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18F-FDG PET-Derived Tumor Blood Flow Changes After 1 Cycle of Neoadjuvant Chemotherapy Predicts Outcome in Triple-Negative Breast Cancer

Abstract : Previous studies have suggested that early changes in blood flow (BF) in response to neoadjuvant chemotherapy and evaluated with 150-water are a surrogate biomarker of outcome in women with breast cancer. This study investigates, in the triple-negative breast cancer subtype, the prognostic relevance of tumor BF changes (Delta BF) in response to chemotherapy, assessed using a short dynamic F-18-FDG PET acquisition. Methods: Forty-six consecutive women with triple-negative breast cancer and an indication for neoadjuvant chemotherapy were prospectively included. Women benefited from a baseline F-18-FDG PET examination with a 2-min chest-centered dynamic acquisition, started at the time of F-18-FDG injection. Breast tumor perfusion was calculated from this short dynamic image using a first-pass model. This dynamic PET acquisition was repeated after the first cycle of chemotherapy to measure early Delta BF. Delayed static PET acquisitions were also performed (90 min after F-18-FDG injection) to measure changes in tumor glucose metabolism (Delta SUVmax). The association between tumor BF, clinicopathologic characteristics, and patients' overall survival (OS) was evaluated. Results: Median baseline tumor BF was 21 mL/min/100 g (range, 6-46 mL/min/100 g) and did not significantly differ according to tumor size, Scarf-Bloom-Richardson grade, or Ki-67 expression. Median tumor Delta BF was-30%, with highly scattered values (range, -93% to +118%). A weak correlation was observed between Delta BF and Delta SUVmax (r = +0.40, P = 0.01). The median follow-up was 30 mo (range, 6-73 mo). Eight women developed recurrent disease, 7 of whom died. Low OS was associated with menopausal history (P = 0.03), persistent or increased tumor vascularization on the interim PET (6.13F cutoff =-30%; P = 0.03), non-breast-conserving surgery (P = 0.04), and the absence of a pathologic complete response (pCR) (P = 0.01). Delta BF and pCR provided incremental prognostic stratification: 3-y OS was 100% in pCR women, 87% in no-pCR women but achieving an early tumor BF response, and only 48% in no-pCR/no-BF-response women (Delta BF cutoff = -30%, P < 0.001). Conclusion: This study suggests the clinical usefulness of an early user- and patient-friendly 2-min dynamic acquisition to monitor breast tumor Delta BF to neoadjuvant chemotherapy using F-18-FDG PET/CT. Monitoring tumor perfusion and angiogenesis response to treatment seems to be a promising target for PET tracers.
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Soumis le : vendredi 20 janvier 2017 - 11:28:03
Dernière modification le : mercredi 17 août 2022 - 15:14:58

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Olivier Humbert, Jean-Marc Riedinger, Jean-Marc Vrigneaud, Salim Kanoun, Inna Dygai-Cochet,, et al.. 18F-FDG PET-Derived Tumor Blood Flow Changes After 1 Cycle of Neoadjuvant Chemotherapy Predicts Outcome in Triple-Negative Breast Cancer. Journal of Nuclear Medicine, Society of Nuclear Medicine, 2016, 57 (11), pp.1707 - 1712. ⟨10.2967/jnumed.116.172759⟩. ⟨hal-01441844⟩



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