<sup>89</sup>Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy: A Feasibility Study
Background: Approximately 20% of invasive ductal breast malignancies are human epidermal growth factor receptor 2 (HER2)-positive. These patients receive neoadjuvant systemic therapy (NAT) including HER2-targeting therapies. Up to 65% of patients achieve a pathological complete response (pCR). These...
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MDPI AG
2023-10-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/20/4980 |
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| author | D. G. J. Linders M. M. Deken M. A. van Dam M. N. J. M. Wasser E. M. C. Voormolen J. R. Kroep G. A. M. S. van Dongen D. Vugts H. M. Oosterkamp M. E. Straver C. J. H. van de Velde D. Cohen P. Dibbets-Schneider F. H. P. van Velden L. M. Pereira Arias-Bouda A. L. Vahrmeijer G. J. Liefers L. F. de Geus-Oei D. E. Hilling |
| author_facet | D. G. J. Linders M. M. Deken M. A. van Dam M. N. J. M. Wasser E. M. C. Voormolen J. R. Kroep G. A. M. S. van Dongen D. Vugts H. M. Oosterkamp M. E. Straver C. J. H. van de Velde D. Cohen P. Dibbets-Schneider F. H. P. van Velden L. M. Pereira Arias-Bouda A. L. Vahrmeijer G. J. Liefers L. F. de Geus-Oei D. E. Hilling |
| author_sort | D. G. J. Linders |
| collection | DOAJ |
| description | Background: Approximately 20% of invasive ductal breast malignancies are human epidermal growth factor receptor 2 (HER2)-positive. These patients receive neoadjuvant systemic therapy (NAT) including HER2-targeting therapies. Up to 65% of patients achieve a pathological complete response (pCR). These patients might not have needed surgery. However, accurate preoperative identification of a pCR remains challenging. A radiologic complete response (rCR) on MRI corresponds to a pCR in only 73% of patients. The current feasibility study investigates if HER2-targeted PET/CT-imaging using Zirconium-89 (<sup>89</sup>Zr)-radiolabeled trastuzumab can be used for more accurate NAT response evaluation. Methods: HER2-positive breast cancer patients scheduled to undergo NAT and subsequent surgery received a <sup>89</sup>Zr-trastuzumab PET/CT both before (PET/CT-1) and after (PET/CT-2) NAT. Qualitative and quantitative response evaluation was performed. Results: Six patients were enrolled. All primary tumors could be identified on PET/CT-1. Four patients had a pCR and two a pathological partial response (pPR) in the primary tumor. Qualitative assessment of PET/CT resulted in an accuracy of 66.7%, compared to 83.3% of the standard-of-care MRI. Quantitative assessment showed a difference between the SUV<sub>R</sub> on PET/CT-1 and PET/CT-2 (ΔSUV<sub>R</sub>) in patients with a pPR and pCR of −48% and −90% (<i>p</i> = 0.133), respectively. The difference in tumor-to-blood ratio on PET/CT-1 and PET/CT-2 (ΔTBR) in patients with pPR and pCR was −79% and −94% (<i>p</i> = 0.133), respectively. Three patients had metastatic lymph nodes at diagnosis that were all identified on PET/CT-1. All three patients achieved a nodal pCR. Qualitative assessment of the lymph nodes with PET/CT resulted in an accuracy of 66.7%, compared to 50% of the MRI. Conclusions: NAT response evaluation using <sup>89</sup>Zr-trastuzumab PET/CT is feasible. In the current study, qualitative assessment of the PET/CT images is not superior to standard-of-care MRI. Our results suggest that quantitative assessment of <sup>89</sup>Zr-trastuzumab PET/CT has potential for a more accurate response evaluation of the primary tumor after NAT in HER2-positive breast cancer. |
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| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T21:22:20Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
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| series | Cancers |
