Positron emission tomography of tumour [18F]fluoroestradiol uptake in patients with acquired hormone-resistant metastatic breast cancer prior to oestradiol therapy

• Published in: European journal of nuclear medicine and molecular imaging Vol. 42; no. 11; pp. 1674 - 1681
• Main Authors: van Kruchten, Michel, Glaudemans, Andor W. J. M., de Vries, Erik F. J., Schröder, Carolien P., de Vries, Elisabeth G. E., Hospers, Geke A. P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2015; Springer Nature B.V
• Subjects: Adult; Aged; Biological Transport; Biomarkers, Tumor - metabolism; Bone and Bones - metabolism; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - drug therapy; Breast Neoplasms - metabolism; Cardiology; Drug Resistance, Neoplasm; Emissions; Estradiol - adverse effects; Estradiol - analogs & derivatives; Estradiol - metabolism; Estradiol - therapeutic use; Female; Humans; Imaging; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Positron-Emission Tomography; Positrons; Predictive Value of Tests; Radiology; Tomography; Treatment Outcome; Oestradiol therapy; Breast cancer; F-FES-PET; Imaging; Oestrogen receptor
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-015-3107-5

Purpose Whereas anti-oestrogen therapy is widely applied to treat oestrogen receptor (ER) positive breast cancer, paradoxically, oestrogens can also induce tumour regression. Up-regulation of ER expression is a marker for oestrogen hypersensitivity. We, therefore, performed an exploratory study to evaluate positron emission tomography (PET) with the tracer 16α-[ 18 F]fluoro-17β-oestradiol ( 18 F-FES) as potential marker to select breast cancer patients for oestradiol therapy. Methods Eligible patients had acquired endocrine-resistant metastatic breast cancer that progressed after ≥2 lines of endocrine therapy. All patients had prior ER-positive histology. Treatment consisted of oestradiol 2 mg, three times daily, orally. Patients underwent 18 F-FES-PET/CT imaging at baseline. Tumour 18 F-FES-uptake was quantified for a maximum of 20 lesions and expressed as maximum standardised uptake value (SUV max ). CT-scan was repeated every 3 months to evaluate treatment response. Clinical benefit was defined as time to radiologic or clinical progression ≥24 weeks. Results 18 F-FES uptake, quantified for 255 lesions in 19 patients, varied greatly between lesions (median 2.8; range 0.6–24.3) and between patients (median 2.5; range 1.1–15.5). Seven (37 %) patients experienced clinical benefit of oestrogen therapy, eight progressed (PD), and four were non-evaluable due to side effects. The positive and negative predictive value (PPV/NPV) of 18 F-FES-PET for response to treatment were 60 % (95 % CI: 31–83 %) and 80 % (95 % CI: 38–96 %), respectively, using SUV max >1.5. Conclusion 18 F-FES-PET may aid identification of patients with acquired antihormone resistant breast cancer that are unlikely to benefit from oestradiol therapy.