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Ghesquières H, Krzisch D, Nicolas-Virelizier E, Kanoun S, Gac AC, Guidez S, Touati M, Laribi K, Morschhauser F, Bonnet C, Waultier-Rascalou A, Orsini-Piocelle F, André M, Fournier M, Morand F, Berriolo-Riedinger A, Burroni B, Damotte D, Traverse-Glehen A, Quittet P, Casasnovas O. The phase 2 LYSA study of prednisone, vinblastine, doxorubicin, and bendamustine for untreated Hodgkin lymphoma in older patients. Blood 2024; 143:983-995. [PMID: 37979133 DOI: 10.1182/blood.2023021564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023] Open
Abstract
ABSTRACT Older patients with classical Hodgkin lymphoma (cHL) require more effective and less toxic therapies than younger patients. In this multicenter, prospective, phase 2 study, we investigated a new firstline therapy regimen comprising 6 cycles of prednisone (40 mg/m2, days 1-5), vinblastine (6 mg/m2, day 1), doxorubicin (40 mg/m2, day 1), and bendamustine (120 mg/m2, day 1) (PVAB regimen) every 21 days for patients with newly diagnosed cHL aged ≥61 years with an advanced Ann Arbor stage. A Mini Nutritional Assessment score ≥17 was the cutoff value for patients aged ≥70 years. The primary end point was the complete metabolic response (CMR) rate after 6 cycles. The median age of the 89 included patients was 68 years (range, 61-88 years), with 35 patients (39%) aged ≥70 years. Seventy-eight patients (88%) completed the 6 cycles. The toxicity rate was acceptable, with a 20% rate of related serious adverse events. CMR was achieved by 69 patients (77.5%; 95% confidence interval [CI], 67-86). After a median follow-up of 42 months, 31 patients progressed or relapsed (35%), and 24 died (27%) from HL (n = 11), toxicity during treatment (n = 4), secondary cancers (n = 6), or other causes (n = 3). The 4-year progression-free survival (PFS) and overall survival rates were 50% and 69%, respectively. Multivariate analysis showed that liver involvement (P = .001), lymphopenia (P = .001), CRP (P = .0005), and comedications (P = .003) were independently associated with PFS. The PVAB regimen yielded a high CMR rate with acceptable toxicity. Over long-term follow-up, survival end points were influenced by unrelated lymphoma events. This trial was registered at www.clinicaltrials.gov as #NCT02414568 and at EudraCT as 2014-001002-17.
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Affiliation(s)
- Hervé Ghesquières
- Department of Hematology, Hopital Lyon Sud, Claude Bernard Lyon 1 University, Pierre Benite, France
| | - Daphné Krzisch
- Department of Hematology, Assistance Publique Hopitaux de Paris, Hopital Saint Louis, Paris, France
| | | | - Salim Kanoun
- Department of Hematology, Cancer Research Center of Toulouse, Team 9, INSERM Unité Mixte de Recherche 1037, Toulouse, France
| | - Anne Claire Gac
- Department of Hematology, Institut d'Hematologie de Basse Normandie, Caen, France
| | - Stéphanie Guidez
- Hematology Department, Centre Hospitalier Universitaire, Poitiers, France
| | - Mohamed Touati
- Department of Hematology, Hôpital Dupuytren, Centre Hospitalier Universitaire, Limoges, France
| | - Kamel Laribi
- Hematology Department, Centre Hospitalier, Le Mans, France
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire Lille, Universite de Lille, ULR 7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | | | | | | | - Marc André
- Department of Hematology, Centre Hospitalier Universitaire, Université Catholique de Louvain Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Marguerite Fournier
- Department of Statistics, Lymphoma Study Association Clinical Research, Hopital Lyon Sud, Pierre Benite, France
| | - Fabienne Morand
- Department of Statistics, Lymphoma Study Association Clinical Research, Hopital Lyon Sud, Pierre Benite, France
| | | | - Barbara Burroni
- Department of Pathology, Université de Paris Cité, Centre de Recherche des Cordeliers UMRS U1138 et GH Paris Centre APHP, Paris, France
| | - Diane Damotte
- Department of Pathology, Université de Paris Cité, Centre de Recherche des Cordeliers UMRS U1138 et GH Paris Centre APHP, Paris, France
| | | | - Philippe Quittet
- Department of Hematology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and INSERM Unité Mixte de Recherche 1231, Dijon, France
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Camus V, Viailly PJ, Drieux F, Veresezan EL, Sesques P, Haioun C, Durot E, Patey M, Rossi C, Martin L, Rainville V, Bohers E, Ruminy P, Penther D, Kaltenbach S, Bruneau J, Paillassa J, Tournilhac O, Willaume A, Antier C, Lazarovici J, Lévêque E, Decazes P, Becker S, Tonnelet D, Berriolo-Riedinger A, Gaulard P, Tilly H, Molina TJ, Traverse-Glehen A, Jardin F. High PDL1/PDL2 gene expression correlates with worse outcome in primary mediastinal large B-cell lymphoma. Blood Adv 2023; 7:7331-7345. [PMID: 37862676 PMCID: PMC10701594 DOI: 10.1182/bloodadvances.2023011169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/11/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
Primary mediastinal B-cell lymphoma (PMBL) is an uncommon entity of aggressive B-cell lymphoma with an unusually good prognosis, except for 10-15% of chemotherapy-refractory cases. To identify earlier these higher risk patients, we performed molecular characterization of a retrospective multicenter cohort of patients treated with firstline immunochemotherapy. The traits of the patients with gene-expression profiling data (n = 120) were as follows: median age of 34 years (range, 18-67 years); female sex, 58.3%; elevated lactate dehydrogenase, 82.5%; Eastern Cooperative Oncology Group performance status score of 0 to 1, 85.7%; Ann Arbor stage I/II, 55%; International Prognostic Index score of 1 to 2, 64.4%; and median metabolic tumor volume, 290.4 cm3 (range, 15.7-1147.5 cm3). Among all 137 markers tested for correlation with survival data, only programmed death-ligand (PDL) 1 and PDL2 expression showed a prognostic impact. Overall, both PDL1 and PDL2 genes were highly expressed in 37 patients (30.8%; PDL1high/PDL2high). The baseline clinical characteristics of patients with PDL1high/PDL2high were similar to those of other patients. In univariate analysis, PDL1high/PDL2high status was associated with poor progression-free survival (PFS) (hazard ratio [HR], 4.292) and overall survival (OS; HR, 8.24). In multivariate analysis, PDL1high/PDL2high status was an independent prognostic factor of adverse outcomes (PFS: HR, 5.22; OS: HR, 10.368). We validated these results in an independent cohort of 40 patients and confirmed the significant association between PDL1high/PDL2high status and inferior PFS (HR, 6.11). High PDL1/PDL2 gene expression defines a population with strong immune privilege and poorer outcomes from standard chemotherapy who might benefit from firstline checkpoint inhibitor therapy.
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Affiliation(s)
- Vincent Camus
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | | | - Fanny Drieux
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | | | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Corinne Haioun
- Lymphoid malignancies Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Eric Durot
- Department of Hematology, Centre Hospitalier Universitaire (CHU) de Reims, Reims, France
| | - Martine Patey
- Department of Pathology, CHU de Reims, Reims, France
| | - Cédric Rossi
- Department of Hematology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Vinciane Rainville
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Elodie Bohers
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Philippe Ruminy
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Dominique Penther
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
- Department of Genetic Oncology, Centre Henri Becquerel, Rouen France
| | - Sophie Kaltenbach
- Laboratory of Onco-Hematology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julie Bruneau
- Université de Paris, Institut Imagine, Laboratory of Hematological Disorders, INSERM UMR1163, Paris, France
- Department of Pathology, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Necker and Robert Debré, Paris, France
| | - Jérome Paillassa
- Department of Hematology, Angers University Hospital, Angers, France
| | - Olivier Tournilhac
- Department of Hematology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Alexandre Willaume
- Department of Hematology, Lille University Hospital – Hôpital Claude Hurriez, Lille, France
| | - Chloé Antier
- Department of Hematology, University Hospital, Nantes, France
| | - Julien Lazarovici
- Department of Hematology, Institut Gustave Roussy, Villejuif, France
| | - Emilie Lévêque
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Pierre Decazes
- Department of Nuclear Medicine and QuantIF-LITIS-EA4108, University of Rouen, Centre Henri Becquerel, Rouen, France
| | - Stéphanie Becker
- Department of Nuclear Medicine and QuantIF-LITIS-EA4108, University of Rouen, Centre Henri Becquerel, Rouen, France
| | - David Tonnelet
- Department of Nuclear Medicine and QuantIF-LITIS-EA4108, University of Rouen, Centre Henri Becquerel, Rouen, France
| | | | - Philippe Gaulard
- Department of Pathology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Thierry Jo Molina
- Department of Pathology, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Necker and Robert Debré, Paris, France
| | | | - Fabrice Jardin
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
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Itti E, Blanc-Durand P, Berriolo-Riedinger A, Kanoun S, Kraeber-Bodéré F, Meignan M, Gat E, Gouill SL, Casasnovas RO, Bodet-Milin C. Validation of the ΔSUV max for Interim PET Interpretation in Diffuse Large B-Cell Lymphoma on the Basis of the GAINED Clinical Trial. J Nucl Med 2023; 64:1706-1711. [PMID: 37734837 DOI: 10.2967/jnumed.123.265871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
The GAINED phase 3 trial (ClinicalTrials.gov identifier: NCT01659099) evaluated a PET-driven consolidative strategy in patients with diffuse large B-cell lymphoma. In this post hoc analysis, we aimed to compare the prognostic value of the per-protocol PET interpretation criteria (Menton 2011 consensus) with the change in the SUVmax (ΔSUVmax) alone. Methods: Real-time central review of 18F-FDG PET/CT was performed in 581 patients after 2 cycles (PET2) and 4 cycles (PET4) of immunochemotherapy using the Menton 2011 criteria, combining the ΔSUVmax (cutoffs of 66% and 70% at PET2 and PET4, respectively) and the Deauville scale. In "special cases," when the baseline SUVmax was less than 10.0 or the interim residual tumor SUVmax was greater than 5.0, the Menton 2011 experts' consensus agreed that the ΔSUVmax may not be reliable and that the Deauville score is preferable. Prognostic values of Menton 2011 and ΔSUVmax were evaluated by Kaplan-Meier analyses in terms of progression-free survival (PFS). Results: Seventeen percent of patients at PET2 (100/581) and 8% at PET4 (49/581) had PET-negative results by ΔSUVmax but were considered to have PET-positive results according to Menton 2011 with residual SUVmax of greater than 5.0. For the population with PET2-positive results, 2-y PFS was 70% (range, 58%-80%) with ΔSUVmax alone, whereas the outcome tended to be better for those who were considered to have PET-positive results by Menton 2011, 81% (range, 72%-87%). Conversely, all 10 patients with baseline SUVmax of less than 10.0 had PET2-positive results by ΔSUVmax but were considered to have PET2-negative results by Menton 2011. These patients had the same 2-y PFS as patients with PET2-negative/PET4-negative results, indicating that the ΔSUVmax yielded false-positive results in this situation. Conclusion: We recommend the use of the ΔSUVmax alone rather than the Menton 2011 criteria for assessing the interim metabolic response in patients with diffuse large B-cell lymphoma, except when the baseline SUVmax is less than 10.0.
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Affiliation(s)
- Emmanuel Itti
- Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France;
| | - Paul Blanc-Durand
- Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France
| | | | - Salim Kanoun
- Nuclear Medicine, Georges-François Leclerc Center, Dijon, France
| | | | - Michel Meignan
- Nuclear Medicine, CHU Henri Mondor, Paris-Est University, Créteil, France
| | - Elodie Gat
- Lymphoma Study Association Recherche Clinique (LYSARC), Pierre-Bénite, France
| | | | | | - Caroline Bodet-Milin
- Nantes University, Angers University, CHU Nantes, INSERM, CNRS, CRCI2NA, Nantes, France
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Stamatoullas A, Ghesquières H, Feugier P, André M, Le Bras F, Gac AC, Borel C, Gastinne T, Quittet P, Morschhauser F, Ribrag V, Guidez S, Nicolas-Virelizier E, Berriolo-Riedinger A, Vander Borght T, Edeline V, Brice P. Final results of brentuximab vedotin combined with ifosfamide-carboplatin-etoposide in first refractory/relapsed Hodgkin lymphoma: a lymphoma study association phase I/II study. Leuk Lymphoma 2022; 63:3063-3071. [PMID: 35975738 DOI: 10.1080/10428194.2022.2107204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This phase I/II study assessed the combination of brentuximab vedotin (BV) with ifosfamide-carboplatin-etoposide (ICE) as a second-line therapy in refractory/relapsed (R/R) classical Hodgkin lymphoma (cHL) patients. Phase I study was designed to determine the maximum tolerated dose (MTD) of BV (10 patients) and phase II evaluated the rate of complete metabolic response (CMR) after 2 cycles of BV-ICE (42 patients). There were no dose-limiting toxicities (DLT) during phase I recommending BV 1.8 mg/kg for phase II. Twenty-six patients (61.9%) achieved CMR after 2 cycles of BV-ICE and 37 patients (88%) were transplanted. With a median follow-up of 38 months, the 3-year progression free survival (PFS) and overall survival (OS) rate were 64.3% and 100%, respectively. Hematological toxicities (81%) and infections (21%) were the most frequent adverse event encountered BV-ICE regimen is feasible with manageable toxicities and could be an alternative to other salvage treatments. Trial Registration: ClinicalTrials.gov identifier: NCT02686346.