| spelling | doaj.art-2f274933af3d4e3c98ca009edb1c47822023-11-19T15:58:50ZengMDPI AGCancers2072-66942023-10-011520498010.3390/cancers15204980<sup>89</sup>Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy: A Feasibility StudyD. G. J. Linders0M. M. Deken1M. A. van Dam2M. N. J. M. Wasser3E. M. C. Voormolen4J. R. Kroep5G. A. M. S. van Dongen6D. Vugts7H. M. Oosterkamp8M. E. Straver9C. J. H. van de Velde10D. Cohen11P. Dibbets-Schneider12F. H. P. van Velden13L. M. Pereira Arias-Bouda14A. L. Vahrmeijer15G. J. Liefers16L. F. de Geus-Oei17D. E. Hilling18Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, 1081 HV Amsterdam, The NetherlandsDepartment of Internal Medicine, Haaglanden Medical Center, 2512 VA The Hague, The NetherlandsDepartment of Surgery, Haaglanden Medical Center, 2512 VA The Hague, The NetherlandsDepartment of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsDepartment of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The NetherlandsBackground: Approximately 20% of invasive ductal breast malignancies are human epidermal growth factor receptor 2 (HER2)-positive. These patients receive neoadjuvant systemic therapy (NAT) including HER2-targeting therapies. Up to 65% of patients achieve a pathological complete response (pCR). These patients might not have needed surgery. However, accurate preoperative identification of a pCR remains challenging. A radiologic complete response (rCR) on MRI corresponds to a pCR in only 73% of patients. The current feasibility study investigates if HER2-targeted PET/CT-imaging using Zirconium-89 (<sup>89</sup>Zr)-radiolabeled trastuzumab can be used for more accurate NAT response evaluation. Methods: HER2-positive breast cancer patients scheduled to undergo NAT and subsequent surgery received a <sup>89</sup>Zr-trastuzumab PET/CT both before (PET/CT-1) and after (PET/CT-2) NAT. Qualitative and quantitative response evaluation was performed. Results: Six patients were enrolled. All primary tumors could be identified on PET/CT-1. Four patients had a pCR and two a pathological partial response (pPR) in the primary tumor. Qualitative assessment of PET/CT resulted in an accuracy of 66.7%, compared to 83.3% of the standard-of-care MRI. Quantitative assessment showed a difference between the SUV<sub>R</sub> on PET/CT-1 and PET/CT-2 (ΔSUV<sub>R</sub>) in patients with a pPR and pCR of −48% and −90% (<i>p</i> = 0.133), respectively. The difference in tumor-to-blood ratio on PET/CT-1 and PET/CT-2 (ΔTBR) in patients with pPR and pCR was −79% and −94% (<i>p</i> = 0.133), respectively. Three patients had metastatic lymph nodes at diagnosis that were all identified on PET/CT-1. All three patients achieved a nodal pCR. Qualitative assessment of the lymph nodes with PET/CT resulted in an accuracy of 66.7%, compared to 50% of the MRI. Conclusions: NAT response evaluation using <sup>89</sup>Zr-trastuzumab PET/CT is feasible. In the current study, qualitative assessment of the PET/CT images is not superior to standard-of-care MRI. Our results suggest that quantitative assessment of <sup>89</sup>Zr-trastuzumab PET/CT has potential for a more accurate response evaluation of the primary tumor after NAT in HER2-positive breast cancer.https://www.mdpi.com/2072-6694/15/20/4980breast cancerhuman epidermal growth factor receptor 2neoadjuvant therapytreatment response evaluationHER2-targeted PET/CTsurgery-free treatment strategy |
| spellingShingle | D. G. J. Linders M. M. Deken M. A. van Dam M. N. J. M. Wasser E. M. C. Voormolen J. R. Kroep G. A. M. S. van Dongen D. Vugts H. M. Oosterkamp M. E. Straver C. J. H. van de Velde D. Cohen P. Dibbets-Schneider F. H. P. van Velden L. M. Pereira Arias-Bouda A. L. Vahrmeijer G. J. Liefers L. F. de Geus-Oei D. E. Hilling <sup>89</sup>Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy: A Feasibility Study Cancers breast cancer human epidermal growth factor receptor 2 neoadjuvant therapy treatment response evaluation HER2-targeted PET/CT surgery-free treatment strategy |
| title | <sup>89</sup>Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy: A Feasibility Study |
| title_full | <sup>89</sup>Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy: A Feasibility Study |
| title_fullStr | <sup>89</sup>Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy: A Feasibility Study |
| title_full_unstemmed | <sup>89</sup>Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy: A Feasibility Study |
| title_short | <sup>89</sup>Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy: A Feasibility Study |
| title_sort | sup 89 sup zr trastuzumab pet ct imaging of her2 positive breast cancer for predicting pathological complete response after neoadjuvant systemic therapy a feasibility study |
| topic | breast cancer human epidermal growth factor receptor 2 neoadjuvant therapy treatment response evaluation HER2-targeted PET/CT surgery-free treatment strategy |
| url | https://www.mdpi.com/2072-6694/15/20/4980 |
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