Jacobs, Joyce Mhlanga, Joo H O, John Carpenter, Anna Maria Storniolo, Stanley Watkins, John H. Fetting, Robert S. Miller, Kostandinos Sideras, Stacie C. Jeter, Bridget Walsh, Penny Powers, Jane Zorzi, Judy C. Boughey, Nancy E. Davidson, Lisa A. Carey, Antonio C. Wolff, Nagi Khouri, Edward Gabrielson, Richard L. Wahl and Vered Stearns
Journal of Nuclear Medicine January 2015, 56 (1) 31-37; DOI: https://doi.org/10.2967/jnumed.114.144741
Roisin M. Connolly
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Jeffrey P. Leal
2Division of Nuclear Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Matthew P. Goetz
3Mayo Clinic, Rochester, Minnesota
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Zhe Zhang
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Xian C. Zhou
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Lisa K. Jacobs
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Joyce Mhlanga
2Division of Nuclear Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Joo H O
2Division of Nuclear Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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John Carpenter
4University of Alabama at Birmingham, Birmingham, Alabama
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Anna Maria Storniolo
5Indiana University, Indianapolis, Indiana
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Stanley Watkins
6Anne Arundel Medical Center, Annapolis, Maryland
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John H. Fetting
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Robert S. Miller
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Kostandinos Sideras
3Mayo Clinic, Rochester, Minnesota
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Stacie C. Jeter
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Bridget Walsh
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Penny Powers
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Jane Zorzi
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Judy C. Boughey
3Mayo Clinic, Rochester, Minnesota
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Nancy E. Davidson
7University of Pittsburgh Cancer Institute and UPMC Cancer Center, Pittsburgh, Pennsylvania; and
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Lisa A. Carey
8University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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Antonio C. Wolff
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Nagi Khouri
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Edward Gabrielson
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Richard L. Wahl
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
2Division of Nuclear Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Vered Stearns
1From the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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  • FIGURE 1.
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    FIGURE 1.

    CONSORT flow diagram for phase II. All 73 patients who signed consent for formal eligibility assessment are included.

  • FIGURE 2.
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    FIGURE 2.

    pCR rates overall and by subgroup (ITT analysis).

  • FIGURE 3.
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    FIGURE 3.

    Box plots of reduction in SULmax in patients with pCR and non-pCR. Horizontal line inside box shows median. Lower and upper hinges of box represent 25th and 75th percentiles, respectively. ● = actual values of percentage reduction in SULmax.

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    TABLE 1

    Patient Characteristics

    CharacteristicVorinostat arm (n = 31)Placebo arm (n = 31)Overall (n = 62)
    Age (y)
     Median484848
     Range31–6824–7224–72
    Race
     Caucasian24 (77)19 (61)43 (69)
     Black5 (16)8 (26)13 (21)
     Other2 (7)4 (13)6 (10)
    Eastern Co-operative Oncology Group Performance Status
     029 (94)30 (97)59 (95)
     12 (6)1 (3)3 (5)
    Tumor size (cm)
     Median454
     Range1.5–11.51.7–181.5–18
    Baseline nodal status
     Negative14 (45)10 (32)24 (39)
     Positive17 (55)21 (68)38 (61)
    Tumor grade
     27 (23)11 (35)18 (29)
     324 (77)20 (65)44 (71)
    Receptor status
     ER-negative/PR-negative12 (39)12 (39)24 (39)
     ER-positive/PR-positive10 (32)12 (39)22 (36)
     ER-positive/PR-negative6 (19)6 (19)12 (19)
     ER-negative/PR-positive3 (10)1 (3)4 (6)
    BRCA status
     BRCA1/2 mutation4 (13)3 (10)7 (11)
     BRCA-negative7 (22)9 (29)16 (26)
     Unknown20 (65)19 (61)39 (63)
    • Data in parentheses are percentages.

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    TABLE 2

    Baseline and Change in SULmax Between Pathologic Responders and Nonresponders

    VariableResponders (n = 16)Nonresponders (n = 43)P*
    Baseline SULmax
     Mean ± SD8.2 ± 3.35.9 ± 3.5
     Median7.6 (range, 4.3–15.1)5.3 (range, 1.4–21.0)0.015
    Percentage change in SULmax
     Mean ± SD55.5 ± 23.630 ± 32.5
     Median63.0 (range, 4.4–85.3)32.9 (range, −84.2 to 77.1)0.003
     ≥50% reduction (n)12 (75.0%)13 (30.2%)0.003
    • ↵* Exact Wilcoxon rank sum test for continuous variables and Fisher exact test for binary variables.

    • Pooled ITT analysis.

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    TABLE 3

    Analysis of Association of SULmax with Pathologic Response

    Univariate analysisMultivariable analysis*
    VariableOdds ratioPAdjusted odds ratioAdjusted P
    Baseline SULmax1.18 (1.01–1.42)0.0511.07 (0.88–1.30)0.469
    Percentage change in SULmax1.04 (1.01–1.08)0.0111.03 (1–1.07)0.057
    Percentage change in SULmax, ≥50% vs. <50%6.6 (1.9–27.3)0.0045.1 (1.3–22.7)0.023
    • ↵* Multivariable logistic regression adjusting for ER and PR status.

    • Pooled ITT analysis. Data in parentheses are 95% CIs.

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Journal of Nuclear Medicine: 56 (1)
Journal of Nuclear Medicine
Vol. 56, Issue 1
January 1, 2015
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TBCRC 008: Early Change in 18F-FDG Uptake on PET Predicts Response to Preoperative Systemic Therapy in Human Epidermal Growth Factor Receptor 2–Negative Primary Operable Breast Cancer
Roisin M. Connolly, Jeffrey P. Leal, Matthew P. Goetz, Zhe Zhang, Xian C. Zhou, Lisa K. Jacobs, Joyce Mhlanga, Joo H O, John Carpenter, Anna Maria Storniolo, Stanley Watkins, John H. Fetting, Robert S. Miller, Kostandinos Sideras, Stacie C. Jeter, Bridget Walsh, Penny Powers, Jane Zorzi, Judy C. Boughey, Nancy E. Davidson, Lisa A. Carey, Antonio C. Wolff, Nagi Khouri, Edward Gabrielson, Richard L. Wahl, Vered Stearns
Journal of Nuclear Medicine Jan 2015, 56 (1) 31-37; DOI: 10.2967/jnumed.114.144741

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TBCRC 008: Early Change in 18F-FDG Uptake on PET Predicts Response to Preoperative Systemic Therapy in Human Epidermal Growth Factor Receptor 2–Negative Primary Operable Breast Cancer
Roisin M. Connolly, Jeffrey P. Leal, Matthew P. Goetz, Zhe Zhang, Xian C. Zhou, Lisa K. Jacobs, Joyce Mhlanga, Joo H O, John Carpenter, Anna Maria Storniolo, Stanley Watkins, John H. Fetting, Robert S. Miller, Kostandinos Sideras, Stacie C. Jeter, Bridget Walsh, Penny Powers, Jane Zorzi, Judy C. Boughey, Nancy E. Davidson, Lisa A. Carey, Antonio C. Wolff, Nagi Khouri, Edward Gabrielson, Richard L. Wahl, Vered Stearns
Journal of Nuclear Medicine Jan 2015, 56 (1) 31-37; DOI: 10.2967/jnumed.114.144741
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