IN VIVO ASSESSMENT OF TUMOR RECEPTOR LEVELS USING PET

尽管最近我们对乳房生物学的了解有所改善 癌症，最近在这种疾病的系统治疗方面取得的进展很少 目前的统计数据表明，3.5%的美国女性将 死于乳腺癌。晚期乳腺癌的初步治疗是 根据体外测定的肿瘤激素受体状态 测定肿瘤组织中ER的含量。晚期荷尔蒙患者- 敏感的(ER+)癌症通过激素治疗，55%-60%的 这些女性会做出积极的回应。需要更多信息才能 根据调查结果更准确地预测个别患者的反应 雌激素受体(ER)状态的体内功能评价及评价 预测肿瘤侵袭性的其他因素；许多这样的预后 已经评估了包括几种核蛋白在内的因素，但没有。 目前证明比腋窝结节的状态更准确 在诊断时。在接受治疗的转移性ER+疾病患者中 通过激素治疗，7-10%的患者会出现症状“红肿”。 这种反应被归因于暂时的激动剂 激素的作用，不能与疾病的进展区分开来 临床或放射学上，但与随后的反应有关 去接受那个治疗。我们之前已经证明了正电子发射 16α-[18F]氟-17β-雌二醇(FES)断层扫描(PET)提供 关于肿瘤ER状态的可靠体内信息。 [18F]-2-氟-2-脱氧葡萄糖(FDG)PET的定量结果 被其他人证明可以预测几种类型的学生的年级和行为 包括乳腺癌在内的恶性肿瘤。 我们建议同时使用FES和FDG进行序列PET和序列肿瘤 活检(用于评估几种免疫组织化学预后 因素)在局部晚期ER+乳腺癌患者之前和早期 开始三苯氧胺治疗后。预计将会有 由PET提供的功能数据与由 预后因素评估将提供有关肿瘤侵袭性的信息 荷尔蒙敏感性使荷尔蒙治疗晚期乳腺癌 可以是个性化的。我们认为一个亚临床耀斑是由 治疗开始后早期的PET成像可预测疗效 在这组患者中进行激素治疗。此外，结果显示 这项研究的内容应可翻译为转移性乳房患者 癌症，因此提供了一种方法来区分 临床闪光反应和疾病进展。

Despite recent improvements in our understanding of the biology of breast cancer, few recent advances have been made in the systemic therapy of this disease, and present statistics indicate that 3.5% of American women will die of breast cancer. Initial treatment of advanced breast cancer is based on the hormone-receptor status of the tumor determined by in vitro assay for the ER in tumor tissue. Patients with advanced hormone- sensitive (ER+) cancer are treated by hormonal manipulation, and 55-60% of these women will respond favorably. Additional information is needed to predict response in individual patients more accurately, based on an in vivo functional assessment of estrogen receptor (ER) status and assessment of other factors predictive of tumor aggression; many such prognostic factors, including several nuclear proteins, have been evaluated, but none has currently proven more accurate than the status of the axillary nodes at diagnosis. In patients with metastatic ER+ disease who are treated with hormonal therapy, 7-10% will experience a symptomatic "flare reaction". This reaction has been attributed to the temporary agonist effect of the hormone and cannot be distinguished from disease progression clinically or radiologically, but is associated with subsequent response to that therapy. We have previously shown that positron emission tomography (PET) with 16alpha-[18F]fluoro-17beta-estradiol (FES) provides reliable in vivo information about the ER status of the tumor. Quantitative results of PET with [18F]-2-fluoro-2 deoxyglucose (FDG) have been shown by others to predict grade and behavior of several types of malignant tumors including breast cancer. We propose to perform serial PET with both FES and FDG and serial tumor biopsies (for assessment of several immunohistochemical prognostic factors) in women with locally advanced ER+ breast cancer before and early after initiation of tamoxifen therapy. It is expected that the combination of functional data provided by PET and that provided by prognostic-factor assessment will yield information about tumor aggression and hormonal sensitivity so that hormone therapy of advanced breast cancer can be individualized. We believe that a subclinical flare detected by PET imaging early after initiation of treatment may predict responsiveness to hormone therapy in this group of patients. Additionally, the results of this study should be translatable to patients with metastatic breast cancer and, hence, provide a method for distinguishing between the clinical flare reaction and disease progression.