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O'Brien SR, Edmonds CE, Ward RE, Taunk NK, Pantel AR, Mankoff DA. Update on 18F-Fluoroestradiol. Semin Nucl Med 2024:S0001-2998(24)00077-1. [PMID: 39368910 DOI: 10.1053/j.semnuclmed.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 10/07/2024]
Abstract
18F-16α-Fluoroestradiol (18F-FES) is a radiolabeled estrogen analogue positron emission tomography (PET) imaging agent that binds to the estrogen receptor (ER) in the nucleus of ER-expressing cells. Proof-of-concept studies of 18F-FES demonstrated expected correlation between tumoral 18F-FES-positivity on PET-imaging and ER+ status assessed on biopsy samples by radioligand binding and immunohistochemistry. After decades of study, 18F-FES PET/CT gained clinical approval in 2016 in France and 2020 in the United States for use in patients with ER+ metastatic or recurrent breast cancer. ER+ as assessed by 18F-FES PET/CT has been shown to serve as a biomarker, identifying metastatic breast cancer patients who may respond to endocrine therapy and those who are unlikely to respond. In 2023, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published Appropriate Use Criteria for 18F-FES PET/CT, identifying four indications in which use of 18F-FES PET/CT was "appropriate": (1) To assess functional ER status in metastatic lesions unfavorable to biopsy or when biopsy is nondiagnostic, (2) To detect ER status when other imaging tests are equivocal or suspicious, and at (3) initial diagnosis of metastatic disease or (4) progression of metastatic disease, for considering endocrine therapy. This article reviews the foundations of 18F-FES imaging, including normal distribution, false positives, and false negatives, and describes the most up-to-date clinical uses as well as emerging research in breast cancer and other patient populations.
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Affiliation(s)
- Sophia R O'Brien
- Division of Nuclear Medicine Imaging and Therapy, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Radiology, Division of Breast Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Christine E Edmonds
- Department of Radiology, Division of Breast Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rebecca E Ward
- Division of Nuclear Medicine Imaging and Therapy, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Neil K Taunk
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Austin R Pantel
- Division of Nuclear Medicine Imaging and Therapy, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David A Mankoff
- Division of Nuclear Medicine Imaging and Therapy, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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2
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Ryu J, Hyung J, Han S, Jeong JH, Lee SB, Yoo TKR, Kim J, Kim HJ, Chung IY, Ko BS, Lee JW, Son BH, Jeong H, Ahn JH, Jung KH, Kim SB, Moon DH. Impact of 18F-FES PET/CT on Clinical Decisions in the Management of Recurrent or Metastatic Breast Cancer. J Nucl Med 2024:jnumed.124.267913. [PMID: 39362758 DOI: 10.2967/jnumed.124.267913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/28/2024] [Indexed: 10/05/2024] Open
Abstract
The clinical impact of 16α-18F-fluoro-17β-estradiol (18F-FES) PET/CT on patient management has not been well investigated. The aim of this study was to assess the clinical impact of 18F-FES PET/CT on the management of patients with recurrent or metastatic breast cancer. Methods: Study subjects were identified retrospectively from a database of a prospective trial for postmarketing surveillance of 18F-FES between 2021 and 2023. Patients who were suspected or known to have recurrent or metastatic estrogen receptor-positive breast cancer based on a routine standard workup were included. Planned management before and actual management after 18F-FES PET/CT were assessed by 2 experienced medical oncologists via medical chart review. A 5-point questionnaire was provided to evaluate the value of 18F-FES PET/CT for management planning. The rate of intention-to-treat and interdisciplinary changes, and the impact of 18F-FES PET/CT according to PET/CT result or clinical indication, were examined. Results: Of the 344 included patients, 120 (35%) experienced a change in management after 18F-FES PET/CT. In 139 (40%) patients,18F-FES PET/CT supported the existing management decision without a change in management. Intention-to-treat and interdisciplinary changes accounted for 64% (77/120) and 68% (82/120) of all changes, respectively. A higher rate of change was observed when lesions were 18F-FES-negative (44% [36/81]) than 18F-FES-positive (30% [51/172]) or mixed 18F-FES-positive/negative (36% [33/91]). Regarding clinical indications, the highest rate of change was shown when evaluating the origins of metastasis of double primary cancers (64% [9/14]). Conclusion: 18F-FES PET/CT modified the management of recurrent or metastatic breast cancer, serving as an impactful imaging modality in clinical practice.