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Affiliation(s)
| | | | | | - Marc André
- Département d'Hématologie, CHU UCL, Namur, Belgique
| | - Fabien Le Bras
- Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France
| | | | - Cécile Borel
- Département d'Hématologie, IUCT Oncopole, Toulouse, France
| | | | | | | | - Vincent Ribrag
- Département of Hématologie, Institut Gustave Roussy, Paris, France
| | - Stephanie Guidez
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | | | | | | | - Véronique Edeline
- Service de Médecine Nucléaire, Institut Curie, Hôpital R Huguenin, Saint-Cloud, France
| | - Pauline Brice
- Département d'Hématologie, Hôpital Saint Louis, APHP Paris, Paris, France
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Casasnovas RO, Bouabdallah R, Brice P, Lazarovici J, Ghesquieres H, Stamatoullas A, Dupuis J, Gac AC, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Feugier P, Morschhauser F, Sibon D, Bonnet C, Berriolo-Riedinger A, Edeline V, Parrens M, Damotte D, Coso D, André M, Meignan M, Rossi C. Positron Emission Tomography-Driven Strategy in Advanced Hodgkin Lymphoma: Prolonged Follow-Up of the AHL2011 Phase III Lymphoma Study Association Study. J Clin Oncol 2022; 40:1091-1101. [PMID: 34990281 DOI: 10.1200/jco.21.01777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The AHL2011 study (ClinicalTrials.gov identifier: NCT01358747) demonstrated that a positron emission tomography (PET)-driven de-escalation strategy after two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) provides similar progression-free survival (PFS) and overall survival (OS) and reduces early toxicity compared with a nonmonitored standard treatment. Here, we report, with a prolonged follow-up, the final study results. METHODS Patients with advanced Hodgkin lymphoma (stage III, IV, or IIB with mediastinum/thorax ratio > 0.33 or extranodal involvement) age 16-60 years were prospectively randomly assigned between 6 × BEACOPP and a PET-driven arm after 2 × BEACOPP delivering 4 × ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in PET2- and 4 × BEACOPP in PET2+ patients. PET performed after four cycles of chemotherapy had to be negative to complete the planned treatment. RESULTS In total, 823 patients were enrolled including 413 in the standard arm and 410 in the PET-driven arm. With a 67.2-month median follow-up, 5-year PFS (87.5% v 86.7%; hazard ratio [HR] = 1.07; 95% CI, 0.74 to 1.57; P = .67) and OS (97.7% in both arms; HR = 1.012; 95% CI, 0.50 to 2.10; P = .53) were similar in both randomization arms. In the whole cohort, full interim PET assessment predicted patients' 5-year PFS (92.3% in PET2-/PET4-, 75.4% [HR = 3.26; 95% CI, 18.3 to 5.77] in PET2+/PET4- and 46.5% [HR = 12.4; 95% CI, 7.31 to 19.51] in PET4+ patients, respectively; P < .0001) independent of international prognosis score. Five-year OS was also affected by interim PET results, and PET2+/PET4- patients (93.5%; HR = 3.3; 95% CI, 1.07 to 10.1; P = .036) and PET4+ patients (91.9%; HR = 3.756; 95% CI, 1.07 to 13.18; P = .038) had a significant lower OS than PET2-/PET4- patients (98.2%). Twenty-two patients (2.7%) developed a second primary malignancy, 13 (3.2%) and 9 (2.2%) in the standard and experimental arms, respectively. CONCLUSION The extended follow-up confirms the continued efficacy and favorable safety of AHL2011 PET-driven strategy, which is noninferior to standard six cycles of BEACOPP. PET4 provides additional prognostic information to PET2 and allows identifying patients with particularly poor prognosis.
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Affiliation(s)
- René-Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Reda Bouabdallah
- Department of Hematology, Institut P. Calmette, Marseille, France.,Department of Hematology, Hopital privé de Provence, Aix en Provence, France
| | - Pauline Brice
- Department of Hematology, APHP, Hopital Saint Louis, Paris, France
| | | | - Hervé Ghesquieres
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, et Université Claude Bernard Lyon-1, Pierre Bénite, France
| | | | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, Créteil, France
| | - Anne-Claire Gac
- Department of Hematology, Institut d'hématologie de basse normandie, Caen, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Bertrand Joly
- Department of Hematology, Hospital Sud Francilien, Corbeille-Essonnes, France
| | - Krimo Bouabdallah
- Department of Hematology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Franck Morschhauser
- Department of Hematology, CHU Lille, Unité GRITA, Université de Lille 2, Lille, France
| | - David Sibon
- Department of Hematology, Hopital Necker, Paris, France
| | | | | | - Véronique Edeline
- Department of Nuclear Medicine, Hopital R. Huguenin, Institut Curie, St-Cloud, France
| | - Marie Parrens
- Department of Pathology, University Hospital of Bordeaux and Inserm UMR 1053, Bordeaux, France
| | - Diane Damotte
- Department of Pathology, Université de Paris et GH Paris Centre APHP, Paris, France
| | - Diane Coso
- Department of Hematology, Institut P. Calmette, Marseille, France
| | - Marc André
- Department of Hematology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium.,Pole Mont, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Meignan
- Department of Nuclear Medicine, University Hospital H. Mondor, Creteil, France
| | - Cédric Rossi
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
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Coudert B, Pierga JY, Mouret-Reynier MA, Kerrou K, Ferrero JM, Petit T, Du FL, Dupré PF, Bachelot T, Gabelle P, Chauvet MP, Coeffic D, Barbe C, Prevost JB, Paintaud G, Thibault G, Ferhat A, Dupin J, Berriolo-Riedinger A, Arnould L. Long-term outcomes in patients with PET-predicted poor-responsive HER2-positive breast cancer treated with neoadjuvant bevacizumab added to trastuzumab and docetaxel: 5-year follow-up of the randomised Avataxher study. EClinicalMedicine 2020; 28:100566. [PMID: 33205032 PMCID: PMC7649610 DOI: 10.1016/j.eclinm.2020.100566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The open-label, randomised Phase 2 AVATAXHER study (NCT01142778) demonstrated that early PET assessment identified HER2-positive breast cancer patients who responded poorly to neoadjuvant docetaxel plus trastuzumab. Adding neoadjuvant bevacizumab for PET-predicted poor-responders improved pathological complete response (pCR) rates (43.8% vs 24.0%). We investigated long-term study outcomes. METHODS Patients were treated in three groups. All patients initially received two cycles of standard neoadjuvant therapy with [¹⁸F]-FDG PET conducted before each cycle. Those with ≥70% change in the maximum standardised uptake value (∆SUVmax) received four further cycles of standard neoadjuvant therapy (PET responders). PET-predicted poor-responders (∆SUVmax <70%) were randomised (2:1) to neoadjuvant therapy with (Group A) or without (Group B) bevacizumab for cycles 3-6. All patients received one further cycle of trastuzumab before surgery plus adjuvant trastuzumab (11 cycles). FINDINGS 142 patients were randomized and treated (PET responders, n = 69; Group A, n = 48; Group B, n = 25). 5-year disease-free survival rates were 90.5% (95% CI: 80.0-95.6%) in PET responders, 90.2% (95% CI: 75.9-96.2%) in Group A, and 76.0% (95% CI: 54.2-88.4%) in Group B. However, no difference was observed between randomised arms in a sensitivity analysis. During adjuvant therapy, the incidence of Grade ≥3 (Group A: 25.6%; Group B 12.5%) and serious adverse events (Group A: 18.6%; Group B 12.5%) was higher in Group A vs Group B, but with no apparent effect on cardiac events. INTERPRETATION In patients with HER2-positive breast cancer, an intervention based on early PET assessment and improvement of pCR does not modify disease-free survival. FUNDING Roche France.
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Affiliation(s)
- Bruno Coudert
- Centre Georges-Francois Leclerc, Dijon, France
- Corresponding author.
| | | | | | | | | | | | | | | | | | | | | | - David Coeffic
- Polyclinique Courlancy, Institut du Cancer Courlancy Reims, France
| | | | | | | | | | | | - Julien Dupin
- Roche France S.A.S., Boulogne Billancourt, France
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Blanc-Durand P, Jégou S, Kanoun S, Berriolo-Riedinger A, Bodet-Milin C, Kraeber-Bodéré F, Carlier T, Le Gouill S, Casasnovas RO, Meignan M, Itti E. Fully automatic segmentation of diffuse large B cell lymphoma lesions on 3D FDG-PET/CT for total metabolic tumour volume prediction using a convolutional neural network. Eur J Nucl Med Mol Imaging 2020; 48:1362-1370. [PMID: 33097974 DOI: 10.1007/s00259-020-05080-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE Lymphoma lesion detection and segmentation on whole-body FDG-PET/CT are a challenging task because of the diversity of involved nodes, organs or physiological uptakes. We sought to investigate the performances of a three-dimensional (3D) convolutional neural network (CNN) to automatically segment total metabolic tumour volume (TMTV) in large datasets of patients with diffuse large B cell lymphoma (DLBCL). METHODS The dataset contained pre-therapy FDG-PET/CT from 733 DLBCL patients of 2 prospective LYmphoma Study Association (LYSA) trials. The first cohort (n = 639) was used for training using a 5-fold cross validation scheme. The second cohort (n = 94) was used for external validation of TMTV predictions. Ground truth masks were manually obtained after a 41% SUVmax adaptive thresholding of lymphoma lesions. A 3D U-net architecture with 2 input channels for PET and CT was trained on patches randomly sampled within PET/CTs with a summed cross entropy and Dice similarity coefficient (DSC) loss. Segmentation performance was assessed by the DSC and Jaccard coefficients. Finally, TMTV predictions were validated on the second independent cohort. RESULTS Mean DSC and Jaccard coefficients (± standard deviation) in the validations set were 0.73 ± 0.20 and 0.68 ± 0.21, respectively. An underestimation of mean TMTV by - 12 mL (2.8%) ± 263 was found in the validation sets of the first cohort (P = 0.27). In the second cohort, an underestimation of mean TMTV by - 116 mL (20.8%) ± 425 was statistically significant (P = 0.01). CONCLUSION Our CNN is a promising tool for automatic detection and segmentation of lymphoma lesions, despite slight underestimation of TMTV. The fully automatic and open-source features of this CNN will allow to increase both dissemination in routine practice and reproducibility of TMTV assessment in lymphoma patients.
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Affiliation(s)
- Paul Blanc-Durand
- Department of Nuclear Medicine, CHU H. Mondor, AP-HP, F-94010, Créteil, France. .,LYmphoma Study Association (LYSA), Pierre-Bénite, France. .,INSERM IMRB Team 8, U-PEC, F-94000, Créteil, France. .,INRIA Epione Team, Sophia Antipolis, France. .,Service de Médecine Nucléaire, CHU Henri Mondor, 51 ave. Du Mal de Lattre de Tassigny, 94010, Créteil, France.
| | | | - Salim Kanoun
- LYmphoma Study Association (LYSA), Pierre-Bénite, France.,Department of Nuclear Medicine, Institut C. Regaud, F-31000, Toulouse, France
| | - Alina Berriolo-Riedinger
- LYmphoma Study Association (LYSA), Pierre-Bénite, France.,Department of Nuclear Medicine, Centre G.-F. Leclerc, F-21000, Dijon, France
| | - Caroline Bodet-Milin
- LYmphoma Study Association (LYSA), Pierre-Bénite, France.,Department of Nuclear Medicine, CHU de Nantes, F-44000, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Françoise Kraeber-Bodéré
- LYmphoma Study Association (LYSA), Pierre-Bénite, France.,Department of Nuclear Medicine, CHU de Nantes, F-44000, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Thomas Carlier
- LYmphoma Study Association (LYSA), Pierre-Bénite, France.,Department of Nuclear Medicine, CHU de Nantes, F-44000, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Steven Le Gouill
- LYmphoma Study Association (LYSA), Pierre-Bénite, France.,Department of Hematology, CHU de Nantes, F-44000, Nantes, France
| | - René-Olivier Casasnovas
- LYmphoma Study Association (LYSA), Pierre-Bénite, France.,Department of Hematology, CHU Le Bocage, F-21000, Dijon, France
| | - Michel Meignan
- LYmphoma Study Association (LYSA), Pierre-Bénite, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, CHU H. Mondor, AP-HP, F-94010, Créteil, France.,LYmphoma Study Association (LYSA), Pierre-Bénite, France.,INSERM IMRB Team 8, U-PEC, F-94000, Créteil, France
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Bailly C, Carlier T, Berriolo-Riedinger A, Casasnovas O, Gyan E, Meignan M, Moreau A, Burroni B, Djaileb L, Gressin R, Devillers A, Lamy T, Thieblemont C, Hermine O, Kraeber-Bodéré F, Le Gouill S, Bodet-Milin C. Prognostic value of FDG-PET in patients with mantle cell lymphoma: results from the LyMa-PET Project. Haematologica 2019; 105:e33-e36. [PMID: 31371411 DOI: 10.3324/haematol.2019.223016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Clément Bailly
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes.,Department of Nuclear Medicine, CHU Nantes, Nantes
| | - Thomas Carlier
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes.,Department of Nuclear Medicine, CHU Nantes, Nantes
| | | | | | | | | | | | | | - Loïc Djaileb
- Department of Nuclear Medicine, CHU Grenoble-Alpes, Grenoble
| | - Remy Gressin
- Onco Hematology Department, Hospital University Grenoble, La Tronche, Grenoble
| | | | - Thierry Lamy
- Department of Hematology, CHU Rennes.,Inserm U1236, University of Rennes, Rennes
| | | | - Olivier Hermine
- Department of Hematology, CHU Paris - Hôpital Necker-Enfants Malades, Paris
| | - Françoise Kraeber-Bodéré
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes.,Department of Nuclear Medicine, CHU Nantes, Nantes.,Department of Nuclear Medicine, ICO-René Gauducheau, Saint-Herblain
| | - Steven Le Gouill
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes .,Department of Hematology, CHU Nantes, Nantes, France
| | - Caroline Bodet-Milin
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes.,Department of Nuclear Medicine, CHU Nantes, Nantes
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9
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Casasnovas RO, Bouabdallah R, Brice P, Lazarovici J, Ghesquieres H, Stamatoullas A, Dupuis J, Gac AC, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Feugier P, Morschhauser F, Delarue R, Farhat H, Quittet P, Berriolo-Riedinger A, Tempescul A, Edeline V, Maisonneuve H, Fornecker LM, Lamy T, Delmer A, Dartigues P, Martin L, André M, Mounier N, Traverse-Glehen A, Meignan M. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol 2019; 20:202-215. [DOI: 10.1016/s1470-2045(18)30784-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022]
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Berriolo-Riedinger A, Becker S, Casasnovas O, Vander Borght T, Édeline V. Role of FDG PET-CT in the treatment management of Hodgkin lymphoma. Cancer Radiother 2018; 22:393-400. [PMID: 30033076 DOI: 10.1016/j.canrad.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 12/29/2022]
Abstract
Fluorodeoxyglucose (FDG) positons emission tomography (PET)-computed tomography (CT) is used in many ways at baseline and during the treatment of patients with Hodgkin lymphoma. Many properties of the technique are used in the different steps of patient's management. Initial staging with PET-CT is more accurate than conventional imaging and PET-CT also became the gold standard imaging at the end of treatment with a negative PET-CT mandatory for reaching a complete remission. Early assessment of response by PET-CT is one of the most powerful prognostic factors for progression-free survival of patients with localized and advanced stages and allows guiding treatment. Conversely, previous studies showed that there is no role of FDG PET-CT for the patient's follow-up.
