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de Mooij CM, Ploumen RAW, Nelemans PJ, Mottaghy FM, Smidt ML, van Nijnatten TJA. The influence of receptor expression and clinical subtypes on baseline [18F]FDG uptake in breast cancer: systematic review and meta-analysis. EJNMMI Res 2023; 13:5. [PMID: 36689007 PMCID: PMC9871105 DOI: 10.1186/s13550-023-00953-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/11/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To quantify the relationship between [18F]FDG uptake of the primary tumour measured by PET-imaging with immunohistochemical (IHC) expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers in breast cancer patients. METHODS PubMed and Embase were searched for studies that compared SUVmax between breast cancer patients negative and positive for IHC expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers. Two reviewers independently screened the studies and extracted the data. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were estimated by using DerSimonian-Laird random-effects models. P values less than or equal to 5% indicated statistically significant results. RESULTS Fifty studies were included in the final analysis. SUVmax is significantly higher in ER-negative (31 studies, SMD 0.66, 0.56-0.77, P < 0.0001), PR-negative (30 studies, SMD 0.56; 0.40-0.71, P < 0.0001), HER2-positive (32 studies, SMD - 0.29, - 0.49 to - 0.10, P = 0.0043) or Ki-67-positive (19 studies, SMD - 0.77; - 0.93 to - 0.61, P < 0.0001) primary tumours compared to their counterparts. The majority of clinical subtypes were either luminal A (LA), luminal B (LB), HER2-positive or triple negative breast cancer (TNBC). LA is associated with significantly lower SUVmax compared to LB (11 studies, SMD - 0.49, - 0.68 to - 0.31, P = 0.0001), HER2-positive (15 studies, SMD - 0.91, - 1.21 to - 0.61, P < 0.0001) and TNBC (17 studies, SMD - 1.21, - 1.57 to - 0.85, P < 0.0001); and LB showed significantly lower uptake compared to TNBC (10 studies, SMD - 0.77, - 1.05 to - 0.49, P = 0.0002). Differences in SUVmax between LB and HER2-positive (9 studies, SMD - 0.32, - 0.88 to 0.24, P = 0.2244), and HER2-positive and TNBC (17 studies, SMD - 0.29, - 0.61 to 0.02, P = 0.0667) are not significant. CONCLUSION Primary tumour SUVmax is significantly higher in ER-negative, PR-negative, HER2-positive and Ki-67-positive breast cancer patients. Luminal tumours have the lowest and TNBC tumours the highest SUVmax. HER2 overexpression has an intermediate effect.
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Affiliation(s)
- Cornelis M de Mooij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.
- GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Roxanne A W Ploumen
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Review of imaging techniques for evaluating morphological and functional responses to the treatment of bone metastases in prostate and breast cancer. Clin Transl Oncol 2022; 24:1290-1310. [PMID: 35152355 PMCID: PMC9192443 DOI: 10.1007/s12094-022-02784-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.Clinical trial registration: Not applicable.
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Sirico M, Bernocchi O, Sobhani N, Giudici F, Corona SP, Vernieri C, Nichetti F, Cappelletti MR, Milani M, Strina C, Cervoni V, Barbieri G, Ziglioli N, Dester M, Bianchi GV, De Braud F, Generali D. Early Changes of the Standardized Uptake Values (SUV max) Predict the Efficacy of Everolimus-Exemestane in Patients with Hormone Receptor-Positive Metastatic Breast Cancer. Cancers (Basel) 2020; 12:E3314. [PMID: 33182575 PMCID: PMC7697290 DOI: 10.3390/cancers12113314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The mTORC1 inhibitor everolimus has been approved in combination with the aromatase inhibitor exemestane for the treatment of hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (HR+ mBC) progressing on prior therapy with a non-steroidal aromatase inhibitor. To date, no predictive biomarkers of tumor sensitivity/resistance for everolimus-based treatments have been identified. We hypothesized that precocious changes in the Standardized Uptake Volume (∆SUV%), as assessed by 18F-Fluorodeoxyglucosepositron-emission tomography (18F-FDG PET/CT), may be a marker of everolimus efficacy. Methods: This was a retrospective study including 31 HR+ HER2- patients treated with everolimus and exemestane in two Italian centers between 2013 and 2018. The objective of the study was to investigate ∆SUV% as a predictive marker of everolimus antitumor efficacy. 18F-FDG PET/CT scans were performed at baseline and after three months of treatment. Patients were defined as long responders (LRs) if disease progression occurred at least 10 months after treatment initiation and long survivors (LSs) if death occurred later than 36 months after starting therapy. ROC analysis was used to determine the optimal cut-off values of ∆SUV% to distinguish LRs from non-LRs and LSs from non-LSs. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method. Results: The SUVmax values decreased significantly from baseline to 3 months after therapy (p = 0.003). Dynamic changes of SUVmax (Delta SUV) had a higher accuracy in discriminating long-responders from non-long-responders (AUC = 0.67, Delta SUV cut-off = 28.8%) respects to its ability to identify long survivors from no-long survivors (AUC = 0.60, Delta SUV cut-off = 53.8%). Patients were divided into groups according to the Delta SUV cut-offs and survival outcomes were evaluated: patients with a decrease of ∆SUV% ≥ 28.8% had significantly better PFS (10 months-PFS: 63.2%, 95% CI: 37.9-80.4% and 16.7%, 95% CI: 2.7-41.3% respectively, p = 0.005). As regard as OS, patients with ∆SUV% ≥ 53.8% had longer OS when compared to patients with ∆SUV% < 53.8% (36 month-OS: 82.5% vs. 45.9% vs. p = 0.048). Conclusion: We found two precocious ∆SUV% thresholds capable of identifying HR+ HER2-mBC patients, which would achieve long-term benefit or long-term survival during everolimus-exemestane therapy. These results warrant further validation in prospective studies and should be integrated with molecular biomarkers related to tumor metabolism and mTORC1 signaling.
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Affiliation(s)
- Marianna Sirico
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Ottavia Bernocchi
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy; (O.B.); (F.G.)
| | - Navid Sobhani
- Section of Epidemiology and Population Science, Department of Medicine, Baylor College of Medicine, Baylor Plaza, Houston, TX 77030, USA
| | - Fabiola Giudici
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy; (O.B.); (F.G.)
| | - Silvia P. Corona
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy; (O.B.); (F.G.)
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.V.); (F.N.); (G.V.B.); (F.D.B.)
- Fondazione Istituto FIRC di Oncologia Molecolare (IFOM), 20129 Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.V.); (F.N.); (G.V.B.); (F.D.B.)
| | - Maria Rosa Cappelletti
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Manuela Milani
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Carla Strina
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Valeria Cervoni
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Giuseppina Barbieri
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Nicoletta Ziglioli
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Martina Dester
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Giulia Valeria Bianchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.V.); (F.N.); (G.V.B.); (F.D.B.)
| | - Filippo De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.V.); (F.N.); (G.V.B.); (F.D.B.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Daniele Generali
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy; (O.B.); (F.G.)
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