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Affiliation(s)
- Jeongryul Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewon Hyung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and
| | - Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Kyung Robyn Yoo
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyehyun Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and
| | - Jin-Hee Ahn
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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3
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Covington MF, O'Brien SR, Lawhn-Heath C, Pantel AR, Ulaner GA, Linden HM, Dehdashti F. 18F-Labeled Fluoroestradiol PET/CT: Current Status, Gaps in Knowledge, and Controversies- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024:1-11. [PMID: 38117098 DOI: 10.2214/ajr.23.30330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PET/CT using 16α-[18F]-fluoro-17β-estradiol (FES) noninvasively images tissues expressing estrogen receptors (ERs). FES has undergone extensive clinicopathologic validation for ER-positive breast cancer and in 2020 received FDA approval for clinical use as an adjunct to biopsy in patients with recurrent or metastatic ER-positive breast cancer. Clinical use of FES PET/CT is increasing but is not widespread in the United States. This AJR Expert Panel Narrative Review explores the present status and future directions of FES PET/CT, including image interpretation, existing and emerging uses, knowledge gaps, and current controversies. Specific controversies discussed include whether both FES PET/CT and FDG PET/CT are warranted in certain scenarios, whether further workup is required after negative FES PET/CT results, whether FES PET/CT findings should inform endocrine therapy selection, and whether immunohistochemistry should remain the stand-alone reference standard for determining ER status for all breast cancers. Consensus opinions from the panel include agreement with the appropriate clinical uses of FES PET/CT published by a multidisciplinary expert work group in 2023, anticipated expanded clinical use of FES PET/CT for staging ER-positive invasive lobular carcinomas and low-grade invasive ductal carcinomas pending ongoing clinical trial results, and the need for further research regarding the use of FES PET/CT for nonbreast malignancies expressing ER.
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Affiliation(s)
- Matthew F Covington
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - Sophia R O'Brien
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Austin R Pantel
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA
- Radiology and Translational Genomics, University of Southern California, Los Angeles, CA
| | - Hannah M Linden
- Department of Medicine, Division of Hematology and Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO
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4
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Zhou W, Franc BL, DeMartini WB, Rosen EL. Estrogen Receptor-targeted PET Imaging for Breast Cancer. Radiology 2024; 312:e240315. [PMID: 39136565 PMCID: PMC11366667 DOI: 10.1148/radiol.240315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 09/04/2024]
Abstract
Two complementary patient cases are presented to highlight the importance of estrogen receptor (ER)-targeting imaging in treatment planning and selection for endocrine therapy in breast cancer patients. This article will discuss the radiopharmaceuticals and biology, imaging interpretation, and current clinical applications of ER-targeting imaging using fluorine 18 fluoroestradiol PET.
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Affiliation(s)
- Wenhui Zhou
- From the Department of Radiology, Stanford University Medical Center,
300 Pasteur Dr, H1MD330, MC 5621, Stanford, CA 94305
| | - Benjamin L. Franc
- From the Department of Radiology, Stanford University Medical Center,
300 Pasteur Dr, H1MD330, MC 5621, Stanford, CA 94305
| | - Wendy B. DeMartini
- From the Department of Radiology, Stanford University Medical Center,
300 Pasteur Dr, H1MD330, MC 5621, Stanford, CA 94305
| | - Eric L. Rosen
- From the Department of Radiology, Stanford University Medical Center,
300 Pasteur Dr, H1MD330, MC 5621, Stanford, CA 94305
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5
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Keigley QJ, Fowler AM, O'Brien SR, Dehdashti F. Molecular Imaging of Steroid Receptors in Breast Cancer. Cancer J 2024; 30:142-152. [PMID: 38753748 PMCID: PMC11101139 DOI: 10.1097/ppo.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
ABSTRACT Steroid receptors regulate gene expression for many important physiologic functions and pathologic processes. Receptors for estrogen, progesterone, and androgen have been extensively studied in breast cancer, and their expression provides prognostic information as well as targets for therapy. Noninvasive imaging utilizing positron emission tomography and radiolabeled ligands targeting these receptors can provide valuable insight into predicting treatment efficacy, staging whole-body disease burden, and identifying heterogeneity in receptor expression across different metastatic sites. This review provides an overview of steroid receptor imaging with a focus on breast cancer and radioligands for estrogen, progesterone, and androgen receptors.
