Total Lesion Glycolysis Levels as Predictive Indicators in Patients With Metastatic and Recurrent Breast Cancer Undergoing Endocrine Therapy With or Without CDK4/6 Inhibitor

• Published in: Anticancer research Vol. 42; no. 10; pp. 4813 - 4824
• Main Authors: Ozawa, Hiromi, Higuchi, Tomoko, Fujimoto, Yukie, Bun, Ayako, Fukui, Reiko, Kanaoka, Haruka, Nagahashi, Masayuki, Kitajima, Kazuhiro, Yamakado, Koichiro, Miyoshi, Yasuo
• Format: Journal Article
• Language: English
• Published: Athens International Institute of Anticancer Research 01.10.2022
• Subjects: Breast cancer; Confidence intervals; Cyclin-dependent kinase 4; Endocrine therapy; ErbB-2 protein; Estrogen receptors; Estrogens; Glycolysis; Lesions; Mathematical analysis; Metabolism; Metastases; Metastasis; Parameter identification; Parameter sensitivity; Patients; Positron emission; Positron emission tomography; Sensitivity; Tumors
• ISSN: 0250-7005; 1791-7530
• DOI: 10.21873/anticanres.15986

Background/Aim: Endocrine therapy (ET) with or without CDK4/6 inhibitors is the primary treatment choice for patients with estrogen receptor (ER)-positive and HER2-negative subtype of metastatic breast cancer (MBC). We examined the metabolic parameters identified using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in terms of sensitivity, since no predictive factors exist. Patients and Methods: We included 136 patients with MBC treated with ET alone (n=107) or combined with CDK4/6 inhibitor (n=29) and examined using FDG-PET before treatment began. The highest maximum value of the standard uptake value (SUVmax), whole-body metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. Results: Progression-free survival (PFS) was significantly longer in patients with low levels of MTV, TLG, and SUVmax than those with higher levels (median PFS 49.5 vs. 20.7 months, p=0.001 for MTV, 49.5 vs. 20.7 months, p=0.0016 for TLG, 37.0 vs. 20.7 months, p=0.012 for SUVmax). Multivariable analysis revealed that TLG (hazard ratio=6.383, 95% confidence interval=1.167-34.913, p=0.033) was independently and significantly associated with PFS. The relationship between TLG levels and PFS was significant in patients treated with ET with (p=0.0054) and without (p=0.0188) CDK4/6 inhibitor. Conclusion: TLG at baseline was a significant predictor for sensitivity to ET alone or combined with CDK4/6 inhibitor. These data may be useful to identify patients that would benefit from ET.