Role of Positron Emission Tomography for the Monitoring of Response to Therapy in Breast Cancer
Role of Positron Emission Tomography for the Monitoring of Response to Therapy in Breast Cancer
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DOI：
10.1634/theoncologist.2014-0342
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发表时间：
2015-02-01
期刊：
影响因子：
5.8
通讯作者：
Fumoleau, Pierre
中科院分区：
文献类型：
--
作者：
Humbert, Olivier;Cochet, Alexandre;Fumoleau, Pierre
该综述考虑了正电子发射断层扫描(PET)示踪剂在乳腺癌反应监测中的潜在应用，特别强调了用F-18-氟代脱氧葡萄糖(FDG)评估的葡萄糖代谢变化。在乳腺癌的新辅助治疗环境中，代谢反应可以预测第一个周期化疗后的最终完全病理反应。由于肿瘤的代谢行为高度依赖于癌症亚型，目前正在进行研究，以确定每个亚型肿瘤反应的最佳代谢标准。最近的多中心随机AVATAXHER试验表明，在人类表皮生长因子2阳性亚型中，对于第一个疗程后代谢反应较差的女性，早期定制新辅助治疗是一种临床益处。在以骨为主的转移环境中，越来越多的临床证据表明，当同时考虑代谢信息和形态信息时，FDG-PET/CT是评估肿瘤治疗反应的最准确的成像方式。然而，有必要定义标准化的代谢反应标准，包括转移瘤之间反应的异质性，并评估FDG-PET/CT与传统成像相比的成本和健康结果。最近在临床前和临床研究中出现了新的非FDG放射示踪剂，突出了乳腺癌细胞的特定分子特征。这些生物标志物可以考虑到转移灶中肿瘤生物学的异质性。它们可能为医生选择和监测针对乳腺肿瘤相同分子通路的新疗法的有效性提供有价值的临床信息。
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 F-18-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.