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Affiliation(s)
- Quinton J Keigley
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Sophia R O'Brien
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Farrokh Dehdashti
- Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
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Kohan AA, Lupien M, Cescon D, Deblois G, Ventura M, Metser U, Veit-Haibach P. Detection of metabolic adaptation in a triple-negative breast cancer animal model with [ 18F]choline-PET imaging as a surrogate for drug resistance. Eur J Nucl Med Mol Imaging 2024; 51:1261-1267. [PMID: 38095672 DOI: 10.1007/s00259-023-06546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/26/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE Test the feasibility of an image-based method to identify taxane resistance in mouse bearing triple-negative breast cancer (TNBC) tumor xenografts. METHODS Xenograft tumor-bearing mice from paclitaxel-sensitive and paclitaxel-resistant TNBC cells (MDA-MD-346) were generated by orthotopic injection into female NOD-SCID mice. When tumors reached 100-150 mm3, mice were scanned using [18F]choline PET/CT. Tumors were collected and sliced for autoradiography and immunofluorescence analysis. Quantitative data was analyzed accordingly. RESULTS From fifteen mice scanned, five had taxane-sensitive cell line tumors of which two underwent taxol-based treatment. From the remaining 10 mice with taxane-resistant cell line tumors, four underwent taxol-based treatment. Only 13 mice had the tumor sample analyzed histologically. When normalized to the blood pool, both cell lines showed differences in metabolic uptake before and after treatment. CONCLUSIONS Treated and untreated taxane-sensitive and taxane-resistant cell lines have different metabolic properties that could be leveraged before the start of chemotherapy.
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Affiliation(s)
- Andres A Kohan
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, 263 McCaul St 4th floor, Toronto, ON, M5T 1W7, Canada.
| | - Mathieu Lupien
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - David Cescon
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Geneviève Deblois
- Institute for Research in Immunology and Cancer (IRIC), Université de Montréal, Montréal, Québec, Canada
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - Manuela Ventura
- STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada
- Animal Resources GSU, Human Technopole Foundation, Milan, Italy
| | - Ur Metser
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, 263 McCaul St 4th floor, Toronto, ON, M5T 1W7, Canada
| | - Patrick Veit-Haibach
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, 263 McCaul St 4th floor, Toronto, ON, M5T 1W7, Canada
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7
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Liu C, Ma G, Xu X, Song S, Yang Z. Can 18F-FES PET Improve the Evaluation of 18F-FDG PET in Patients With Metastatic Invasive Lobular Carcinoma? Clin Nucl Med 2024; 49:301-307. [PMID: 38427956 DOI: 10.1097/rlu.0000000000005085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE Invasive lobular carcinoma (ILC) exhibits a low affinity for 18F-FDG. The estrogen receptor (ER) is commonly expressed in ILCs, suggesting a potential benefit of targeting with the ER probe 18F-FES in this patient population. The objective of this study was to evaluate the diagnostic performance of 18F-FES imaging in patients with metastatic ILC and compare it with that of 18F-FDG. METHODS We conducted a retrospective analysis of 20 ILC patients who underwent concurrent 18F-FES and 18F-FDG PET/CT examinations in our center. 18F-FES and 18F-FDG imaging were analyzed to determine the total count of tracer-avid lesions in nonbone sites and their corresponding organ systems, assess the extent of anatomical regions involved in bone metastases, and measure the SUVmax values for both tracers. RESULTS Among 20 ILC patients, 65 nonbone lesions were found to be distributed in 13 patients, and 16 patients were diagnosed with bone metastasis, which was distributed in 54 skeletal anatomical regions. The detection rate of 18F-FDG in nonbone lesions was higher than that of 18F-FES (57 vs 37, P < 0.001). 18F-FES demonstrated a superior ability to detect nonbone lesions in 4 patients, whereas 18F-FDG was superior in 5 patients (P > 0.05). Among 9/16 patients with bone metastasis, 18F-FES demonstrated a significant advantage in the detection of bone lesions compared with 18F-FDG (P = 0.05). Furthermore, patients with only 18F-FES-positive lesions (12/12) were administered endocrine regimens, whereas patients lacking 18F-FES uptake (2/3) predominantly received chemotherapy. CONCLUSIONS 18F-FES is more effective than 18F-FDG in detecting bone metastasis in ILC, but it does not demonstrate a significant advantage in nonbone lesions. Additionally, the results of examination with 18F-FES have the potential to guide patient treatment plans.
