Annals of nuclear medicine · 2026
The role of 18 F-FDG PET/CT SUVmax values in evaluating treatment response in hormone receptor-positive metastatic breast cancer patients receiving CDK4/6 inhibitor therapy.
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Özbek Rahime Dilara, Aytekin Aydın, Yerdes Enes, Elboga Umut
Аннотация
OBJECTIVE: Metastatic breast cancer is a disease with poor prognosis. For many years, it has been treated with endocrine therapy; however, due to the promising results of CDK 4/6 inhibitors, their combination with endocrine therapy has recently become an essential component of metastatic breast cancer treatment. Although no standardized approach exists for evaluating the response to CDK 4/6 inhibitors, assessment with 18 F-FDG PET/CT may be possible. In this study, we aimed to assess the treatment response using 18 F-FDG PET/CT SUVmax values in hormone receptor-positive metastatic breast cancer patients receiving CDK 4/6 inhibitors.
METHODS: Our study was designed as a single-center, retrospective analysis including 94 patients (93 females, 1 male). The mean age at diagnosis was 55 years. The most commonly used treatment combination was ribociclib + letrozole (45.7%). Neutropenia was the most frequent adverse event associated with CDK 4/6 inhibitors (35.5% of patients), followed by fatigue (25.8%) and nausea (19.4%).
RESULTS: The mean highest SUVmax value (primary tumor + metastases) before CDK4/6 inhibitor treatment was 11.20, which decreased to 7.32 after treatment initiation (p = 0.001). Patients with a marked absolute reduction in SUVmax (AUC: 0.769, p = 0.001, cut-off: 3.35) had longer progression-free survival (PFS) compared with those without a reduction (28.92 months vs. 14.47 months). The difference between pre- and post-treatment SUVmax values was significantly associated with both Clinical Benefit Rate (CBR) and Objective Response Rate (ORR) (p = 0.001).
CONCLUSION: Early changes in 18 F-FDG PET/CT SUVmax values can serve as a valuable predictive marker for treatment response and survival in patients with metastatic breast cancer treated with CDK 4/6 inhibitors.
METHODS: Our study was designed as a single-center, retrospective analysis including 94 patients (93 females, 1 male). The mean age at diagnosis was 55 years. The most commonly used treatment combination was ribociclib + letrozole (45.7%). Neutropenia was the most frequent adverse event associated with CDK 4/6 inhibitors (35.5% of patients), followed by fatigue (25.8%) and nausea (19.4%).
RESULTS: The mean highest SUVmax value (primary tumor + metastases) before CDK4/6 inhibitor treatment was 11.20, which decreased to 7.32 after treatment initiation (p = 0.001). Patients with a marked absolute reduction in SUVmax (AUC: 0.769, p = 0.001, cut-off: 3.35) had longer progression-free survival (PFS) compared with those without a reduction (28.92 months vs. 14.47 months). The difference between pre- and post-treatment SUVmax values was significantly associated with both Clinical Benefit Rate (CBR) and Objective Response Rate (ORR) (p = 0.001).
CONCLUSION: Early changes in 18 F-FDG PET/CT SUVmax values can serve as a valuable predictive marker for treatment response and survival in patients with metastatic breast cancer treated with CDK 4/6 inhibitors.