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Affiliation(s)
- A Berriolo-Riedinger
- Department of Nuclear Medicine, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France
| | - S Becker
- Department of Nuclear Medicine, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - O Casasnovas
- Department of Hematology, CHU F.-Mitterrand, 21000 Dijon, France; Inserm, UMR 1231, 21000 Dijon, France
| | - T Vander Borght
- Department Nuclear Medicine, CHU UCL Namur, site de Godinne, rue Dr-Gaston-Thérasse 1, 5530 Yvoir, Belgium; Namur Research Institute in Life Sciences (Narilis), rue de Bruxelles 61, 5000 Namur, Belgium
| | - V Édeline
- Department of Nuclear Medicine, hôpital René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France.
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11
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Casasnovas O, Brice P, Bouabdallah R, Salles GA, Stamatoulas A, Dupuis J, Reman O, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Feugier P, Morschhauser F, Delarue R, Berriolo-Riedinger A, Edeline V, Traverse-Glehen A, Andre M, Mounier N, Meignan M. Randomized phase III study comparing an early PET driven treatment de-escalation to a not PET-monitored strategy in patients with advanced stages Hodgkin lymphoma: Final analysis of the AHL2011 LYSA study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Pauline Brice
- AP-HP at Saint-Louis Hospital, Paris Diderot- Sorbonne University, Paris, France
| | | | | | | | - Jehan Dupuis
- Department of Hematology, CHU Henri Mondor, Creteil, France
| | - Oumedaly Reman
- Department of Hematology, Centre Hospitalier Universitaire Caen, Caen, France
| | | | - Bertrand Joly
- Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Kamal Bouabdallah
- Department of Haematology, University Hospital of Bordeaux, Bordeaux, France
| | | | | | - Franck Morschhauser
- Department of Clinical Hematology, Centre Hospitalier Regional Universitaire (CHRU) de Lille, and Unite Groupe de Recherche sur les Formes Injetables et les Technologies Associees (GRITA), Universite de Lille 2, Lille, France
| | | | | | | | | | - Marc Andre
- Université catholique de Louvain, CHU UCL Namur, Department of Hematology, Yvoir, Belgium
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12
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Kanoun S, Cottereau AS, Berriolo-Riedinger A, Meignan M, Casasnovas O, Courbon F, Kraeber-Bodéré F. Staging, Restaging, and Treatment Response Assessment in Lymphomas: What We Should Know. J Nucl Med 2017; 59:714-715. [DOI: 10.2967/jnumed.117.205351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Meignan M, Cottereau AS, Deau B, Kanoun S, Berriolo-Riedinger A, Casasnovas O. Interim PET in Hodgkin Lymphoma: Is It So Useless? J Nucl Med 2017; 58:1180. [PMID: 28254870 DOI: 10.2967/jnumed.117.190462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Michel Meignan
- Hospital Henri Mondor 51, avenue du Marechal de Lattre de Tassigny Creteil, 94010, France E-mail:
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14
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Casasnovas RO, Kanoun S, Tal I, Cottereau AS, Edeline V, Brice P, Bouabdallah R, Salles GA, Stamatoullas A, Dupuis J, Reman O, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Andre M, Mounier N, Ferme C, Meignan M, Berriolo-Riedinger A. Baseline total metabolic volume (TMTV) to predict the outcome of patients with advanced Hodgkin lymphoma (HL) enrolled in the AHL2011 LYSA trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7509] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Salim Kanoun
- Department of Nuclear Medicine, Centre G.F. Leclerc, Dijon, France
| | - Ilan Tal
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Pauline Brice
- AP-HP at Saint-Louis Hospital, Paris Diderot- Sorbonne University, Paris, France
| | | | | | | | | | | | | | - Bertrand Joly
- Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | | | | | - Marc Andre
- Centre Hospitalier Universitaire Mont-Godinne, Dinant, Belgium
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15
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Humbert O, Riedinger JM, Vrigneaud JM, Kanoun S, Dygai-Cochet I, Berriolo-Riedinger A, Toubeau M, Depardon E, Lassere M, Tisserand S, Fumoleau P, Brunotte F, Cochet A. 18F-FDG PET-Derived Tumor Blood Flow Changes After 1 Cycle of Neoadjuvant Chemotherapy Predicts Outcome in Triple-Negative Breast Cancer. J Nucl Med 2016; 57:1707-1712. [PMID: 27103025 DOI: 10.2967/jnumed.116.172759] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/14/2016] [Indexed: 12/20/2022] Open
Abstract
Previous studies have suggested that early changes in blood flow (BF) in response to neoadjuvant chemotherapy and evaluated with 15O-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 (ΔBF) in response to chemotherapy, assessed using a short dynamic 18F-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 18F-FDG PET examination with a 2-min chest-centered dynamic acquisition, started at the time of 18F-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 ΔBF. Delayed static PET acquisitions were also performed (90 min after 18F-FDG injection) to measure changes in tumor glucose metabolism (ΔSUVmax). 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 ∆BF was -30%, with highly scattered values (range, -93% to +118%). A weak correlation was observed between ΔBF and ∆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 (ΔBF cutoff = -30%; P = 0.03), non-breast-conserving surgery (P = 0.04), and the absence of a pathologic complete response (pCR) (P = 0.01). ΔBF 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 (ΔBF 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 ΔBF to neoadjuvant chemotherapy using 18F-FDG PET/CT. Monitoring tumor perfusion and angiogenesis response to treatment seems to be a promising target for PET tracers.
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Affiliation(s)
- Olivier Humbert
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France .,LE2I UMR 6306, CNRS, Arts et Métiers, Université de Bourgogne Franche-Comté, Besançon, France
| | - Jean-Marc Riedinger
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France.,Departments of Biology and Pathology, Centre GF Leclerc, Dijon, France
| | - Jean-Marc Vrigneaud
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France.,LE2I UMR 6306, CNRS, Arts et Métiers, Université de Bourgogne Franche-Comté, Besançon, France
| | - Salim Kanoun
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France.,LE2I UMR 6306, CNRS, Arts et Métiers, Université de Bourgogne Franche-Comté, Besançon, France.,Imaging Department, CHU Le Bocage, Dijon, France; and
| | | | | | - Michel Toubeau
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
| | - Edouard Depardon
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
| | - Maud Lassere
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
| | - Simon Tisserand
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
| | - Pierre Fumoleau
- Department of Medical Oncology, Centre GF Leclerc, Dijon, France
| | - François Brunotte
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France.,LE2I UMR 6306, CNRS, Arts et Métiers, Université de Bourgogne Franche-Comté, Besançon, France.,Imaging Department, CHU Le Bocage, Dijon, France; and
| | - Alexandre Cochet
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France.,LE2I UMR 6306, CNRS, Arts et Métiers, Université de Bourgogne Franche-Comté, Besançon, France.,Imaging Department, CHU Le Bocage, Dijon, France; and
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Humbert O, Riedinger JM, Charon-Barra C, Berriolo-Riedinger A, Desmoulins I, Lorgis V, Kanoun S, Coutant C, Fumoleau P, Cochet A, Brunotte F. Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer. Clin Cancer Res 2015; 21:5460-8. [DOI: 10.1158/1078-0432.ccr-15-0384] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/23/2015] [Indexed: 12/31/2022]
Abstract
Abstract
Purpose: To investigate the value of the metabolic tumor response assessed with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), compared with clinicobiologic markers to predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in women with triple-negative breast cancer (TNBC).
Experimental Design: Fifty consecutive women with TNBC and an indication for NAC were prospectively included. Different pretreatment clinical, biologic, and pathologic biomarkers, including SBR grade, the Ki-67 proliferation index, androgen receptor expression, EGF receptor (EGFR), and cytokeratin 5/6 staining, were assessed. Tumor glucose metabolism at baseline and its change after the first cycle of NAC (ΔSUVmax) were assessed using FDG-PET.
Results: The pCR rate was 42%. High Ki-67 proliferation index (P = 0.016), negative EGFR status (P = 0.042), and high ΔSUVmax (P = 0.002) were significantly associated with pCR. In multivariate logistic regression, both negative EGFR status (OR, 6.4; P = 0.043) and high ΔSUVmax (OR, 7.1; P = 0.014) were independent predictors of pCR. Using a threshold at −50%, tumor ΔSUVmax predicted pCR with a negative, a positive predictive value, and an accuracy of 79%, 70%, and 75%, respectively. Combining a low ΔSUVmax and positive EGFR status could predict non-pCR with an accuracy of 92%.
Conclusions: It is important to define the chemosensitivity of TNBC to NAC early. Combining EGFR status and the metabolic response assessed with FDG-PET can help the physician to early predict the probability of achieving pCR or not. Given these results, the interest of response-guided tailoring of the chemotherapy might be tested in multicenter trials. Clin Cancer Res; 21(24); 5460–8. ©2015 AACR.
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Affiliation(s)
- Olivier Humbert
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 2Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Jean-Marc Riedinger
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 3Departments of Biology and Pathology, Centre GF Leclerc, Dijon, France
| | | | | | | | - Véronique Lorgis
- 4Department of Medical Oncology, Centre GF Leclerc, Dijon, France
| | - Salim Kanoun
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 2Université de Bourgogne, UMR CNRS 6306, Dijon, France
- 5Imaging Department, CHU Le Bocage, Dijon, France
| | | | - Pierre Fumoleau
- 4Department of Medical Oncology, Centre GF Leclerc, Dijon, France
| | - Alexandre Cochet
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 2Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - François Brunotte
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 2Université de Bourgogne, UMR CNRS 6306, Dijon, France
- 5Imaging Department, CHU Le Bocage, Dijon, France
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Kanoun S, Tal I, Berriolo-Riedinger A, Rossi C, Riedinger JM, Vrigneaud JM, Legrand L, Humbert O, Casasnovas O, Brunotte F, Cochet A. Influence of Software Tool and Methodological Aspects of Total Metabolic Tumor Volume Calculation on Baseline [18F]FDG PET to Predict Survival in Hodgkin Lymphoma. PLoS One 2015; 10:e0140830. [PMID: 26473950 PMCID: PMC4608733 DOI: 10.1371/journal.pone.0140830] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/29/2015] [Indexed: 11/19/2022] Open
Abstract
AIM To investigate the respective influence of software tool and total metabolic tumor volume (TMTV0) calculation method on prognostic stratification of baseline 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography ([18F]FDG-PET) in newly diagnosed Hodgkin lymphoma (HL). METHODS 59 patients with newly diagnosed HL were retrospectively included. [18F]FDG-PET was performed before any treatment. Four sets of TMTV0 were calculated with Beth Israel (BI) software: based on an absolute threshold selecting voxel with standardized uptake value (SUV) >2.5 (TMTV02.5), applying a per-lesion threshold of 41% of the SUV max (TMTV041) and using a per-patient adapted threshold based on SUV max of the liver (>125% and >140% of SUV max of the liver background; TMTV0125 and TMTV0140). TMTV041 was also determined with commercial software for comparison of software tools. ROC curves were used to determine the optimal threshold for each TMTV0 to predict treatment failure. RESULTS Median follow-up was 39 months. There was an excellent correlation between TMTV041 determined with BI and with the commercial software (r = 0.96, p<0.0001). The median TMTV0 value for TMTV041, TMTV02.5, TMTV0125 and TMTV0140 were respectively 160 (used as reference), 210 ([28;154] p = 0.005), 183 ([-4;114] p = 0.06) and 143 ml ([-58;64] p = 0.9). The respective optimal TMTV0 threshold and area under curve (AUC) for prediction of progression free survival (PFS) were respectively: 313 ml and 0.70, 432 ml and 0.68, 450 ml and 0.68, 330 ml and 0.68. There was no significant difference between ROC curves. High TMTV0 value was predictive of poor PFS in all methodologies: 4-years PFS was 83% vs 42% (p = 0.006) for TMTV02.5, 83% vs 41% (p = 0.003) for TMTV041, 85% vs 40% (p<0.001) for TMTV0125 and 83% vs 42% (p = 0.004) for TMTV0140. CONCLUSION In newly diagnosed HL, baseline metabolic tumor volume values were significantly influenced by the choice of the method used for determination of volume. However, no significant differences were found in term of prognosis.