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8
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Ulaner GA, Vaz SC, Groheux D. Quarter-Century Transformation of Oncology: Positron Emission Tomography for Patients with Breast Cancer. PET Clin 2024; 19:147-162. [PMID: 38177052 DOI: 10.1016/j.cpet.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
PET radiotracers have become indispensable in the care of patients with breast cancer. 18F-fluorodeoxyglucose has become the preferred method of many oncologists for systemic staging of breast cancer at initial diagnosis, detecting recurrent disease, and for measuring treatment response after therapy. 18F-Sodium Fluoride is valuable for detection of osseous metastases. 18F-fluoroestradiol is now FDA-approved with multiple appropriate clinical uses. There are multiple PET radiotracers in clinical trials, which may add utility of PET imaging for patients with breast cancer in the future. This article will describe the advances during the last quarter century in PET for patients with breast cancer.
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Affiliation(s)
- Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Irvine, CA, USA; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, USA.
| | - Sofia Carrilho Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - David Groheux
- Nuclear Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France
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9
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Ulaner GA, Vaz SC. Women's Health Update: Growing Role of PET for Patients with Breast Cancer. Semin Nucl Med 2024; 54:247-255. [PMID: 38365547 DOI: 10.1053/j.semnuclmed.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/18/2024]
Abstract
Positron Emission Tomography (PET) has been growing in usage for patients with breast cancer, due to an increased number of FDA-approved PET radiotracers pertinent to patients with breast cancer as well as increased prospective evidence for the value of these agents. The leading PET radiotracer for patients with breast cancer is 18F-fluorodeoxyglucose (18F-FDG), which measures glucose metabolism. There is prospective evidence for the use of 18F-FDG PET in systemic staging of newly diagnosed locally advanced breast cancer (stages IIB-IIIC), monitoring breast cancer treatment response, and detecting breast cancer recurrence, particularly in no special type (NST) breast cancer. 16α-18F-fluoro-17β-Fluoroestradiol (18F-FES) is a radiolabeled estrogen which evaluates estrogen receptor (ER) accessible for estrogen binding. There is prospective evidence supporting 18F-FES PET as a predictive biomarker for selecting patients with metastatic breast cancer for endocrine therapies. 18F-FES PET has also been shown to be valuable in the evaluation of ER status of lesions which are difficult to biopsy, for evaluation of ER status in lesions that are equivocal on other imaging modalities, and for selecting optimal dosage of novel ER-targeted systemic therapies in early clinical trials. Multiple investigators have suggested 18F-FES PET will have an increasing role for patients with invasive lobular breast cancer (ILC), which is less optimally evaluated by 18F-FDG PET. Sodium 18F-Fluoride (18F-NaF) evaluates bone turnover and has been effective in evaluation of malignancies which commonly metastasize to bone. In patients with metastatic breast cancer, 18F-NaF PET/CT has demonstrated superior sensitivity for osseous metastases than 99mTc-MDP or CT. In addition to these three FDA-approved PET radiotracers, there are multiple novel radiotracers currently in clinical trials with potential to further increase PET usage for patients with breast cancer.
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Affiliation(s)
- Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA; Radiology, University of Southern California, Los Angeles, CA.
| | - Sofia Carrilho Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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10
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Ndlovu H, Lawal IO, Mokoala KMG, Sathekge MM. Imaging Molecular Targets and Metabolic Pathways in Breast Cancer for Improved Clinical Management: Current Practice and Future Perspectives. Int J Mol Sci 2024; 25:1575. [PMID: 38338854 PMCID: PMC10855575 DOI: 10.3390/ijms25031575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Breast cancer is the most frequently diagnosed cancer and leading cause of cancer-related deaths worldwide. Timely decision-making that enables implementation of the most appropriate therapy or therapies is essential for achieving the best clinical outcomes in breast cancer. While clinicopathologic characteristics and immunohistochemistry have traditionally been used in decision-making, these clinical and laboratory parameters may be difficult to ascertain or be equivocal due to tumor heterogeneity. Tumor heterogeneity is described as a phenomenon characterized by spatial or temporal phenotypic variations in tumor characteristics. Spatial variations occur within tumor lesions or between lesions at a single time point while temporal variations are seen as tumor lesions evolve with time. Due to limitations associated with immunohistochemistry (which requires invasive biopsies), whole-body molecular imaging tools such as standard-of-care [18F]FDG and [18F]FES PET/CT are indispensable in addressing this conundrum. Despite their proven utility, these standard-of-care imaging methods are often unable to image a myriad of other molecular pathways associated with breast cancer. This has stimulated interest in the development of novel radiopharmaceuticals targeting other molecular pathways and processes. In this review, we discuss validated and potential roles of these standard-of-care and novel molecular approaches. These approaches' relationships with patient clinicopathologic and immunohistochemical characteristics as well as their influence on patient management will be discussed in greater detail. This paper will also introduce and discuss the potential utility of novel PARP inhibitor-based radiopharmaceuticals as non-invasive biomarkers of PARP expression/upregulation.
