FDG PET could forecast breast cancer patients’ response to therapy

Quantitative PET using agents like FDG could predict the outcome of chemotherapy for patients with particularly tricky cases of advanced breast cancer, according to a study published Dec. 4 in the Journal of Nuclear Medicine.

Breast cancer patients who test negative for estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2) expression rely on chemotherapy as a neoadjuvant treatment prior to surgery, but recurring cancer and poor survival remain daunting.

Roisin M. Connolly, MBBS, assistant professor of oncology for the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, and colleagues conducted a prospective, multisite, randomized, controlled study of 62 patients receiving a 12-week course of chemotherapy consisting of carboplatin and nanoparticle albumin-bound paclitaxel and vorinostat prior to surgery.

“Many women suffer recurrence and death despite this approach, emphasizing the need for new therapeutic strategies,” wrote Connolly et al. “Preclinical research supports the investigation of epigenetic modifiers such as the histone deacetylase (HDAC) inhibitor vorinostat for the treatment of breast cancer.”

Each patient was biopsied and underwent multiple FDG PET scans to gauge the correlation between FDG uptake and response to therapy. Results of the study showed that this chemotherapy technique was similar to placebo in terms of pathologic complete response. However, the study did provide evidence of quantitative PET’s potential for treatment selection.

“Our study confirms the feasibility of conducting multicenter neoadjuvant studies that add novel agents to chemotherapy backbones, and incorporate serial tissue biopsies and quantitative imaging for biomarker development,” the researchers concluded.