Estrogen receptor binding (18F-FES PET) and glycolytic activity (18F-FDG PET) predict progression-free survival on endocrine therapy in patients with ER+ breast cancer

Brenda F. Kurland, Lanell M. Peterson, Jean H. Lee, Erin K. Schubert, Erin R. Currin, Jeanne M. Link, Kenneth A. Krohn, David A. Mankoff, Hannah M. Linden

Research output: Contribution to journalArticle

  • 10 Citations

Abstract

Purpose:18F-fluoroestradiol (FES) PET scans measure regional estrogen binding, and 18F-fluorodeoxyglucose (FDG) PET measures tumor glycolytic activity. We examined quantitative and qualitative imaging biomarkers of progression-free survival (PFS) in breast cancer patients receiving endocrine therapy. Experimental Design: Ninety patients with breast cancer from an estrogen receptor-positive (ER+), HER2- primary tumor underwent FES PET and FDG PET scans prior to endocrine therapy (63% aromatase inhibitor, 22% aromatase inhibitor and fulvestrant, 15% other). Eighty-four had evaluable data for PFS prediction. Results: Recursive partitioning with 5-fold internal cross-validation used both FES PET and FDG PET measures to classify patients into three distinct response groups. FDG PET identified 24 patients (29%) with low FDG uptake, suggesting indolent tumors. These patients had a median PFS of 26.1 months (95% confidence interval, 11.2-49.7). Of patients with more FDG-avid tumors, 50 (59%) had high average FES uptake, and 10 (12%) had low average FES uptake. These groups had median PFS of 7.9 (5.6-11.8) and 3.3 months (1.4-not evaluable), respectively. Patient and tumor features did not replace or improve the PET measures' prediction of PFS. Prespecified endocrine resistance classifiers identified in smaller cohorts did not individually predict PFS. Conclusions: A wide range of therapy regimens are available for treatment of ER+ metastatic breast cancer, but no guidelines are established for sequencing these therapies. FDG PET and FES PET may help guide the timing of endocrine therapy and selection of targeted and/or cytotoxic chemotherapy. A multicenter trial is ongoing for external validation.

LanguageEnglish (US)
Pages407-415
Number of pages9
JournalClinical Cancer Research
Volume23
Issue number2
DOIs
StatePublished - Jan 15 2017
Externally publishedYes

Fingerprint

Estrogen Receptors
Disease-Free Survival
Breast Neoplasms
Aromatase Inhibitors
Neoplasms
Positron-Emission Tomography
Therapeutics
Fluorodeoxyglucose F18
Multicenter Studies
Estrogens
Research Design
Biomarkers
Guidelines
Confidence Intervals
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Estrogen receptor binding (18F-FES PET) and glycolytic activity (18F-FDG PET) predict progression-free survival on endocrine therapy in patients with ER+ breast cancer. / Kurland, Brenda F.; Peterson, Lanell M.; Lee, Jean H.; Schubert, Erin K.; Currin, Erin R.; Link, Jeanne M.; Krohn, Kenneth A.; Mankoff, David A.; Linden, Hannah M.

In: Clinical Cancer Research, Vol. 23, No. 2, 15.01.2017, p. 407-415.

Research output: Contribution to journalArticle

Kurland, Brenda F. ; Peterson, Lanell M. ; Lee, Jean H. ; Schubert, Erin K. ; Currin, Erin R. ; Link, Jeanne M. ; Krohn, Kenneth A. ; Mankoff, David A. ; Linden, Hannah M./ Estrogen receptor binding (18F-FES PET) and glycolytic activity (18F-FDG PET) predict progression-free survival on endocrine therapy in patients with ER+ breast cancer. In: Clinical Cancer Research. 2017 ; Vol. 23, No. 2. pp. 407-415
@article{bd5914b4fd6444e59f3387ed6b1143ee,
title = "Estrogen receptor binding (18F-FES PET) and glycolytic activity (18F-FDG PET) predict progression-free survival on endocrine therapy in patients with ER+ breast cancer",
abstract = "Purpose:18F-fluoroestradiol (FES) PET scans measure regional estrogen binding, and 18F-fluorodeoxyglucose (FDG) PET measures tumor glycolytic activity. We examined quantitative and qualitative imaging biomarkers of progression-free survival (PFS) in breast cancer patients receiving endocrine therapy. Experimental Design: Ninety patients with breast cancer from an estrogen receptor-positive (ER+), HER2- primary tumor underwent FES PET and FDG PET scans prior to endocrine therapy (63\{%} aromatase inhibitor, 22\{%} aromatase inhibitor and fulvestrant, 15\{%} other). Eighty-four had evaluable data for PFS prediction. Results: Recursive partitioning with 5-fold internal cross-validation used both FES PET and FDG PET measures to classify patients into three distinct response groups. FDG PET identified 24 patients (29\{%}) with low FDG uptake, suggesting indolent tumors. These patients had a median PFS of 26.1 months (95\{%} confidence interval, 11.2-49.7). Of patients with more FDG-avid tumors, 50 (59\{%}) had high average FES uptake, and 10 (12\{%}) had low average FES uptake. These groups had median PFS of 7.9 (5.6-11.8) and 3.3 months (1.4-not evaluable), respectively. Patient and tumor features did not replace or improve the PET measures\{textquoteleft} prediction of PFS. Prespecified endocrine resistance classifiers identified in smaller cohorts did not individually predict PFS. Conclusions: A wide range of therapy regimens are available for treatment of ER+ metastatic breast cancer, but no guidelines are established for sequencing these therapies. FDG PET and FES PET may help guide the timing of endocrine therapy and selection of targeted and/or cytotoxic chemotherapy. A multicenter trial is ongoing for external validation.",
author = "Kurland, {Brenda F.} and Peterson, {Lanell M.} and Lee, {Jean H.} and Schubert, {Erin K.} and Currin, {Erin R.} and Link, {Jeanne M.} and Krohn, {Kenneth A.} and Mankoff, {David A.} and Linden, {Hannah M.}",
year = "2017",
month = "1",
day = "15",
doi = "10.1158/1078-0432.CCR-16-0362",
language = "English (US)",
volume = "23",
pages = "407--415",
journal = "Clinical Cancer Research",
issn = "1078-0432",
publisher = "American Association for Cancer Research Inc.",
number = "2",