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Affiliation(s)
- Honest Ndlovu
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa; (H.N.); (K.M.G.M.)
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa;
| | - Ismaheel O. Lawal
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa;
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Kgomotso M. G. Mokoala
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa; (H.N.); (K.M.G.M.)
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa;
| | - Mike M. Sathekge
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa; (H.N.); (K.M.G.M.)
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa;
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11
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Ulaner GA, Fowler AM, Clark AS, Linden H. Estrogen Receptor-Targeted and Progesterone Receptor-Targeted PET for Patients with Breast Cancer. PET Clin 2023; 18:531-542. [PMID: 37270377 DOI: 10.1016/j.cpet.2023.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Estrogen receptor (ER)-targeted imaging with 16α-18F-fluoro-17β-fluoroestradiol (18F-FES) has multiple proven clinical applications for patients with ER-positive breast cancer, including helping to select optimal patients for endocrine therapies, assessing ER status in lesions that are difficult to biopsy, and evaluating lesions with inconclusive results on other imaging tests. This has led to US Food and Drug Administration approval of 18F-FES PET for patients with ER-positive breast cancer. Newer progesterone receptor-targeted imaging agents are in clinical trials.
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Affiliation(s)
- Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, USA; Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, USA.
| | - Amy M Fowler
- Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amy S Clark
- Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Linden
- Medical Oncology, University of Washington, Seattle, WA, USA
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12
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Matushita CS, Coelho FDARFB, Stasiak CES, Rodrigues DF, Pianta DB, Kurkowski FD, da Silva MM, de Souza SAL, Lopes RW, de Castro PHR. 18F-fluoroestradiol positron emission tomography in patients with breast cancer: a systematic review and meta-analysis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S116. [PMID: 37556635 PMCID: PMC10411708 DOI: 10.1590/1806-9282.2023s116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/21/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Cristina S. Matushita
- Sociedade Brasileira de Medicina Nuclear – São Paulo (SP), Brazil
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto Do Cérebro do Rio Grande do Sul – Porto Alegre (RS), Brazil
- São Marcos Diagnósticos por Imagem – Joinville (SC), Brazil
| | | | - Camila Edith Stachera Stasiak
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Departamento de Radiologia – Rio de Janeiro (RJ), Brazil
- Universidade Federal Fluminense, Serviço de Medicina Nuclear – Niterói (RJ), Brazil
| | - Denise Ferreira Rodrigues
- Nuclear Medcenter – Belo Horizonte (MG), Brazil
- Axial Inteligência Diagnóstica – Belo Horizonte (MG), Brazil
| | - Diego Bromfman Pianta
- Sociedade Brasileira de Medicina Nuclear – São Paulo (SP), Brazil
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto Do Cérebro do Rio Grande do Sul – Porto Alegre (RS), Brazil
- São Marcos Diagnósticos por Imagem – Joinville (SC), Brazil
| | - Flávia Dornelas Kurkowski
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto Do Cérebro do Rio Grande do Sul – Porto Alegre (RS), Brazil
| | - Marcelo Moreira da Silva
- São Marcos Diagnósticos por Imagem – Joinville (SC), Brazil
- Instituto de Medicina Nuclear e Endo de Brasília – Brasília (DF), Brazil
| | - Sergio Augusto Lopes de Souza
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Departamento de Radiologia – Rio de Janeiro (RJ), Brazil
| | - Rafael Willain Lopes
- Sociedade Brasileira de Medicina Nuclear – São Paulo (SP), Brazil
- Hospital do Coração, Setor de Medicina Nuclear – São Paulo (SP), Brazil
| | - Paulo Henrique Rosado de Castro
- Sociedade Brasileira de Medicina Nuclear – São Paulo (SP), Brazil
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto Do Cérebro do Rio Grande do Sul – Porto Alegre (RS), Brazil
- São Marcos Diagnósticos por Imagem – Joinville (SC), Brazil
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Huang YT, Chen TWW, Chen LY, Huang YY, Lu YS. The Application of 18F-FES PET in Clinical Cancer Care: A Systematic Review. Clin Nucl Med 2023:00003072-990000000-00634. [PMID: 37482660 DOI: 10.1097/rlu.0000000000004760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