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Affiliation(s)
- Salim Kanoun
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
- Le2i UMR CNRS 6306, Dijon, France
- MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital Le Bocage, Dijon, France
- * E-mail:
| | - Ilan Tal
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | | | - Cédric Rossi
- Department of Clinical Hematology, Centre Hospitalier Régional Universitaire, Hôpital Le Bocage, Dijon, France
| | - Jean-Marc Riedinger
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
| | - Jean-Marc Vrigneaud
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
| | | | - Olivier Humbert
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
- Le2i UMR CNRS 6306, Dijon, France
| | - Olivier Casasnovas
- Department of Clinical Hematology, Centre Hospitalier Régional Universitaire, Hôpital Le Bocage, Dijon, France
- Inserm U866, Labex team, Faculté de Médecine, Université de Bourgogne, Dijon, France
| | - François Brunotte
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
- Le2i UMR CNRS 6306, Dijon, France
- MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital Le Bocage, Dijon, France
| | - Alexandre Cochet
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
- Le2i UMR CNRS 6306, Dijon, France
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Mazeron R, Gonzague-Casabianca L, Peignaux K, Isnardi V, Remouchamps V, Van der Borght T, Chira C, Berriolo-Riedinger A, Lazarovici J, Edeline V. Techniques de radiothérapie des lymphomes de Hodgkin localisés de l’adulte : résultats d’une enquête nationale. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Humbert O, Cochet A, Coudert B, Berriolo-Riedinger A, Kanoun S, Brunotte F, Fumoleau P. Role of positron emission tomography for the monitoring of response to therapy in breast cancer. Oncologist 2015; 20:94-104. [PMID: 25561512 DOI: 10.1634/theoncologist.2014-0342] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This review considers the potential utility of positron emission tomography (PET) tracers in the setting of response monitoring in breast cancer, with a special emphasis on glucose metabolic changes assessed with (18)F-fluorodeoxyglucose (FDG). In the neoadjuvant setting of breast cancer, the metabolic response can predict the final complete pathologic response after the first cycles of chemotherapy. Because tumor metabolic behavior highly depends on cancer subtype, studies are ongoing to define the optimal metabolic criteria of tumor response in each subtype. The recent multicentric randomized AVATAXHER trial has suggested, in the human epidermal growth factor 2-positive subtype, a clinical benefit of early tailoring the neoadjuvant treatment in women with poor metabolic response after the first course of treatment. In the bone-dominant metastatic setting, there is increasing clinical evidence that FDG-PET/computed tomography (CT) is the most accurate imaging modality for assessment of the tumor response to treatment when both metabolic information and morphologic information are considered. Nevertheless, there is a need to define standardized metabolic criteria of response, including the heterogeneity of response among metastases, and to evaluate the costs and health outcome of FDG-PET/CT compared with conventional imaging. New non-FDG radiotracers highlighting specific molecular hallmarks of breast cancer cells have recently emerged in preclinical and clinical studies. These biomarkers can take into account the heterogeneity of tumor biology in metastatic lesions. They may provide valuable clinical information for physicians to select and monitor the effectiveness of novel therapeutics targeting the same molecular pathways of breast tumor.
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Affiliation(s)
- Olivier Humbert
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Alexandre Cochet
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Bruno Coudert
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Alina Berriolo-Riedinger
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Salim Kanoun
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - François Brunotte
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Pierre Fumoleau
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
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Coudert B, Pierga JY, Mouret-Reynier MA, Kerrou K, Ferrero JM, Petit T, Kerbrat P, Dupré PF, Bachelot T, Gabelle P, Giard S, Coeffic D, Bougnoux P, Prevost JB, Paintaud G, Thibault G, Hernandez J, Coudert M, Arnould L, Berriolo-Riedinger A. Use of [(18)F]-FDG PET to predict response to neoadjuvant trastuzumab and docetaxel in patients with HER2-positive breast cancer, and addition of bevacizumab to neoadjuvant trastuzumab and docetaxel in [(18)F]-FDG PET-predicted non-responders (AVATAXHER): an open-label, randomised phase 2 trial. Lancet Oncol 2014; 15:1493-1502. [PMID: 25456368 DOI: 10.1016/s1470-2045(14)70475-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND An effective and well tolerated treatment is needed for patients with early HER2-positive breast cancer who do not achieve a pathological complete response after neoadjuvant therapy. The AVATAXHER trial aimed to predict pathological complete response early with the use of PET and to investigate whether the addition of bevacizumab could improve the proportion of patients achieving a pathological complete response in patients unlikely to respond to treatment. METHODS AVATAXHER was a randomised, open-label, non-comparative, multicentre phase 2 study that enrolled women (≥18 years of age) with early-stage HER2-positive breast cancer from 26 oncology centres in France. Patients initially received two cycles of neoadjuvant docetaxel (100 mg/m(2) intravenously every 3 weeks) plus trastuzumab (8 mg/kg intravenously every 3 weeks then 6 mg/kg intravenously every 3 weeks for the second course). Before the first and second cycles, [(18)F]-fluorodeoxyglucose (FDG) PET was done and the change in standardised uptake value was used to predict pathological complete response in each patient. Patients who were predicted to be responders on PET continued to receive standard therapy. Predicted non-responders were randomly assigned (2:1) to receive four cycles of docetaxel (100 mg/m(2) intravenously every 3 weeks) and trastuzumab (6 mg/kg intravenously every 3 weeks) plus bevacizumab (15 mg/kg intravenously every 3 weeks; group A) or continue on docetaxel plus trastuzumab alone (group B). Randomisation was open label and was done by an adaptive minimisation method. Although investigators and patients were aware of group assignment, the anatomo-pathologist in charge of centralised review of surgical samples and lymph nodes was masked to treatment assignment. The primary endpoint was centrally assessed pathological complete response according to the Chevallier classification. Efficacy analyses were done in the intention-to-treat population. Safety analyses in this Article were done on all patients who received at least one dose of treatment starting from cycle 3. Survival outcomes are not yet mature. This study is registered with ClinicalTrials.gov (NCT01142778) and EUDRACT (2009-013410-26). FINDINGS Between May 19, 2010, and Oct 1, 2012, 152 patients were recruited for the study. Ten patients were subsequently excluded, leaving 142 patients in the intention-to-treat population. Of these 142 patients, 69 were predicted by [(18)F]-FDG PET to be treatment responders after two cycles of treatment. The 73 predicted non-responders were randomly assigned to group A (n=48) and group B (n=25). Pathological complete responses were noted in 37 (53·6%, 95% CI 41·2-65·7) of the PET responders, 21 (43·8%, 29·5-58·8) of those in group A, and six (24·0%, 9·4-45·1) of those in group B. Incidences of grade 3-4 adverse events were similar in all three groups. The most common grade 3-4 adverse events were neutropenia (four in PET responders, five in group A, and three in group B), febrile neutropenia (one, three, and one, respectively), and myalgia (four, none, and one, respectively). Overall, 24 serious adverse events were reported in 15 patients (PET responders: nine events in four [6%] of 67 patients; group A: 14 events in ten [21%] of 47 patients; group B: one event in one [4%] of 25 patients). No deaths occurred during the study. INTERPRETATION In patients with HER2-positive breast cancer, early PET assessment can help to identify non-responders to neoadjuvant docetaxel plus trastuzumab therapy. In these patients, the addition of bevacizumab can increase the proportion of patients achieving a pathological complete response. This potential new role for PET and the activity of bevacizumab in this setting need to be confirmed in larger phase 3 trials. FUNDING Roche France.
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Affiliation(s)
- Bruno Coudert
- Department of Medical Oncology, Centre Georges-Francois Leclerc, Dijon, France.
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris Descartes, Paris, France
| | | | - Kaldoun Kerrou
- Department of Nuclear Medicine, Hopital Tenon, Paris, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - Pierre Kerbrat
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Pierre-François Dupré
- Department of Medical Oncology, Centre Hospitalier Universitaire Augustin-Morvan, Brest, France
| | - Thomas Bachelot
- Department of Medical Oncology et Unité INSERM U590, Centre Léon Berard, Lyon, France
| | - Philippe Gabelle
- Department of Surgery, Institut Daniel Hollard, Grenoble, France
| | - Sylvia Giard
- Department of Surgery, Centre Oscar Lambret, Lille, France
| | - David Coeffic
- Department of Medical Oncology, Clinique Hartmann, Neuilly sur Seine, France
| | | | | | - Gilles Paintaud
- Université François-Rabelais de Tours, CNRS, GICC UMR 7292, CHRU de Tours, Laboratory of Pharmacology-Toxicology, Tours, France
| | | | | | | | - Laurent Arnould
- Department of Pathology, Centre Georges-Francois Leclerc, Dijon, France
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Trotman J, Luminari S, Boussetta S, Versari A, Dupuis J, Tychyj C, Marcheselli L, Berriolo-Riedinger A, Franceschetto A, Julian A, Ricard F, Guerra L, Haioun C, Biasoli I, Tilly H, Federico M, Salles G, Meignan M. Prognostic value of PET-CT after first-line therapy in patients with follicular lymphoma: a pooled analysis of central scan review in three multicentre studies. Lancet Haematol 2014; 1:e17-27. [PMID: 27030064 DOI: 10.1016/s2352-3026(14)70008-0] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The value of (18)F-fluorodeoxyglucose (FDG) PET-CT (PET) imaging in response assessment after first-line rituximab chemotherapy for follicular lymphoma has been documented. We analysed the application of the five-point Deauville scale (5PS; used to score FDG uptake on PET images) in a large cohort derived from three studies, to assess the correlation between post-induction PET status and survival in patients with follicular lymphoma. METHODS In this pooled analysis, we used data from three multicentre prospective studies of first-line rituximab chemotherapy for patients with high-tumour-burden follicular lymphoma (the PRIMA study, the PET-Folliculaire study, and the Fondazione Italiana Linfomi FOLL05 study). Patients included in this analysis received at least six cycles of rituximab and chemotherapy before response assessment with conventional contrast-enhanced CT and PET low-dose CT (PET). We included only patients who had a PET scan within 3 months of the last dose of induction rituximab. Patient data, including conventional CT-based response assessment, were recorded for all patients undergoing PET review. Scans undergoing central PET review were scored independently by three reviewers according to the 5PS. The primary endpoints were progression-free survival and overall survival according to the 5PS score of post-induction PET scan (ie, positive [≥4 points] or negative [<4 points]), analysed in the central review population. FINDINGS Between Dec 24, 2004, and Sept 22, 2010, 439 of the patients enrolled in the three studies underwent local PET assessment, 246 of whom had centrally reviewed post-induction scans. 41 (17%) of 246 patients had a positive post-induction PET scan according to a cutoff of 4 or higher on the 5PS, with substantial reporter concordance. With a median follow-up of 54·8 months (IQR 39·7-68·5; range 7·7-90·1), the hazard ratio (HR) for progression-free survival for patients with a positive PET scan versus those with a negative PET scan was 3·9 (95% CI 2·5-5·9; p<0·0001), and for overall survival was 6·7 (2·4-18·5; p=0·0002). For patients with a positive PET scan, 23·2% (95% CI 11·1-37·9) of patients were progression free at 4 years compared with 63·4% (55·9-70·0) of those who had a negative PET scan (p<0·0001); 4-year overall survival was 87·2% (95% CI 71·9-94·5) versus 97·1% (93·2-98·8), respectively (p<0·0001). Conventional CT-based response (ie, complete response or unconfirmed complete response vs partial response) was weakly predictive of progression-free survival (HR 1·7 [95% CI 1·1-2·5]; p=0·017). INTERPRETATION PET-CT rather than contrast-enhanced CT scanning should be considered as a new standard for response assessment of follicular lymphoma in clinical practice, and could help guide response-adapted therapy. FUNDING Groupe d'Etude des Lymphomes de l'Adulte (Paris, France), now LYSA (Lymphoma Study Association), Direction de la Recherche Clinique de l'Assistance Publique-Hôpitaux de Paris, Fondazione Italiana Linfomi, and the Italian Ministry of Health.
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Affiliation(s)
- Judith Trotman
- Haematology Department, Concord Hospital, University of Sydney, Sydney, NSW, Australia.
