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Prognostic relevance at 5 years of the early monitoring of neoadjuvant chemotherapy using 18F-FDG PET in luminal HER2-negative breast cancer

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Abstract

Purpose

The objective of this study was to evaluate, in the luminal human epidermal growth factor receptor 2 (HER2)-negative breast cancer subtype, the prognostic value of tumour glucose metabolism at baseline and of its early changes during neoadjuvant chemotherapy (NAC).

Methods

This prospective study included 61 women with hormone-sensitive HER2-negative breast cancer treated with NAC. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) was performed at baseline. Hepatic activity was used as a reference to distinguish between low metabolic and hypermetabolic tumours. In hypermetabolic tumours, a PET exam was repeated after the first course of NAC. The relative change in the maximum standardized uptake value of the tumour (∆SUV) was calculated.

Results

Nineteen women had low metabolic luminal breast cancers at baseline, correlated with low proliferation indexes. Forty-two women had hypermetabolic tumours, corresponding to more proliferative breast cancers with higher Ki-67 expression (p = 0.017) and higher grade (p = 0.04). The median follow-up period was 64.2 months (range 11.5–93.2). Thirteen women developed recurrent disease, nine of whom died. Worse overall survival was associated with larger tumour size [>5 cm, hazard ratio (HR) = 6.52, p = 0.009] and with hypermetabolic tumours 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 responder patients was 49.2 %. Overall survival in women with low metabolic tumours or hypermetabolic/good response tumours was 100 and 96.15 %, respectively.

Conclusion

In luminal HER2-negative breast tumours, tumour metabolism at baseline and changes after the first course of NAC are early surrogate markers of patients’ survival. A subgroup of women with hypermetabolic/poorly responding tumours, correlated with poor prognosis at 5 years, can be identified early. These results may guide future studies by tailoring the NAC regimen to the metabolic response.

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Acknowledgments

We are grateful to Mr. Bastable for his writing services. This study is part of the PharmImage® project.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Centre GF Leclerc, 1 rue du Pr Marion, 21000, Dijon, France

    Olivier Humbert, Alina Berriolo-Riedinger, Alexandre Cochet, Michel Toubeau, Inna Dygai-Cochet & François Brunotte

  2. Biostatistics and Quality of Life Unit, EA 4184, Centre GF Leclerc, Dijon, France

    Mélanie Gauthier

  3. Department of Pathology, Centre GF Leclerc, Dijon, France

    Céline Charon-Barra

  4. Department of Medical Oncology, Centre GF Leclerc, Dijon, France

    Séverine Guiu, Isabelle Desmoulins & Pierre Fumoleau

  5. Department of Surgery, Centre GF Leclerc, Dijon, France

    Charles Coutant

  6. Imaging Department, CHU Le Bocage, Dijon, France

    Olivier Humbert & François Brunotte

  7. Université de Bourgogne, UMR CNRS 5158, Dijon, France

    Olivier Humbert, Alexandre Cochet & François Brunotte

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  1. Olivier Humbert
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Correspondence to Olivier Humbert.

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Humbert, O., Berriolo-Riedinger, A., Cochet, A. et al. Prognostic relevance at 5 years of the early monitoring of neoadjuvant chemotherapy using 18F-FDG PET in luminal HER2-negative breast cancer. Eur J Nucl Med Mol Imaging 41, 416–427 (2014). https://doi.org/10.1007/s00259-013-2616-3

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  • DOI: https://doi.org/10.1007/s00259-013-2616-3

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