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Abstract

PURPOSE:

To investigate the value of the metabolic tumor response assessed with (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET), compared with clinicobiologic markers to predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in women with triple-negative breast cancer (TNBC).

EXPERIMENTAL DESIGN:

Fifty consecutive women with TNBC and an indication for NAC were prospectively included. Different pretreatment clinical, biologic, and pathologic biomarkers, including SBR grade, the Ki-67 proliferation index, androgen receptor expression, EGF receptor (EGFR), and cytokeratin 5/6 staining, were assessed. Tumor glucose metabolism at baseline and its change after the first cycle of NAC (ΔSUVmax) were assessed using FDG-PET.

RESULTS:

The pCR rate was 42%. High Ki-67 proliferation index (P = 0.016), negative EGFR status (P = 0.042), and high ΔSUVmax (P = 0.002) were significantly associated with pCR. In multivariate logistic regression, both negative EGFR status (OR, 6.4; P = 0.043) and high ΔSUVmax (OR, 7.1; P = 0.014) were independent predictors of pCR. Using a threshold at -50%, tumor ΔSUVmax predicted pCR with a negative, a positive predictive value, and an accuracy of 79%, 70%, and 75%, respectively. Combining a low ΔSUVmax and positive EGFR status could predict non-pCR with an accuracy of 92%.

CONCLUSIONS:

It is important to define the chemosensitivity of TNBC to NAC early. Combining EGFR status and the metabolic response assessed with FDG-PET can help the physician to early predict the probability of achieving pCR or not. Given these results, the interest of response-guided tailoring of the chemotherapy might be tested in multicenter trials. Clin Cancer Res; 21(24); 5460-8.

Author information

Humbert O1, Riedinger JM2, Charon-Barra C3, Berriolo-Riedinger A4, Desmoulins I5, Lorgis V5, Kanoun S6, Coutant C7, Fumoleau P5, Cochet A8, Brunotte F6.

1 Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France. Université de Bourgogne, UMR CNRS 6306, Dijon, France. ohumbert@cgfl.fr.

2 Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France. Departments of Biology and Pathology, Centre GF Leclerc, Dijon, France.

3 Departments of Biology and Pathology, Centre GF Leclerc, Dijon, France.

4 Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France.

5 Department of Medical Oncology, Centre GF Leclerc, Dijon, France.

6 Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France. Université de Bourgogne, UMR CNRS 6306, Dijon, France. Imaging Department, CHU Le Bocage, Dijon, France.

7 Department of Surgery, Centre GF Leclerc, Dijon, France.

8 Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France. Université de Bourgogne, UMR CNRS 6306, Dijon, France.