| | - Stefano Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sami Boussetta
- Department of Biostatistics, The Lymphoma Academic Research Organisation (LYSARC), Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Annibale Versari
- Nuclear Medicine Department, Santa Maria Nuova Hospital, IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Jehan Dupuis
- Unité Hémopathies Lymphoïdes, Hopital Henri Mondor, Creteil, France
| | - Christelle Tychyj
- Service de Médecine Nucléaire, Centre Hospitalier Alpes Léman, Contamine sur Arve, France
| | - Luigi Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonella Franceschetto
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Anne Julian
- Service de Médecine Nucléaire, Hôpital Perpan, Toulouse, France
| | - Fabien Ricard
- Service de Médecine Nucléaire, Hospices Civils de Lyon, Université Lyon 1, Pierre-Bénite, France
| | - Luca Guerra
- Nuclear Medicine Department, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Corinne Haioun
- Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor and Université Paris Est Créteil, Créteil, France
| | - Irene Biasoli
- Department of Medicine, University Hospital and School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hervé Tilly
- Département d'Hématologie, UMR918, Centre Henri Becquerel, Université de Rouen, Rouen, France
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gilles Salles
- Service d'Hématologie, Hospices Civils de Lyon, Université Lyon 1, Pierre-Bénite, France
| | - Michel Meignan
- Service de Médecine Nucléaire, Hôpital Henri Mondor and Université Paris Est Créteil, Créteil, France
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Sasanelli M, Meignan M, Haioun C, Berriolo-Riedinger A, Casasnovas RO, Biggi A, Gallamini A, Siegel BA, Cashen AF, Véra P, Tilly H, Versari A, Itti E. Pretherapy metabolic tumour volume is an independent predictor of outcome in patients with diffuse large B-cell lymphoma. Eur J Nucl Med Mol Imaging 2014; 41:2017-22. [DOI: 10.1007/s00259-014-2822-7] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/19/2014] [Indexed: 11/25/2022]
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Trotman J, Luminari S, Boussetta S, Versari A, Dupuis J, Tychyj-Pinel C, Marcheselli L, Berriolo-Riedinger A, Franceschetto A, Julian A, Ricard F, Guerra L, Haioun C, Biasoli I, Tilly H, Federico M, Salles GA, Meignan M. Prognostic value of PET-CT after frontline therapy in follicular lymphoma: A pooled analysis of central review in three multicenter studies. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Judith Trotman
- Concord Hospital, University of Sydney, Sydney, Australia
| | - Stefano Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | | - Luigi Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonella Franceschetto
- Nuclear medicine, Department of Diagnostic, Clinical and Public Health medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Luca Guerra
- Nuclear Medicine - PET, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Irene Biasoli
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Casasnovas RO, Ysebaert L, Thieblemont C, Coiffier B, Bologna S, Lepeu G, Delmer A, Plantier I, Gabarre J, Andre M, Senecal D, Fruchart C, Meignan M, Berriolo-Riedinger A, Bardet S, Molina TJ, Jais JP, Haioun C, Tilly H, Morschhauser F. Final results of a randomized phase II GELA/LYSA study of rituximab plus ACVBP or CHOP, using a PET-driven consolidation strategy, in patients with high-risk diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marc Andre
- Centre Hospitalier Universitaire Mont-Godinne, Dinant, Belgium
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Coudert BP, Pierga JY, Mouret-Reynier MA, Kerrou K, Ferrero JM, Petit T, Kerbrat P, Dupre PF, Bachelot TD, Gabelle P, Giard S, Coeffic D, Bougnoux P, Prevost JB, Paintaud G, Thibault G, Hernandez J, Coudert M, Arnould L, Berriolo-Riedinger A. AVATAXHER: An open-label, randomized, multicenter study investigating the addition of bevacizumab (B) to neoadjuvant trastuzumab (T) plus docetaxel (D) in patients with early stage HER2-positive breast cancer (HER2+ BC) stratified according to PET change after one therapy cycle. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bruno P. Coudert
- Department of Medical Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | | | | | - Khaldoun Kerrou
- Department of Nuclear Medicine, Hopital Tenon, Paris, France
| | - Jean-Marc Ferrero
- Centre Antoine Lacassagne, Department d'Oncologie Medicale, Nice, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | | | | | | | - Philippe Gabelle
- Department of Surgery, Institut Daniel Hollard, Grenoble, France
| | - Sylvia Giard
- Department of Surgery, Centre Oscar Lambret, Lille, France
| | - David Coeffic
- Department of Medical Oncology, Clinique Hartmann, Neuilly sur Seine, France
| | | | | | | | | | | | | | - Laurent Arnould
- Department of Pathology, Centre Georges-Francois Leclerc, Dijon, France
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Kanoun S, Rossi C, Berriolo-Riedinger A, Dygai-Cochet I, Cochet A, Humbert O, Toubeau M, Ferrant E, Brunotte F, Casasnovas RO. Baseline metabolic tumour volume is an independent prognostic factor in Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2014; 41:1735-43. [PMID: 24811577 DOI: 10.1007/s00259-014-2783-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/07/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE The presence of a bulky tumour at staging in Hodgkin lymphoma (HL) is a predictor of a poor outcome. The total metabolic tumour volume at baseline (TMTV0) computed on PET may improve the evaluation of tumour burden. To explore the clinical usefulness of TMTV0, we compared the prognostic value of TMTV0, tumour bulk and interim PET response in a retrospective single-centre study. METHODS From 2007 to 2010, 59 consecutive patients with a first diagnosis of HL were treated in our institution. PET was done at baseline (PET0) and after two cycles of chemotherapy (PET2), and treatment was not modified according to the PET2 result. TMTV0 was measured with a semiautomatic method using a 41 % SUVmax threshold. SUVmax reduction between PET0 and PET2 (ΔSUVmaxPET0-2) was also computed. Based on ROC analysis, patients with a ΔSUVmaxPET0-2 >71 % were considered good responders and a TMTV0 >225 ml was considered to represent hypermetabolic bulky disease. RESULTS Median TMTV0 was 117 ml and 17 patients (29 %) had a TMTV0 >225 ml. TMTV0 (>225 ml vs. ≤225 ml) and tumour bulk (<10 cm vs. ≥10 cm) were predictive of 4-year PFS: 42 % vs. 85 % (p = 0.001) and 44 % vs. 79 % (p < 0.03), respectively. In multivariate analysis, using ΔSUVmaxPET0-2, TMTV0 and bulky tumour as covariates, only ΔSUVmaxPET0-2 (p = 0.0005, RR 6.3) and TMTV0 (p < 0.006, RR 4.4) remained independent predictors of PFS. Three prognosis groups were thus identified: ΔSUVmaxPET0-2 >71 % and TMTV0 ≤225 ml (n = 37, 63 %), ΔSUVmaxPET0-2 = <71 % or TMTV0 >225 ml (n = 17, 29 %), and ΔSUVmaxPET0-2 = <71 % and TMTV0 >225 ml (n = 5, 8 %). In these three groups the 4-year PFS rates were 92 %, 49 %, and 20 % (p < 0.0001), respectively. CONCLUSION TMTV0 is more relevant than tumour bulk for predicting the outcome in patients with HL, and adds a significant prognostic insight to interim PET response assessment. The combination of TMTV0 and ΔSUVmaxPET0-2 made it possible to identify three subsets of HL patients with different outcomes. This may guide clinicians in their choice of therapeutic strategy.
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Affiliation(s)
- Salim Kanoun
- Médecine nucléaire, Centre G.F. Leclerc, Dijon, France
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Humbert O, Cochet A, Riedinger JM, Berriolo-Riedinger A, Arnould L, Coudert B, Desmoulins I, Toubeau M, Dygai-Cochet I, Guiu S, Coutant C, Fumoleau P, Brunotte F. HER2-positive breast cancer: ¹⁸F-FDG PET for early prediction of response to trastuzumab plus taxane-based neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging 2014; 41:1525-33. [PMID: 24647576 DOI: 10.1007/s00259-014-2739-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/17/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate the value of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET/CT) to predict a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. MATERIAL AND METHODS Fifty-seven consecutive women with HER2-positive breast cancer, treated with trastuzumab plus taxane-based NAC, were prospectively included. Maximum Standardized Uptake Value of the primary tumor and axillary nodes were measured at baseline (PET₁.SUVmax) and after the first course of NAC (PET₂.SUVmax). Tumor metabolic volumes were assessed to determine Total Lesion Glycolysis (TLG). The tumor metabolic response (ΔSUVmax and ΔTLG) was calculated. RESULTS In univariate analysis, negative hormonal receptor status (p = 0.04), high tumor grade (p = 0.03), and low tumor PET₂.SUVmax (p = 0.001) were predictive of pCR. Tumor ΔSUVmax correlated with pCR (p = 0.03), provided that tumors with low metabolic activity at baseline were excluded. ΔTLG did not correlate with pCR. In multivariate analysis, tumor PET₂.SUVmax < 2.1 was the best independent predictive factor (Odds ratio =14.3; p = 0.004) with both negative and positive predictive values of 76 %. Although the metabolic features of the primary tumor did not depend on hormonal receptor status, both the baseline metabolism and early response of axillary nodes were higher if estrogen receptors were not expressed (p = 0.01 and p = 0.03, respectively). CONCLUSION In HER2-positive breast cancer, very low tumor residual metabolism after the first cycle of NAC (SUVmax < 2.1) was the main predictor of pCR. These results should be further explored in multicenter studies and incorporated into the design of clinical trials.
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Affiliation(s)
- Olivier Humbert
- Department of Nuclear Medicine, Centre GF Leclerc, 1 rue du Pr Marion, 21000, Dijon, France,
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Rossi C, Kanoun S, Berriolo-Riedinger A, Dygai-Cochet I, Humbert O, Legouge C, Chrétien ML, Bastie JN, Brunotte F, Casasnovas RO. Interim 18F-FDG PET SUVmax Reduction Is Superior to Visual Analysis in Predicting Outcome Early in Hodgkin Lymphoma Patients. J Nucl Med 2014; 55:569-73. [DOI: 10.2967/jnumed.113.130609] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Couturier O, Rousseau C, Pierga JY, Berriolo-Riedinger A, Alberini JL, Girault S, Fumoleau P, Brain E, Abadie-Lacourtoisie S, Vera P, Liehn JC, Olivier P, Uwer L, Cachin F, Sagan C, Bouchet F, Lebas N, Mesleard C, Fourme E, Martin AL, Lovinfosse P, Lacœuille F, Campone M. Abstract P4-01-05: 3’-deoxy-3’-[18F]fluoro-thymidine (18F-FLT) positron emission tomography (PET): An accurate and effective tool for assessing tumor response in breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-01-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives : A French multicenter study was promoted by the national French cancer federation (Unicancer R&D) to assess the potential of [18F]FLT (positron emission tomography (PET) biomarker of proliferation)to manage breast cancer neoadjuvant chemotherapy (NAC). The main objective was to compare changes in tumor [18F]FLT uptake to histopathological changes induced by NAC, assuming an arrest of tumor growth related to the effectiveness of NAC.
Methods : 97 patients (age 48.6 +/- 10.2 y.) were included in 13 nuclear medicine centers. All patients were eligible to anthracycline-based NAC for a de novo unifocal breast cancer (ductal n = 84, lobular = 11, other type = 2; stage II n = 75, stage III n = 21 et stage IV n = 1). 90 patients underwent a baseline PET before the onset of NAC (PET1) and a final PET after the end of NAC and before surgery (PET3). PET acquisitions were performed 60±7min after FLT injection. SUVmax (maximum standardized uptake value), SUVpeak (1 cm3 ROI including pixel max) and SUV41 (isocontour 41% of pixel max) were computed. Changes in SUV on PET3 vs PET1 were analyzed in relation to histopathological findings at the end of NAC (Sataloff criteria).
Results : Tumor FLT uptake decreased markedly between TEP1 and TEP3 (SUVmax = 6.2±4.8 vs 1.3±1.2 respectively; SUVpeak = 4.6±3.2 vs 0.9±0.9; SUV41 = 3.6±2.8 vs 0.8±0.7). Total or near-total therapeutic effect (grade A) were obtained in 20 patients, more than 50% therapeutic effect but less than total or near-total effect (grade B) in 37 patients, less than 50% therapeutic effect but visible effect (grade C) in 22 patients, or no therapeutic effect (grade D) in 11 patients. SUVmax decreased dramatically (87.5%) to background levels in all patients with a complete response (grade A). Overall, changes in SUV differed depending on the type of histological response (p<0.01) i.e. SUVmax changes were more pronounced as pathological responses were good: 61% for grade D; 65.7% grade C and 69.8% grade B. The same results were obtained with the two other SUV types.
Conclusions : Pathologic response to NAC in breast cancer can be assessed accurately by FLT.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-05.
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Affiliation(s)
- O Couturier
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - C Rousseau
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - J-Y Pierga
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - A Berriolo-Riedinger
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - J-L Alberini
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - S Girault
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - P Fumoleau
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - E Brain
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - S Abadie-Lacourtoisie
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - P Vera
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - J-C Liehn
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - P Olivier
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - L Uwer
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - F Cachin
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - C Sagan
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - F Bouchet
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - N Lebas
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - C Mesleard
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - E Fourme
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - A-L Martin
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - P Lovinfosse
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - F Lacœuille
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - M Campone
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
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Humbert O, Berriolo-Riedinger A, Cochet A, Gauthier M, Charon-Barra C, Guiu S, Desmoulins I, Toubeau M, Dygai-Cochet I, Coutant C, Fumoleau P, Brunotte F. Prognostic relevance at 5 years of the early monitoring of neoadjuvant chemotherapy using (18)F-FDG PET in luminal HER2-negative breast cancer. Eur J Nucl Med Mol Imaging 2013; 41:416-27. [PMID: 24258007 DOI: 10.1007/s00259-013-2616-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The objective of this study was to evaluate, in the luminal human epidermal growth factor receptor 2 (HER2)-negative breast cancer subtype, the prognostic value of tumour glucose metabolism at baseline and of its early changes during neoadjuvant chemotherapy (NAC). METHODS This prospective study included 61 women with hormone-sensitive HER2-negative breast cancer treated with NAC. (18)F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) was performed at baseline. Hepatic activity was used as a reference to distinguish between low metabolic and hypermetabolic tumours. In hypermetabolic tumours, a PET exam was repeated after the first course of NAC. The relative change in the maximum standardized uptake value of the tumour (∆SUV) was calculated. RESULTS Nineteen women had low metabolic luminal breast cancers at baseline, correlated with low proliferation indexes. Forty-two women had hypermetabolic tumours, corresponding to more proliferative breast cancers with higher Ki-67 expression (p = 0.017) and higher grade (p = 0.04). The median follow-up period was 64.2 months (range 11.5-93.2). Thirteen women developed recurrent disease, nine of whom died. Worse overall survival was associated with larger tumour size [>5 cm, hazard ratio (HR) = 6.52, p = 0.009] and with hypermetabolic tumours achieving a low metabolic response after one cycle of NAC (ΔSUV < 16%, HR = 10.63, p = 0.004). Five-year overall survival in these poor responder patients was 49.2%. Overall survival in women with low metabolic tumours or hypermetabolic/good response tumours was 100 and 96.15%, respectively. CONCLUSION In luminal HER2-negative breast tumours, tumour metabolism at baseline and changes after the first course of NAC are early surrogate markers of patients' survival. A subgroup of women with hypermetabolic/poorly responding tumours, correlated with poor prognosis at 5 years, can be identified early. These results may guide future studies by tailoring the NAC regimen to the metabolic response.
