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Title: 18F-FDG PET/CT for early prediction of response to neoadjuvant lapatinib, trastuzumab, and their combination in HER2-positive breast cancer: results from Neo-ALTTO
Author: Gebhart, Geraldine
Gámez, Cristina
Holmes, Eileen
Robles, Javier
Garcia, Camilo
Cortés Romera, Montserrat
De Azambuja, Evandro
Fauria, Karine
Van Dooren, Veerle
Aktan, Gursel
Coccia-Portugal, Maria Antonia
Kim, Sung-Bae
Vuylsteke, Peter
Cure, Hervé
Eidtmann, Holger
Baselga Torres, Josep, 1959-
Piccart, Martine
Flamen, Patrick
Di Cosimo, Serena
Keywords: Càncer de mama
Tomografia per emissió de positrons
Raigs X
Breast cancer
Positron emission tomography
Issue Date: Nov-2013
Publisher: The Society of Nuclear Medicine and Molecular Imaging
Abstract: Molecular imaging receives increased attention for selecting patients who will benefit from targeted anticancer therapies. Neo-ALTTO (Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimisation) enrolled 455 women with invasive human epidermal growth factor receptor 2 (HER2)-positive breast cancer and compared rates of pathologic complete response (pCR) to neoadjuvant lapatinib, trastuzumab, and their combination. Each anti-HER2 therapy was given alone for 6 wk, followed by 12 wk of the same therapy plus weekly paclitaxel. The early metabolic effects of the anti-HER2 therapies on the primary tumors and their predictive values for pCR were assessed in a subset of patients. Methods: eighty-six patients underwent (18)F-FDG PET/CT at baseline and weeks 2 and 6 of anti-HER2 treatment. An imaging core laboratory provided central validation, and 2 independent reviewers, masked to assigned treatment arm and clinical outcomes, performed consensus (18)F-FDG PET/CT readings. Maximum standardized uptake value (SUVmax) reductions from baseline were used to measure metabolic response. Results: seventy-seven of the 86 enrolled patients presented an evaluable baseline (18)F-FDG PET/CT scan; of these, 68 and 66 were evaluable at weeks 2 and 6, respectively. Metabolic responses in the primary tumors were evident after 2 wk of targeted therapy and correlated highly with metabolic responses at week 6 (R(2) = 0.81). pCRs were associated with greater SUVmax reductions at both time points. Mean SUVmax reductions for pCR and non-pCR, respectively, were 54.3% versus 32.8% at week 2 (P = 0.02) and 61.5% versus 34.1% at week 6 (P = 0.02). (18)F-FDG PET/CT metabolic response rates at weeks 2 and 6 were 71.6% and 60%, respectively using European Organization for Research and Treatment of Cancer criteria; pCR rates were twice as high for (18)F-FDG PET/CT responders than nonresponders (week 2: 42% vs. 21%, P = 0.12; week 6: 44% vs. 19%, P = 0.05). Conclusion: early metabolic assessment using (18)F-FDG PET/CT can identify patients with an increased likelihood of pCR after neoadjuvant trastuzumab, lapatinib, or their combination when given with chemotherapy.
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It is part of: Journal of Nuclear Medicine, 2013, vol. 54, num. 11, p. 1862-1868
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ISSN: 0161-5505
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

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