}

TY - JOUR

T1 - Estrogen receptor binding (18F-FES PET) and glycolytic activity (18F-FDG PET) predict progression-free survival on endocrine therapy in patients with ER+ breast cancer

AU - Kurland,Brenda F.

AU - Peterson,Lanell M.

AU - Lee,Jean H.

AU - Schubert,Erin K.

AU - Currin,Erin R.

AU - Link,Jeanne M.

AU - Krohn,Kenneth A.

AU - Mankoff,David A.

AU - Linden,Hannah M.

PY - 2017/1/15

Y1 - 2017/1/15

N2 - Purpose:18F-fluoroestradiol (FES) PET scans measure regional estrogen binding, and 18F-fluorodeoxyglucose (FDG) PET measures tumor glycolytic activity. We examined quantitative and qualitative imaging biomarkers of progression-free survival (PFS) in breast cancer patients receiving endocrine therapy. Experimental Design: Ninety patients with breast cancer from an estrogen receptor-positive (ER+), HER2- primary tumor underwent FES PET and FDG PET scans prior to endocrine therapy (63% aromatase inhibitor, 22% aromatase inhibitor and fulvestrant, 15% other). Eighty-four had evaluable data for PFS prediction. Results: Recursive partitioning with 5-fold internal cross-validation used both FES PET and FDG PET measures to classify patients into three distinct response groups. FDG PET identified 24 patients (29%) with low FDG uptake, suggesting indolent tumors. These patients had a median PFS of 26.1 months (95% confidence interval, 11.2-49.7). Of patients with more FDG-avid tumors, 50 (59%) had high average FES uptake, and 10 (12%) had low average FES uptake. These groups had median PFS of 7.9 (5.6-11.8) and 3.3 months (1.4-not evaluable), respectively. Patient and tumor features did not replace or improve the PET measures' prediction of PFS. Prespecified endocrine resistance classifiers identified in smaller cohorts did not individually predict PFS. Conclusions: A wide range of therapy regimens are available for treatment of ER+ metastatic breast cancer, but no guidelines are established for sequencing these therapies. FDG PET and FES PET may help guide the timing of endocrine therapy and selection of targeted and/or cytotoxic chemotherapy. A multicenter trial is ongoing for external validation.

AB - Purpose:18F-fluoroestradiol (FES) PET scans measure regional estrogen binding, and 18F-fluorodeoxyglucose (FDG) PET measures tumor glycolytic activity. We examined quantitative and qualitative imaging biomarkers of progression-free survival (PFS) in breast cancer patients receiving endocrine therapy. Experimental Design: Ninety patients with breast cancer from an estrogen receptor-positive (ER+), HER2- primary tumor underwent FES PET and FDG PET scans prior to endocrine therapy (63% aromatase inhibitor, 22% aromatase inhibitor and fulvestrant, 15% other). Eighty-four had evaluable data for PFS prediction. Results: Recursive partitioning with 5-fold internal cross-validation used both FES PET and FDG PET measures to classify patients into three distinct response groups. FDG PET identified 24 patients (29%) with low FDG uptake, suggesting indolent tumors. These patients had a median PFS of 26.1 months (95% confidence interval, 11.2-49.7). Of patients with more FDG-avid tumors, 50 (59%) had high average FES uptake, and 10 (12%) had low average FES uptake. These groups had median PFS of 7.9 (5.6-11.8) and 3.3 months (1.4-not evaluable), respectively. Patient and tumor features did not replace or improve the PET measures' prediction of PFS. Prespecified endocrine resistance classifiers identified in smaller cohorts did not individually predict PFS. Conclusions: A wide range of therapy regimens are available for treatment of ER+ metastatic breast cancer, but no guidelines are established for sequencing these therapies. FDG PET and FES PET may help guide the timing of endocrine therapy and selection of targeted and/or cytotoxic chemotherapy. A multicenter trial is ongoing for external validation.

UR - http://www.scopus.com/inward/record.url?scp=85010952841&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010952841&partnerID=8YFLogxK

U2 - 10.1158/1078-0432.CCR-16-0362

DO - 10.1158/1078-0432.CCR-16-0362

M3 - Article

VL - 23

SP - 407

EP - 415

JO - Clinical Cancer Research

T2 - Clinical Cancer Research

JF - Clinical Cancer Research

SN - 1078-0432

IS - 2

ER -