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Affiliation(s)
- Olivier Humbert
- Department of Nuclear Medicine, Centre GF Leclerc, 1 rue du Pr Marion, 21000, Dijon, France,
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Cochet A, Dygai-Cochet I, Riedinger JM, Humbert O, Berriolo-Riedinger A, Toubeau M, Guiu S, Coutant C, Coudert B, Fumoleau P, Brunotte F. ¹⁸F-FDG PET/CT provides powerful prognostic stratification in the primary staging of large breast cancer when compared with conventional explorations. Eur J Nucl Med Mol Imaging 2013; 41:428-37. [PMID: 24196916 DOI: 10.1007/s00259-013-2595-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/01/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this study was to assess the impact on management and the prognostic value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for initial staging of newly diagnosed large breast cancer (BC) when compared with conventional staging. METHODS We prospectively included 142 patients with newly diagnosed BC and at least grade T2 tumour. All patients were evaluated with complete conventional imaging (CI) procedures (mammogram and/or breast ultrasound, bone scan, abdominal ultrasound and/or CT, X-rays and/or CT of the chest), followed by FDG PET/CT exploration, prior to treatment. The treatment plan based on CI staging was compared with that based on PET/CT findings. CI and PET/CT findings were confirmed by imaging and clinical follow-up and/or pathology when assessable. Progression-free survival (PFS) was analysed using the Cox proportional hazards regression model. RESULTS According to CI staging, 79 patients (56%) were stage II, 46 (32%) stage III and 17 (12%) stage IV (distant metastases). Of the patients, 30 (21%) were upstaged by PET/CT, including 12 (8%) from stage II or III to stage IV. On the other hand, 23 patients (16%) were downstaged by PET/CT, including 4 (3%) from stage IV to stage II or III. PET/CT had a high or medium impact on management planning for 18 patients (13%). Median follow-up was 30 months (range 9-59 months); 37 patients (26%) experienced recurrence or progression of disease during follow-up and 17 patients (12%) died. The Cox model indicated that CI staging was significantly associated with PFS (p = 0.01), but PET/CT staging provided stronger prognostic stratification (p < 0.0001). Moreover, Cox regression multivariate analysis showed that only PET/CT staging remained associated with PFS (p < 0.0001). CONCLUSION FDG PET/CT provides staging information that more accurately stratifies prognostic risk in newly diagnosed large BC when compared with conventional explorations alone.
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Affiliation(s)
- Alexandre Cochet
- Department of Nuclear Medicine, Centre Georges-François Leclerc, 1 rue Professeur Marion, 21079, Dijon Cedex, France,
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Thureau S, Chaumet-Riffaud P, Modzelewski R, Fernandez P, Tessonnier L, Vervueren L, Cachin F, Berriolo-Riedinger A, Olivier P, Kolesnikov-Gauthier H, Blagosklonov O, Bridji B, Devillers A, Collombier L, Courbon F, Gremillet E, Houzard C, Caignon JM, Roux J, Aide N, Brenot-Rossi I, Doyeux K, Dubray B, Vera P. Interobserver agreement of qualitative analysis and tumor delineation of 18F-fluoromisonidazole and 3'-deoxy-3'-18F-fluorothymidine PET images in lung cancer. J Nucl Med 2013; 54:1543-50. [PMID: 23918733 DOI: 10.2967/jnumed.112.118083] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
UNLABELLED As the preparation phase of a multicenter clinical trial using (18)F-fluoro-2-deoxy-d-glucose ((18)F-FDG), (18)F-fluoromisonidazole ((18)F-FMISO), and 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) in non-small cell lung cancer (NSCLC) patients, we investigated whether 18 nuclear medicine centers would score tracer uptake intensity similarly and define hypoxic and proliferative volumes for 1 patient and we compared different segmentation methods. METHODS Ten (18)F-FDG, ten (18)F-FMISO, and ten (18)F-FLT PET/CT examinations were performed before and during curative-intent radiotherapy in 5 patients with NSCLC. The gold standards for uptake intensity and volume delineation were defined by experts. The between-center agreement (18 nuclear medicine departments connected with a dedicated network, SFMN-net [French Society of Nuclear Medicine]) in the scoring of uptake intensity (5-level scale, then divided into 2 levels: 0, normal; 1, abnormal) was quantified by κ-coefficients (κ). The volumes defined by different physicians were compared by overlap and κ. The uptake areas were delineated with 22 different methods of segmentation, based on fixed or adaptive thresholds of standardized uptake value (SUV). RESULTS For uptake intensity, the κ values between centers were, respectively, 0.59 for (18)F-FDG, 0.43 for (18)F-FMISO, and 0.44 for (18)F-FLT using the 5-level scale; the values were 0.81 for (18)F-FDG and 0.77 for both (18)F-FMISO and (18)F-FLT using the 2-level scale. The mean overlap and mean κ between observers were 0.13 and 0.19, respectively, for (18)F-FMISO and 0.2 and 0.3, respectively, for (18)F-FLT. The segmentation methods yielded significantly different volumes for (18)F-FMISO and (18)F-FLT (P < 0.001). In comparison with physicians, the best method found was 1.5 × maximum SUV (SUVmax) of the aorta for (18)F-FMISO and 1.3 × SUVmax of the muscle for (18)F-FLT. The methods using the SUV of 1.4 and the method using 1.5 × the SUVmax of the aorta could be used for (18)F-FMISO and (18)F-FLT. Moreover, for (18)F-FLT, 2 other methods (adaptive threshold based on 1.5 or 1.6 × muscle SUVmax) could be used. CONCLUSION The reproducibility of the visual analyses of (18)F-FMISO and (18)F-FLT PET/CT images was demonstrated using a 2-level scale across 18 centers, but the interobserver agreement was low for the (18)F-FMISO and (18)F-FLT volume measurements. Our data support the use of a fixed threshold (1.4) or an adaptive threshold using the aorta background to delineate the volume of increased (18)F-FMISO or (18)F-FLT uptake. With respect to the low tumor-on-background ratio of these tracers, we suggest the use of a fixed threshold (1.4).
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Affiliation(s)
- Sébastien Thureau
- Nuclear Medicine and Radiotherapy, Henri Becquerel Cancer Center and Rouen University Hospital, and QuantIF-LITIS (EA [Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, Rouen, France
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Casasnovas RO, Meignan M, Reman O, Gaillard I, Stamatoullas A, Brice P, Salles GA, Bouabdallah R, Bologna S, Nicolas-Virelizier E, Morschhauser F, Janvier M, Andre M, Berriolo-Riedinger A, Traverse-Glehen A, Edeline V, Dartigues P, Parrens M, Mounier N, Ferme C. AHL 2011: A Lysa randomized phase III study of a treatment driven by early PET response compared to a standard treatment in patients with Ann Arbor stage III-IV or high-risk IIB Hodgkin lymphoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps8615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8615 Background: ABVD is the most widely chemotherapy regimen used as standard treatment of advanced Hodgkin lymphoma (HL). The escalated BEACOPP (BEAesc) regimen which delivers more drugs at higher dose intensity was shown to improve patient’s PFS but not OS when compared to ABVD (Federico M, 2009; Viviani S, 2011; Carde P, 2012). The better efficiency of BEAesc is associated to a marked immediate hematologic toxicity and a higher risk of secondary myelodysplasia/leukemia. Also, the gonadal toxicity which is a real concern in young women, is quite higher when using BEAesc. So, to better manage HL treatment we need to identify early responding patients able to benefit from a strategy of dose intensity decrease after upfront BEAesc, without impairing the disease control. PET performed after 2 cycles of chemotherapy (PET2) might identify such a population suitable for receiving ABVD after 2 cycles of upfront BEAesc, and was implemented in the present study. Methods: The AHL 2011 trial (NCT01358747) was designed to test in 16 to 60 years old HL patients with Ann Arbor stage III, IV or high risk IIB, a treatment strategy driven by PET after 2 cycles of BEACOPPesc, delivering 4 cycles of ABVD for PET2 negative patients and 4 cycles of BEAesc for PET2 positive patients, compared to a treatment not monitored by PET, delivering the best BEAesc schedule consisting in 6 cycles of this regimen (Engert A, 2012). A baseline PET is mandatory before treatment and PET2 are centrally reviewed within 48 hours and interpreted according to Deauville criteria. The allocation of treatment in the experimental arm is based on the PET2 central review result. PFS is the primary endpoint of the study with an hypothesis of non-inferiority of the experimental arm with a margin of 10% (85% 5y-PFS in the control arm vs >75% in the experimental arm). With a 6-year of accrual period, inclusion of 405 patients in each arm would have 80% power to detect a HR of 1.77 using a one-sided log rank test with significance level of 0.025. The trial started in May 2011 and to date, 385 patients have been enrolled. The DSMC reviewed the trial in November 2012 and suggested that the trial continue as planned. Clinical trial information: NCT01358747.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Marc Andre
- Centre Hospitalier Universitaire Mont-Godinne, Dinant, Belgium
| | | | | | | | | | - Marie Parrens
- Centre Hospitalier Universitaire, Bordeaux, Bordeaux, France
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Humbert O, Berriolo-Riedinger A, Cochet A, Gauthier M, Charon-Barra C, Desmoulins I, Guiu S, Toubeau M, Dygai-Cochet I, Coutant C, Fumoleau P, Brunotte F. Prognostic relevance at 5 years of the early monitoring of neoadjuvant chemotherapy using FDG PET in luminal HER2-negative breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.11007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11007 Background: To evaluate, in the luminal breast cancer subtype, the prognostic value of tumor glucose metabolism at baseline and of its changes after one cycle of neoadjuvant chemotherapy (NAC). Methods: This prospective study included 61 women with immunophenotypically defined luminal HER2-negative breast cancer treated with NAC. 18F-FDG PET was performed at baseline. Hepatic activity was used as a reference to distinguish between low-metabolic and hypermetabolic tumors. In hypermetabolic tumors, a PET exam was repeated after the first course of NAC. The relative change in the maximal Standardized Uptake Value of the tumor (ΔSUV), corresponding to the metabolic response, was calculated. Results: Forty-two women had hypermetabolic tumors at baseline, corresponding to more proliferative breast cancers with higher Ki-67 expression (p=0.017) and higher grade (p=0.04). Nineteen women had low-metabolic tumors with lower proliferation indexes. Worse overall survival was associated with larger tumor size (>5cm, HR=6.52, P=0.009) and with hypermetabolic tumors achieving a low metabolic response after one cycle of NAC (ΔSUV<16%, HR=10.63, P=0.004). Five-year overall survival in these poor-response patients was 49.22% (95% CI=[14.76%-76.90%]). In contrast, overall survival in women with low-metabolic tumors or hypermetabolic/good-response tumors (ΔSUV≥16%) was good, 100% and 96.15%, respectively (95% CI=[75.69%-99.45%]). Conclusions: In luminal HER2-negative breast tumors, tumor metabolism at baseline and changes after the first course of NAC are surrogate markers of patients’ survival. A subgroup of women with hypermetabolic/bad-responding tumors correlated with poor prognosis can be identified. These results may create the ability to tailor the NAC regimen to the metabolic response at an early stage.
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Affiliation(s)
| | | | - Alexandre Cochet
- Department of Nuclear Medicine, Centre Georges-Francois Leclerc, Dijon, France
| | - Mélanie Gauthier
- Biostatistics and Epidemiology Unit, Centre Georges François Leclerc, Dijon, France and EA4184, College of Medicine, Dijon, France
| | | | | | - Séverine Guiu
- Georges-François Leclerc Cancer Center, Dijon, France
| | | | | | - Charles Coutant
- Department of Surgery/Georges François Leclerc Comprehensive Cancer Care Centre, Dijon, France
| | | | - Francois Brunotte
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
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Berthet L, Cochet A, Kanoun S, Berriolo-Riedinger A, Humbert O, Toubeau M, Dygai-Cochet I, Legouge C, Casasnovas O, Brunotte F. In Newly Diagnosed Diffuse Large B-Cell Lymphoma, Determination of Bone Marrow Involvement with 18F-FDG PET/CT Provides Better Diagnostic Performance and Prognostic Stratification Than Does Biopsy. J Nucl Med 2013; 54:1244-50. [DOI: 10.2967/jnumed.112.114710] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Casasnovas RO, Meignan M, Berriolo-Riedinger A, Itti E, Huglo D, Haioun C, Morschhauser F. Early interim PET scans in diffuse large B-cell lymphoma: can there be consensus about standardized reporting, and can PET scans guide therapy choices? Curr Hematol Malig Rep 2012; 7:193-9. [PMID: 22723050 DOI: 10.1007/s11899-012-0129-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prognosis value of interim positron emission tomography (PET) remains controversial in diffuse large B-cell lymphoma (DLBCL) patients because of the absence of consensus on criteria able to early identify good and bad responders to treatment. Visual interpretation using the International Harmonization Project (IHP) criteria, primarily established for end of treatment evaluation, was related to a low positive predictive value of treatment failure. The 5-point scale (5PS) that refers the residual uptake to the liver as background tissue was shown to slightly reduce false-positive interim PET interpretations compared to IHP criteria. Semiquantification of fluorodeoxyglucose (FDG) uptake using standardized uptake value (SUV) and assessment of reduction of maximum SUV (SUVmax) between baseline and interim PET drastically improves both the interpretation accuracy and the interobserver reproducibility, and better predicts patient outcome than visual analysis. This latter approach is feasible in a multicenter setting and allows clinicians to design a risk-adapted therapeutic strategy based on early PET response assessment.
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Dupuis J, Berriolo-Riedinger A, Julian A, Brice P, Tychyj-Pinel C, Tilly H, Mounier N, Gallamini A, Feugier P, Soubeyran P, Colombat P, Laurent G, Berenger N, Casasnovas RO, Vera P, Paone G, Xerri L, Salles G, Haioun C, Meignan M. Impact of [18F]Fluorodeoxyglucose Positron Emission Tomography Response Evaluation in Patients With High–Tumor Burden Follicular Lymphoma Treated With Immunochemotherapy: A Prospective Study From the Groupe d'Etudes des Lymphomes de l'Adulte and GOELAMS. J Clin Oncol 2012; 30:4317-22. [DOI: 10.1200/jco.2012.43.0934] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose [18F]Fluorodeoxyglucose positron emission tomography (PET) is widely used for the staging and restaging of patients with aggressive lymphoma, but less is known about the utility of PET in patients with follicular lymphoma (FL). In a prospective study, we evaluated the prognostic value of PET performed during treatment and at the end of treatment in 121 patients with FL treated with first-line immunochemotherapy. Patients and Methods Patients with previously untreated high–tumor burden FL were treated with six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) plus two cycles of rituximab, without rituximab maintenance. PET was performed before treatment, after four cycles of R-CHOP (interim PET), and at the end of treatment (final PET). PET scans were centrally reviewed. Results The total number of patients included was 121. Median age was 57 years. After central review, interim PET (n = 111) was negative in 76% of patients, and final PET (n = 106) was negative in 78%. With a median follow-up of 23 months, 2-year progression-free survival rates were 86% for interim PET–negative versus 61% for interim PET–positive patients (P = .0046) and 87% for final PET–negative versus 51% for final PET–positive patients (P < .001), respectively. Two-year overall survival also significantly differed according to final PET results: 100% versus 88% (P = .0128). Conclusion PET performed either after four cycles of R-CHOP or at the end of therapy was strongly predictive of outcome in this prospective study. Therapeutic intervention based on PET results during or after inductive treatment should be evaluated.
