Imaging early changes in proliferation at 1 week post chemotherapy: a pilot study in breast cancer patients with 3'-deoxy-3'-[18F]fluorothymidine positron emission tomography

• Published in: European journal of nuclear medicine and molecular imaging Vol. 34; no. 9; pp. 1339 - 1347
• Main Authors: Kenny, Laura, Coombes, R Charles, Vigushin, David M, Al-Nahhas, Adil, Shousha, Sami, Aboagye, Eric O
• Format: Journal Article
• Language: English
• Published: Germany Springer Nature B.V 01.09.2007
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Cell Proliferation; Chemotherapy; Cyclophosphamide - administration & dosage; Dideoxynucleosides - pharmacology; Epirubicin - administration & dosage; Female; Fluorouracil - administration & dosage; Humans; Ki-67 Antigen - biosynthesis; Kinetics; Medical imaging; Middle Aged; Neoplasm Metastasis; Nuclear medicine; Positron-Emission Tomography - methods; Tomography; Treatment Outcome
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-007-0379-4

3'-deoxy-3'-[18F]fluorothymidine positron emission tomography ([18F]FLT-PET) has been developed for imaging cell proliferation and findings correlate strongly with the Ki-67 labelling index in breast cancer. The aims of this pilot study were to define objective criteria for [18F]FLT response and to examine whether [18F]FLT-PET can be used to quantify early response of breast cancer to chemotherapy. Seventeen discrete lesions in 13 patients with stage II-IV breast cancer were scanned prior to and at 1 week after treatment with combination 5-fluorouracil, epirubicin and cyclophosphamide (FEC) chemotherapy. The uptake at 90 min (SUV90) and irreversible trapping (Ki) of [18F]FLT were calculated for each tumour. The reproducibility of [18F]FLT-PET was determined in nine discrete lesions from eight patients who were scanned twice before chemotherapy. Clinical response was assessed at 60 days after commencing FEC. All tumours showed [18F]FLT uptake and this was reproducible in serial measurements (SD of mean % difference=10.5% and 15.1%, for SUV90 and Ki, respectively; test-retest correlation coefficient>or=0.97). Six patients had a significant clinical response (complete or partial) at day 60; these patients also had a significant reduction in [18F]FLT uptake at 1 week. Decreases in Ki and SUV90 at 1 week discriminated between clinical response and stable disease (p=0.022 for both parameters). In three patients with multiple lesions there was a mixed [18F]FLT response in primary tumours and metastases. [18F]FLT response generally preceded tumour size changes. [18F]FLT-PET can detect changes in breast cancer proliferation at 1 week after FEC chemotherapy.