INTRODUCTION [18F]fluoroestradiol (FES) can be used for the noninvasive visualization and quantification of tumor estrogen receptor (ER) expression and activity and was FDA-approved as a diagnostic agent in May 2022 for detecting ER-positive lesions in patients with recurrent or metastatic breast cancer. PET imaging was also used to detect ER-positive lesions and malignancy among patients with uterine, ovarian, and other ER-positive solid tumors. We conducted a systemic review of the studies on FES PET imaging used among patients with cancer not limited to breast cancer to better understand the application of FES PET imaging. METHODS PubMed/MEDLINE and Cochrane Library databases were used to perform a comprehensive and systematic search and were updated until August 15, 2022. Two authors independently reviewed the titles and abstracts of the retrieved articles by using the search algorithm and selected the articles based on the inclusion and exclusion criteria. All statistical analyses were conducted using R statistical software. RESULTS Forty-three studies with 2352 patients were included in the qualitative synthesis, and 23 studies with 1388 patients were included in the quantitative analysis, which estimated the FES-positive detection rate. Thirty-two studies (77%) included breast cancer patients in 43 included studies. The FES SUVmean was higher in patients with endometrial cancer (3.4-5.3) than in those with breast cancer (2.05) and uterine sarcoma (1.1-2.6). The pooled detection rates of FES PET imaging were 0.80 for breast and 0.84 for ovarian cancer patients, both similar to that of 18F-FDG. The FES uptake threshold of 1.1 to 1.82 could detect 11.1% to 45% ER heterogeneity, but the threshold of FES uptake did not have consistent predictive ability for prognosis among patients with breast cancer, unlike uterine cancer. However, FES uptake can effectively predict and monitor treatment response, especially endocrine therapy such as estradiol, ER-blocking agents (fulvestrant and tamifoxen), and aromatase inhibitors (such as letrozole and Z-endoxifen). CONCLUSIONS [18F]fluoroestradiol PET is not only a convenient and accurate diagnostic imaging tool for detecting ER-expressing lesions in patients with breast and ovarian cancer but also among patients with uterine cancer. [18F]fluoroestradiol PET is a noninvasive predictive and monitoring tool for treatment response and prognosis.
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Affiliation(s)
| | | | - Li-Yu Chen
- From the Primo Biotechnology Co, Ltd, Taipei
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14
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Ulaner GA, Mankoff DA, Clark AS, Fowler AM, Linden HM, Peterson LM, Dehdashti F, Kurland BF, Mortimer J, Mouabbi J, Moon DH, de Vries EGE. Summary: Appropriate Use Criteria for Estrogen Receptor-Targeted PET Imaging with 16α- 18F-Fluoro-17β-Fluoroestradiol. J Nucl Med 2023; 64:351-354. [PMID: 36863779 DOI: 10.2967/jnumed.123.265420] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 03/04/2023] Open
Abstract
PET imaging with 16α-18F-fluoro-17β-fluoroestradiol (18F-FES), a radiolabeled form of estradiol, allows whole-body, noninvasive evaluation of estrogen receptor (ER). 18F-FES is approved by the U.S. Food and Drug Administration as a diagnostic agent "for the detection of ER-positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer." The Society of Nuclear Medicine and Molecular Imaging (SNMMI) convened an expert work group to comprehensively review the published literature for 18F-FES PET in patients with ER-positive breast cancer and to establish appropriate use criteria (AUC). The findings and discussions of the SNMMI 18F-FES work group, including example clinical scenarios, were published in full in 2022 and are available at https://www.snmmi.org/auc Of the clinical scenarios evaluated, the work group concluded that the most appropriate uses of 18F-FES PET are to assess ER functionality when endocrine therapy is considered either at initial diagnosis of metastatic breast cancer or after progression of disease on endocrine therapy, the ER status of lesions that are difficult or dangerous to biopsy, and the ER status of lesions when other tests are inconclusive. These AUC are intended to enable appropriate clinical use of 18F-FES PET, more efficient approval of FES use by payers, and promotion of investigation into areas requiring further research. This summary includes the rationale, methodology, and main findings of the work group and refers the reader to the complete AUC document.