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Affiliation(s)
- Jehan Dupuis
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Alina Berriolo-Riedinger
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Anne Julian
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Pauline Brice
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Christelle Tychyj-Pinel
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Hervé Tilly
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Nicolas Mounier
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Andrea Gallamini
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Pierre Feugier
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Pierre Soubeyran
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Philippe Colombat
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Guy Laurent
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Nathalie Berenger
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Rene-Olivier Casasnovas
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Pierre Vera
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Gaetano Paone
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Luc Xerri
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Gilles Salles
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Corinne Haioun
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
| | - Michel Meignan
- Jehan Dupuis, Corinne Haioun, and Michel Meignan, Hôpital Henri Mondor, Créteil; Alina Berriolo-Riedinger, Centre Georges Francois Leclerc; Rene-Olivier Casasnovas, Hôpital Le Bocage, Dijon; Anne Julian and Guy Laurent, Hôpital Purpan, Toulouse; Pauline Brice and Nathalie Berenger, Hôpital Saint Louis, Paris; Christelle Tychyj-Pinel and Gilles Salles, Centre Hospitalier Lyon Sud, Pierre Benite; Hervé Tilly and Pierre Vera, Centre Henri Becquerel, Rouen; Nicolas Mounier and Gaetano Paone, Hôpital de
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Cochet A, Kerrou K, Nabholtz JMA, Cachin F, Pierga JY, Champion L, Ferrero JM, Darcourt J, Petit T, Bourahla K, Bougnoux P, Baulieu JL, Dupre PF, Salaun PY, Bachelot TD, Mognetti T, Coeffic DE, Mesnard N, Coudert BP, Berriolo-Riedinger A. An open-label randomized, multicenter, phase II study on neoadjuvant treatment with trastuzumab plus docetaxel versus trastuzumab plus docetaxel plus bevacizumab according to positron emission tomography (PET) value modification in patients with early stage HER2-positive breast cancer (AVATAXHER): Design description. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS646 Background: For patients with early HER2+ breast cancer at diagnosis, addition of trastuzumab (T) to 6 cycles of preoperative docetaxel (D) can reach a pathological complete response (pCR) in ~50% of cases, and a high rate of conservative surgery. pCR can be predicted by changes of Fluorodeoxyglucose (FDG) tumor uptake evaluated by Positon Emission Tomography (PET) after one cycle of therapy. In order to increase this pCR rate, adding an antiangiogenic compound could be considered. Pre-clinical and phase I-II data support that the combination of bevacizumab (B) and T is synergistic and safe when patients are chemotherapy naïve. The neoadjuvant AVATAXHER trial (EUDRACT 2009-013410-26) investigates the potential increase of pCR rate by combining B with T and D for patients with HER2+ breast cancer who are not predicted for pCR by FDG PET. Methods: In this multicenter, open-label, phase II trial, 2 phases are planned after a selection period: phase I: all patients receive two cycles of therapy combining T (8 mg/kg at the first cycle, then 6 mg/kg) and D (100 mg/m2). FDG PET is also performed within 7 days before cycle 1 (baseline) and less than 3 days before cycle 2 in order to calculate changes of the tumor FDG uptake between baseline and after cycle 1 (ΔSUV). Phase 2: if ΔSUV≥70%, patients will continue to receive T and D for (cycles 3 to 6: D 100 mg/m2 + T 6 mg/kg); if ΔSUV<70%, patients are randomized 2:1 to arm A (cycles 3 to 6 D 100 mg/m2 + T 6 mg/kg + B 15 mg/kg) or arm B ( cycles 3 to 6: D 100 mg/m2 + T 6 mg/kg). The primary endpoint is pCR rate evaluated post-surgery 4 to 6 weeks after the last treatment of cycle 6. Enrolment began in May 2010 and 125 patients were to be recruited in 26 sites. According to the hypothesis that 60% of patients will have a ΔSUV<70%, it is presumed that 72 patients will be randomized. There are currently 107 patients included (as of 06 January 2012 ), 95 of them reached the phase 1; 52 of them (55%) showed a ΔSUV<70% and after randomization 34 were included in arm A and 18 in arm B.
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Affiliation(s)
- Alexandre Cochet
- Department of Nuclear Medicine, Centre Georges-Francois Leclerc, Dijon, France
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Humbert O, Berriolo-Riedinger A, Riedinger JM, Coudert B, Arnould L, Cochet A, Loustalot C, Fumoleau P, Brunotte F. Changes in 18F-FDG tumor metabolism after a first course of neoadjuvant chemotherapy in breast cancer: influence of tumor subtypes. Ann Oncol 2012; 23:2572-2577. [PMID: 22499859 DOI: 10.1093/annonc/mds071] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the impact of the different breast cancer subtypes on the tumor (18)F-FDG uptake at baseline and on its changes after the first course of neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS One hundred and fifteen women with newly diagnosed, large or locally advanced breast cancer undergoing NAC were included. Estrogen receptor (ER), progesterone receptor (PR) and HER2 status were used to define three major tumor subtypes: triple negative (TN) (ER-/PR-/HER2-), luminal (ER+ and/or PR+; HER2-) and HER2 positive (HER2+). Using Fluorine-18 fluorodeoxyglucose positron emission tomography, the tumoral standard uptake value (SUV) maximal index was measured at baseline and just before the second course of NAC. RESULTS TN tumors presented the highest baseline SUV (11.3 ± 8.5; P < 0.0001). The decrease of SUV after the first course of NAC (ΔSUV) was significantly higher in TN and HER2-positive subtypes (-45% ± 25% and -57% ± 30%, respectively) than in luminal one (-19% ± 35%; P < 0.0001). ΔSUV was a predictive factor of the pathological complete response only in HER2-positive tumors (cut-off = -75%; P < 0.03) with an accuracy of 76%. CONCLUSION The baseline (18)F-FDG tumoral uptake but also its early response to NAC is different according to the immunohistological subtypes of breast cancer.
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Affiliation(s)
- O Humbert
- Departments of Nuclear Medicine, Dijon, France.
| | | | | | - B Coudert
- Depertment of Medical Oncology, Dijon, France
| | | | - A Cochet
- Departments of Nuclear Medicine, Dijon, France; LE2I, UMR CNRS 5158, Université de Bourgogne, Dijon, France
| | | | - P Fumoleau
- Depertment of Medical Oncology, Dijon, France; LE2I, UMR CNRS 5158, Université de Bourgogne, Dijon, France
| | - F Brunotte
- Departments of Nuclear Medicine, Dijon, France; LE2I, UMR CNRS 5158, Université de Bourgogne, Dijon, France
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Cochet A, Pigeonnat S, Khoury B, Vrigneaud JM, Touzery C, Berriolo-Riedinger A, Dygai-Cochet I, Toubeau M, Humbert O, Coudert B, Fumoleau P, Arnould L, Brunotte F. Evaluation of breast tumor blood flow with dynamic first-pass 18F-FDG PET/CT: comparison with angiogenesis markers and prognostic factors. J Nucl Med 2012; 53:512-20. [PMID: 22343501 DOI: 10.2967/jnumed.111.096834] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The purpose of this study was to prospectively evaluate the relationship between tumor blood flow and glucose metabolism as evaluated by dynamic first-pass (18)F-FDG PET and by proliferation and endothelial pathologic markers in the setting of newly diagnosed breast cancer. METHODS Forty patients were prospectively included. Biopsy samples of each tumor were used to assess the Ki67 index of proliferation and immunostaining for CD34 (a panendothelial cell marker) and CD105 (a proliferation-related endothelial cell marker). All patients underwent (18)F-FDG PET/CT at least 1 wk after sample biopsy and before any treatment. A dynamic 2-min acquisition was performed immediately after intravenous injection of a 5 MBq/kg dose of (18)F-FDG; tumor blood flow was then calculated using a single-compartment kinetic model. A static acquisition was performed 90 min after injection for quantification of delayed (18)F-FDG tumor uptake (standardized uptake value maximal index [SUV(max)]), reflecting tumor metabolism. RESULTS Pathologic and PET/CT data were available for all patients. The SUV(max) measured on delayed PET images correlated strongly and positively with the expression of Ki67 (r = +0.69; P < 0.0001). In contrast, there was no significant correlation between SUV(max) and endothelial markers (CD34 and CD105). Tumor blood flow correlated positively with the expression of CD34 and CD105 (P = 0.016 and P = 0.007, respectively) and with the expression of Ki67 (P = 0.028). By logistic regression analysis, only expression of Ki67 remained an independent predictor of high (supramedian) SUV(max); CD105 score and histopathologic grade 3 were independently associated with a high (supramedian) tumor blood flow level. CONCLUSION Tumor blood flow quantified by dynamic first-pass (18)F-FDG PET/CT is significantly associated with tumor angiogenesis as evaluated by immunohistochemistry in the setting of breast cancer, whereas tumor metabolism appears to be more associated with markers of proliferation. Thus, determination of tumor blood flow and metabolism with a single injection of (18)F-FDG could be an exciting alternative to more complex and less available techniques.
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Affiliation(s)
- Alexandre Cochet
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.
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Cochet A, Quilichini G, Dygai-Cochet I, Touzery C, Toubeau M, Berriolo-Riedinger A, Coudert B, Cottin Y, Fumoleau P, Brunotte F. Baseline diastolic dysfunction as a predictive factor of trastuzumab-mediated cardiotoxicity after adjuvant anthracycline therapy in breast cancer. Breast Cancer Res Treat 2011; 130:845-54. [PMID: 21918836 DOI: 10.1007/s10549-011-1714-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 07/29/2011] [Indexed: 11/26/2022]
Abstract
To evaluate the interest in assessing left ventricular diastolic function at baseline for prediction of trastuzumab-mediated cardiotoxicity (TMC) in the setting of adjuvant treatment for breast cancer. The study included 118 women presenting with HER2-positive early-stage invasive breast cancer. Patients received trastuzumab therapy over 1 year, concurrent with six cycles of docetaxel (n = 53), or following anthracycline-based chemotherapy with a cumulative dose of 300 mg/m(2) (n = 45) or 600 mg/m(2) (n = 20) of epirubicine. RNA was performed before anthracycline-based chemotherapy, before trastuzumab treatment (baseline), and every 3 months during treatment. Left ventricular ejection fraction (LVEF) and peak ejection rate (PER) were calculated to evaluate LV systolic function; peak filling rate (PFR), and time to peak filling rate (TPFR) were also calculated to evaluate LV diastolic function. Eighteen patients (15%) developed grade 1 or 2 TMC during follow-up. No significant difference was observed for age, cardiovascular risk factors, fasting blood glucose level, heart rate, systolic blood pressure, baseline LVEF, PER, and PFR between patients with and without TMC. In contrast, patients with TMC showed a longer TPFR at baseline (median [Q1-Q3]: 165 ms [149-190] vs. 142 ms [130-162]; P < 0.001). Furthermore, by logistic regression analysis, baseline TPFR >180 ms and the cumulative dose of epirubicin remained independent predictors of TMC. Patients receiving 600 mg/m(2) of epirubicin before trastuzumab showed a higher incidence of TMC (35%) than did both patients who previously received 300 mg/m(2) of epirubicin (13%) and those who received only docetaxel associated with trastuzumab (9%). Impaired left ventricular diastolic function before treatment is an independent predictor of trastuzumab-mediated cardiotoxicity. The evaluation of diastolic function could allow optimal risk stratification before the introduction of trastuzumab.
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Affiliation(s)
- Alexandre Cochet
- Nuclear Medicine Department, Centre Georges-François Leclerc, 1, rue Professeur Marion, 21079 Dijon Cedex, France.
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Berriolo-Riedinger A, Humbert O, Riedinger JM, Arnoud L, Coudert B, Dygai-Cochet I, Cochet A, Toubeau M, Fumoleau P, Brunotte F. Abstract P5-01-06: 18[F]-FDG Tumoral Uptake and Metabolic Response after 1 Cycle of Primary Chemotherapy According to Tumoral Phenotype of Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-01-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
To compare the 18[F]-FDG-PET (PET) metabolic characteristics in triple-negative, luminal and positive HER2 breast cancer. Material and Methods: One hundred and forty-five patients with newly diagnosed locally advanced breast cancer were evaluated. Twenty one metastatic patients (discovered in baseline PET) were excluded and 9 patients were lost. One hundred and fifteen had undergone FDG PET before and after the first course of neoadjuvant chemotherapy. Breast cancer lesions were imaged at 80-90 minutes after administration of FDG. Maximum standardized uptake values (SUV) were measured at both time point (SUV1 and SUV 2). Metabolic response was measured by the relative decrease of SUV (ΔSUV). Using Immunohistochemistry as a surrogate for expression profiling, the tumours were classified as follows: triple negative defined by the lack of oestrogen receptors, progesterone receptors and human epidermal growth factor receptors 2 (HER2) expression, luminal (hormonal receptor positive, HER2 negative) and HER2 positive (overexpression of HER 2). Relationships between baseline [18F]-FDG uptake and clinical, histopathological and biological parameters were assessed by Mann-Whitney test. Relationships between SUV1, SUV2, ΔSUV and the tumoral phenotype were assessed by Kruskal-Wallis test.
Results: In the overall population the mean ±SD SUV1, SUV2 and ΔSUV values were 6.7± 5.9, 3.7± 3 and −36.7% ± 35.7%, respectively. Significant relationships were found between baseline FDG uptake and initial clinical and histopathological parameters : a high mitotic activity (p≥0.0001), a high nuclear pleomorphism (≥0.0002), a high tumour grading (p≥0.0001) and a negative oestrogen hormonal receptor status (p≥0.0001) were associated with a high baseline SUV. Patient age, lymph node involvement, architectural differentiation, progesterone hormonal receptor and HER2 status were not found to be related with SUV values.
