Abstract
Whole-body PET imaging in metastatic breast cancer with a focus on hormone receptors
Breast cancer is the most common type of cancer diagnosed in women. Some of these women will develop distant metastases. The clinical course of the disease depends on the expression of hormone receptors. Whole-body PET imaging can be of added value. The estrogen receptor is expressed by the large majority of breast cancers, and can be visualized by means of [18F]-FES-PET. This scan can help to solve clinical dilemmas that may remain after standard workup, such as determining the extent of metastatic disease, unclear estrogen receptor status of the tumor, and inability to determine which primary tumor caused the metastases. In addition, we conclude that fasting, which is less patient-friendly, is not necessary to improve the quality of the [18F]-FES-PET scan. We have also constructed a flowchart for assessment of the estrogen receptor status of liver metastases with [18F]-FES-PET/CT.
The [18F]-FES-PET scan can also be combined with [18F]-FDG-PET to determine estrogen receptor heterogeneity. The tumor estrogen receptor heterogeneity percentage may potentially identify the patients who benefit from the treatment with aromatase inhibitor letrozole and the CDK 4/6 inhibitor palbociclib. [18F]-FDG-PET is also a useful tool to detect metastases, including invasive lobular carcinomas.
Like the estrogen receptor, the androgen receptor is another potential endocrine target in breast cancer. This receptor could be visualized by [18F]-FDHT-PET and changes in [18F]-FDHT uptake during androgen receptor antagonist bicalutamide treatment can be detected.
Breast cancer is the most common type of cancer diagnosed in women. Some of these women will develop distant metastases. The clinical course of the disease depends on the expression of hormone receptors. Whole-body PET imaging can be of added value. The estrogen receptor is expressed by the large majority of breast cancers, and can be visualized by means of [18F]-FES-PET. This scan can help to solve clinical dilemmas that may remain after standard workup, such as determining the extent of metastatic disease, unclear estrogen receptor status of the tumor, and inability to determine which primary tumor caused the metastases. In addition, we conclude that fasting, which is less patient-friendly, is not necessary to improve the quality of the [18F]-FES-PET scan. We have also constructed a flowchart for assessment of the estrogen receptor status of liver metastases with [18F]-FES-PET/CT.
The [18F]-FES-PET scan can also be combined with [18F]-FDG-PET to determine estrogen receptor heterogeneity. The tumor estrogen receptor heterogeneity percentage may potentially identify the patients who benefit from the treatment with aromatase inhibitor letrozole and the CDK 4/6 inhibitor palbociclib. [18F]-FDG-PET is also a useful tool to detect metastases, including invasive lobular carcinomas.
Like the estrogen receptor, the androgen receptor is another potential endocrine target in breast cancer. This receptor could be visualized by [18F]-FDHT-PET and changes in [18F]-FDHT uptake during androgen receptor antagonist bicalutamide treatment can be detected.
| Original language | English |
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| Qualification | Doctor of Philosophy |
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| Award date | 5-Jul-2023 |
| Place of Publication | [Groningen] |
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| Publication status | Published - 2023 |