Quantitative fluoroestradiol positron emission tomography imaging predicts response to endocrine treatment in breast cancer

Hannah M. Linden, Svetlana A. Stekhova, Jeanne M. Link, Julie R. Gralow, Robert B Livingston, Georgiana K. Ellis, Philip H. Petra, Lanell M. Peterson, Erin K. Schubert, Lisa K. Dunnwald, Kenneth A. Krohn, David A. Mankoff

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Purpose: In breast cancer, [18F]fluoroestradiol (FES) positron emission tomography (PET) correlates with estrogen receptors (ER) expression and predicts response to tamoxifen. We tested the ability of FES-PET imaging to predict response to salvage hormonal treatment in heavily pretreated metastatic breast cancer patients, predominantly treated with aromatase inhibitors. Patients and Methods: Initial FES uptake measurements in 47 patients with ER-positive tumors were correlated with subsequent tumor response to 6 months of hormonal treatment. Most patients had bone dominant disease and prior tamoxifen exposure. Response was compared to initial FES-PET uptake, measured qualitatively and quantitatively using standardized uptake value (SUV) and estradiol-binding flux. Results: Eleven of 47 patients (23%) had an objective response. While no patients with absent FES uptake had a response to treatment, the association between qualitative FES-PET results and response was not significant (P = .14). However, quantitative FES uptake and response were significantly associated; zero of 15 patients with initial SUV less than 1.5 responded to hormonal therapy, compared with 11 of 32 patients (34%) with SUV higher than 1.5 (P < .01). In the subset of patients whose tumors did not overexpress HER2/neu, 11 of 24 patients (46%) with SUV higher than 1.5 responded. Conclusion: Quantitative FES-PET can predict response to hormonal therapy and may help guide treatment selection. Treatment selection using quantitative FES-PET in our patient series would have increased the rate of response from 23% to 34% overall, and from 29% to 46% in the subset of patients lacking HER2/neu overexpression. A multi-institutional collaborative trial would permit definitive assessment of the value of FES-PET for therapeutic decision making.

Original languageEnglish (US)
Pages (from-to)2793-2799
Number of pages7
JournalJournal of Clinical Oncology
Issue number18
Publication statusPublished - Jun 20 2006
Externally publishedYes


ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Quantitative fluoroestradiol positron emission tomography imaging predicts response to endocrine treatment in breast cancer. / Linden, Hannah M.; Stekhova, Svetlana A.; Link, Jeanne M.; Gralow, Julie R.; Livingston, Robert B; Ellis, Georgiana K.; Petra, Philip H.; Peterson, Lanell M.; Schubert, Erin K.; Dunnwald, Lisa K.; Krohn, Kenneth A.; Mankoff, David A.

In: Journal of Clinical Oncology, Vol. 24, No. 18, 20.06.2006, p. 2793-2799.

Research output: Contribution to journalArticle