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Affiliation(s)
- Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, California;
| | - David A Mankoff
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy S Clark
- Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy M Fowler
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Hannah M Linden
- Department of Medical Oncology, University of Washington, Seattle, Washington
| | - Lanell M Peterson
- Department of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Farrokh Dehdashti
- Department of Radiology, Washington University of St. Louis, St. Louis, Missouri
| | | | - Joanne Mortimer
- Department of Medical Oncology, City of Hope, Duarte, California
| | - Jason Mouabbi
- Department of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; and
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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Parent EE, Fowler AM. Nuclear Receptor Imaging In Vivo-Clinical and Research Advances. J Endocr Soc 2022; 7:bvac197. [PMID: 36655003 PMCID: PMC9838808 DOI: 10.1210/jendso/bvac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Indexed: 01/01/2023] Open
Abstract
Nuclear receptors are transcription factors that function in normal physiology and play important roles in diseases such as cancer, inflammation, and diabetes. Noninvasive imaging of nuclear receptors can be achieved using radiolabeled ligands and positron emission tomography (PET). This quantitative imaging approach can be viewed as an in vivo equivalent of the classic radioligand binding assay. A main clinical application of nuclear receptor imaging in oncology is to identify metastatic sites expressing nuclear receptors that are targets for approved drug therapies and are capable of binding ligands to improve treatment decision-making. Research applications of nuclear receptor imaging include novel synthetic ligand and drug development by quantifying target drug engagement with the receptor for optimal therapeutic drug dosing and for fundamental research into nuclear receptor function in cells and animal models. This mini-review provides an overview of PET imaging of nuclear receptors with a focus on radioligands for estrogen receptor, progesterone receptor, and androgen receptor and their use in breast and prostate cancer.
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Affiliation(s)
- Ephraim E Parent
- Mayo Clinic Florida, Department of Radiology, Jacksonville, Florida 32224, USA
| | - Amy M Fowler
- Correspondence: Amy M. Fowler, MD, PhD, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252, USA.
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Gilardi L, Airò Farulla LS, Ceci F. Imaging for illuminating actionable pathways in breast cancer. Curr Opin Oncol 2022; 34:606-613. [PMID: 36093891 PMCID: PMC10852035 DOI: 10.1097/cco.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Nuclear medicine has the potential to explore and illuminate several pathways in breast cancer (BC) offering different radiopharmaceuticals for positron emission tomography (PET) designed to target specific tumor characteristics. The aim of this critical review is to give an overview about emerging opportunities in PET imaging, underlining the future potential contribution in the management of BC patients. RECENT FINDINGS Beside 2-deoxy-2-[ 18 F]-fluoro- d -glucose (FDG), new generation tracers for PET imaging have been recently proposed to investigate specific characteristics in breast cancer, both targeting tumor cells and the tumor micro-environment (TME). SUMMARY FDG-PET is a procedure that received extensive clinical validation. However, its role in BC is still suboptimal due to the low-FDG avidity of specific tumor subtypes. Human epidermal growth receptor-2 and integrin targeted PET radiotracers might provide useful information selecting patients more likely to respond to target therapy. FluoroEstradiol (FES) is a FDA-approved PET radiotracer targeting the estrogen receptor (ER), useful to investigate metastatic ER+ patients, to assess in vivo ER heterogeneity and to evaluate hormonal therapy efficacy. Inhibitors of the fibroblast activation protein (FAPi) targeting the cancer-associated fibroblast can explore the TME with PET imaging. FAPi is also proposed a theranostic agent for radio-ligand therapy.
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Affiliation(s)
- Laura Gilardi
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS
| | - Lighea Simona Airò Farulla
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Ulaner GA. 16α-18F-fluoro-17β-Fluoroestradiol (FES): Clinical Applications for Patients With Breast Cancer. Semin Nucl Med 2022; 52:574-583. [DOI: 10.1053/j.semnuclmed.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 12/25/2022]
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