Metabolic characteristics (mean ± SD) according to tumoral phenotype:
Conclusion: Our results show a significant positive relationship between the baseline FDG uptake and the proliferation markers, the tumour grading, the number of mitoses and the nuclear pleomorphism. A significant negative relationship was found between the baseline FDG uptake and the oestrogen hormonal receptor status. The triple negative phenotype was associated with higher baseline FDG uptake and higher residual FDG uptake after one course of chemotherapy commensurate with their aggressive biology. Luminal tumours showed a lower ΔSUV reflecting their lower chemosensibility.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-01-06.
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Affiliation(s)
| | - O Humbert
- Centre Georges-François Leclerc, Dijon, France
| | | | - L Arnoud
- Centre Georges-François Leclerc, Dijon, France
| | - B Coudert
- Centre Georges-François Leclerc, Dijon, France
| | | | - A Cochet
- Centre Georges-François Leclerc, Dijon, France
| | - M Toubeau
- Centre Georges-François Leclerc, Dijon, France
| | - P Fumoleau
- Centre Georges-François Leclerc, Dijon, France
| | - F. Brunotte
- Centre Georges-François Leclerc, Dijon, France
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Cochet A, Pigeonnat S, Buvry B, Berriolo-Riedinger A, Humbert O, Coudert B, Fumoleau P, Arnould L, Brunotte F. Abstract P5-01-09: Evaluation of Tumor Blood Flow with Dynamic 18F-Fluorodeoxyglucose Positron Emission Tomography: Correlation with Microvessel Density. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-01-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer is typically associated with an increase in tumor blood flow (due to angiogenesis) and tumor metabolism. Thus, these 2 key parameters are essential to characterize aggressiveness of breast tumors. Moreover, angiogenesis is a potential target for specific therapies. Positron Emission Tomography (PET) with 18F-Fluorodeoxyglucose (FDG) has become the gold standard for in vivo evaluation of tumor metabolism. A method for simultaneous measurement of blood flow and metabolism from a single injection of FDG may be an important addition for functional imaging of breast tumors. Unfortunately, there is no consensus on the validity of dynamic FDG acquisition for the evaluation of tumor blood flow.
Objective: to compare a new technique for simultaneous evaluation of tumor blood flow and metabolism, using a dynamic acquisition of FDG PET, with proliferation and endothelial cell markers. Material and methods: Twenty-eight patients with new diagnosed locally advanced breast cancer were included. In addition to diagnosis and tumor grading, biopsy samples of each tumor were used to assess the Ki-67 index of proliferation and the immuno-staining for CD31 (a panendothelial cell marker) and CD105 (a proliferation-related endothelial cell marker) (both expressed as number of labeled vessels counted on 10 consecutive high power fields, 400X magnification). All patients underwent FDG PET at least one week after sample biopsy and before any treatment. Dynamic 2 minutes acquisition was performed immediately after intravenous injection of 5 MBq/Kg of FDG; tumor Blood Flow (BF, in ml/min/g) was then calculated using a single compartiment kinetic model. Static acquisition was performed 60 minutes after injection for quantification of delayed FDG tumor uptake (“Standardized Uptake Value”, SUV), reflecting tumor metabolism.
Results: Pathologic and PET data were available for all patients. The SUV measured on delayed PET images was strongly positively correlated with the expression of Ki-67 (r=+0.693; P<0.0001). In contrast, there was no significant correlation between SUV and endothelial markers (CD31 and CD105). Tumor BF was positively correlated with the expression of CD31 (r=+0.392; p=0.039) and CD105 (r=+0.470; p=0.016). In contrast, there was no significant correlation between BF and Ki-67. Patients were categorized according to low (inframedian) or high (supramedian) tumor BF. Patients with high tumor BF showed a higher mean CD31 expression (236±169 vs 124±47, p=0.025) and a higher mean CD105 expression (110±73 vs 51±14; p=0.006) when compared with low tumor BF. In contrast there was no significant difference concerning SUV and Ki-67.
Conclusion: Tumor BF quantified by dynamic FDG PET is related to tumor microvessel density evaluated by immunohistochemistry. Thus, dynamic FDG PET is a valuable tool to evaluate both tumor blood flow and metabolism. Further investigations are needed to confirm the respective role of these 2 key parameters for elaboration of therapeutic strategies and response assessment in locally advanced breast cancer.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-01-09.
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Affiliation(s)
- A Cochet
- Centre Georges-François Leclerc, Dijon, France
| | - S Pigeonnat
- Centre Georges-François Leclerc, Dijon, France
| | - B Buvry
- Centre Georges-François Leclerc, Dijon, France
| | | | - O Humbert
- Centre Georges-François Leclerc, Dijon, France
| | - B Coudert
- Centre Georges-François Leclerc, Dijon, France
| | - P Fumoleau
- Centre Georges-François Leclerc, Dijon, France
| | - L Arnould
- Centre Georges-François Leclerc, Dijon, France
| | - F. Brunotte
- Centre Georges-François Leclerc, Dijon, France
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Humbert O, Berriolo-Riedinger A, Arnoud L, Coudert B, Toubeau M, Dygai-Cochet I, Cochet A, Mayer F, Fumoleau P, Brunotte F. Abstract P5-01-05: Prognostic Value at 4 Years of FDG PET, after the First Course of Neoadjuvant Chemotherapy in Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-01-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
FDG-PET may be a powerful examination to evaluate the effectiveness of neoadjuvant chemotherapy: it appears to be possible to predict the preoperative histological response after the first cycle of chemotherapy. The aim of this prospective study was to investigate the prognostic value of the early decrease of tumoral glucidic metabolism, evaluated with FDG-PET, after the first cycle of neoadjuvant chemotherapy in breast cancer. Material and methods: FDG-PET was performed before and after the first cycle of neoadjuvant chemotherapy in 92 patients with large or locally advanced, non inflammatory, breast cancer. The change of 18F-FDG tumoral uptake was calculated from the maximum Standard Uptake Value corrected for body surface and glycemia (ΔSUVmax). Disease free survival (DFS) was assessed, and the prognostic value of ΔSUVmax was first studied among all patients. Using immunohistochemistry as a surrogate for expression profiling, patients were then classified according to tumoral phenotypes as follow: triple negative (defined by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression), luminal (ER positive or PR positive, HER2 negative) and HER2 positive.
Results: The median follow-up was 46.3 months (range: 37–52 months). Twenty one patients had recurrent disease, 9 of whom died. Using univariate Cox regression analysis with all patients, DFS showed significant correlation with initial tumor size measured with ultrasound scan (p=0.03), and ΔSUVmax after the first cycle of neoadjuvant chemotherapy (cut-off = -45%, p=0.01). Using multivariate cox regression analysis, only ΔSUVmax remained an independent prognostic factor of DFS at four years (p=0.028). According to tumoral phenotypes, ΔSUVmax was a prognostic factor of DFS for the 50 patients with a luminal cancer : the risk of relapse was 8.7 times higher in women whose SUVmax decreased less than 24% after the first course of chemotherapy (p=0,04). No significant correlation between
ΔSUVmax and DFS was shown in the 22 triple negative phenotypes. For the 31 patients overexpressing HER2, a tumoral SUVmax lower than 1,8 after one cycle of chemotherapy tended to be a favorable prognostic factor with a lower risk of relapse (p = 0,058) but ΔSUVmax had no significant prognostic value (p=0.08).
Conclusion: Using immunohistochemistry, the change of tumoral FDG uptake after the first cycle of neoadjuvant chemotherapy in operable breast cancer patients appears to be an early surrogate marker of disease free survival for luminal tumors in this study. For HER2 positive tumors, FDG-PET seems to provide prognostic information but, as for the triple negative tumors, it was not statistically significant. FDG-PET might be useful to guide the early therapeutic choice for breast cancer treated with neoadjuvant chemotherapy.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-01-05.
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Affiliation(s)
- O Humbert
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
| | | | - L Arnoud
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
| | - B Coudert
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
| | - M Toubeau
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
| | - I Dygai-Cochet
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
| | - A Cochet
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
| | - F Mayer
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
| | - P Fumoleau
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
| | - F. Brunotte
- Centre Georges-François Leclerc, Dijon, France; UMR 5158, Dijon, France
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Cochet A, Berriolo-Riedinger A, Girault S, Rousseau C, Brunotte F, Couturier O. Bone metastasis of a breast cancer detected by 3'-deoxy-3'-18F-fluorothymidine PET/CT. Nuklearmedizin 2009. [DOI: 10.1055/s-0037-1621115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cochet A, Berriolo-Riedinger A, Girault S, Rousseau C, Brunotte F, Couturier O. Bone metastasis of a breast cancer detected by 3'-deoxy-3'-18F-fluorothymidine PET/CT. Nuklearmedizin 2009; 48:N45-N46. [PMID: 20512194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 06/26/2009] [Indexed: 05/29/2023]
Affiliation(s)
- A Cochet
- Nuclear Medicine Department, Centre Georges-François Leclerc, Dijon, France
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Chamois J, Peignaux K, Ciappuccini R, Bonnetain F, Brunotte F, Berriolo-Riedinger A, Maingon P. Valeur deprédiction delaTEP auFDG initiale surlaréponse àlachimioradiothérapie première descancers ducol utérin localement évolués. Cancer Radiother 2007. [DOI: 10.1016/j.canrad.2007.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Berriolo-Riedinger A, Touzery C, Riedinger JM, Toubeau M, Coudert B, Arnould L, Boichot C, Cochet A, Fumoleau P, Brunotte F. [18F]FDG-PET predicts complete pathological response of breast cancer to neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging 2007; 34:1915-24. [PMID: 17579854 DOI: 10.1007/s00259-007-0459-5] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 03/18/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate, in breast cancer patients treated by neoadjuvant chemotherapy, the predictive value of reduction in FDG uptake with regard to complete pathological response (pCR). METHODS Forty-seven women with non-metastatic, non-inflammatory, large or locally advanced breast cancer were included. Tumour uptake of FDG was evaluated before and after the first course of neoadjuvant chemotherapy. Four indices were used: maximal and average SUV without or with correction by body surface area and glycaemia (SUV(max), SUV(avg), SUV(max-BSA-G) and SUV(avg-BSA-G), respectively). The predictive value of reduction in FDG uptake with respect to pCR was studied by logistic regression analysis. Relationships between baseline [(18)F]FDG uptake and prognostic parameters were assessed. RESULTS The relative decrease in FDG uptake (DeltaSUV) after the first course of neoadjuvant chemotherapy was significantly greater in the pCR group than in the non-pCR group (p < 0.000066). The four FDG uptake indices were all strongly correlated with each other. A decrease in SUV(max-BSA-G) of 85.4% +/- 21.9% was found in pCR patients, versus 22.6% +/- 36.6% in non-pCR patients. DeltaSUV(max-BSA-G) <-60% predicted the pCR with an accuracy of 87% and DeltaSUVs were found to be only factors predictive of the pCR at multivariate analysis. An elevated baseline SUV was associated with high mitotic activity (p < 0.0016), tumour grading (p < 0.004), high nuclear pleomorphism score (p < 0.03) and negative hormonal receptor status (p < 0.005). CONCLUSION In breast cancer patients, after only one course of neoadjuvant chemotherapy the reduction in FDG uptake is an early and powerful predictor of pCR.
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Favier L, Berriolo-Riedinger A, Coudert B, Touzery C, Riedinger J, Toubeau M, Arnould L, Brunotte F, Fumoleau P. Predicative value of [18F]-FDG PET scan for pathological complete response to neoadjuvant chemotherapy in breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
505 Background: To evaluate, in breast cancer patients treated by neoadjuvant chemotherapy, the early predictive value of the FDG uptake decrease for the assessment of the pathological complete response (pCR). Methods: Forty seven women with non metastatic with conventional imaging, non inflammatory, large or locally advanced breast cancer were included. Pathological tumour regression determined on surgical resection specimens served as the gold standard for the assessment of the neoadjuvant chemotherapy response. According to the Sataloff classification, patients were classified in two groups: patients with a pathological complete response (pCR) and patients with a pathological non complete response (non pCR). FDG uptake of breast lesions was evaluated before and after the first course of neoadjuvant chemotherapy, using Standard Uptake Value maximum (SUV) corrected by body surface area and glycaemia. Relations between baseline [18F]-FDG uptake and clinical, histopathological and biological parameters were assessed by Mann-Whitney test. Predictive value of the FDG decrease for the assessment of the pCR was studied with logistic regression analysis. Results: An elevated baseline SUV was found independently associated with a high mitotic activity (p<0.002), tumour grading (p<0.004), high score of nuclear pleomorphism (p= 0.03) and positive hormonal receptor status (p<0.005). After completion of chemotherapy, 11 (23%) of the 47 breast tumours examined at surgery showed a pCR while 36 (77%) showed a non pCR. The relative decrease (ΔSUV) after the first course of neoadjuvant chemotherapy was significantly greater in the pCR group than in the non pCR group (p< 10-4). A SUV decrease of 85.4% ± 21.9% in pCR patients versus 22.6% ± 36.6% in non pCR patients was found. ΔSUV<-60% predicted pCR with an accuracy of 87%. With multivariate logistic regression analyses, ΔSUV<-60% was the only predictive factor of the pCR Conclusions: In breast cancer patients treated by neoadjuvant chemotherapy, the FDG uptake decrease, after only one course of treatment, is an early and powerful predictor of the pCR. No significant financial relationships to disclose.
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Toubeau M, Touzery C, Berriolo-Riedinger A, Cochet A, Brunotte F, Bedenne L, Cercueil JP, Krause D. 131I thyroid uptake in patients treated with 131I-Lipiodol for hepatocellular carcinoma. Eur J Nucl Med 2001; 28:669-70. [PMID: 11383874 DOI: 10.1007/s002590100516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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