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Войти в исследования Clinical breast cancer · 2026
Clinical Utility of [18F]Fluoroestradiol PET/CT to Guide Second Line Treatment Decision in ER-Positive HER2-Negative Metastatic Breast Cancer After Progression on First Line Endocrine Therapy.
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Linden Hannah M, O'Brien Sophia R, van de Ven Stephanie M, La Porte Paul, Conti Peter S, Peddi Parvin F, Mortimer Joanne E, Brenin Christiana, Takalkar Amol M, McGuinness Julia E, Cheng Edgar, Rao Amol, Peterson Lanell M, Specht Jennifer M, Wong Terence Z, Buck David A, Brufsky Adam M, Ulaner Gary A
Аннотация
PURPOSE: Many patients with ER-positive HER2-negative metastatic breast cancer (MBC) derive limited benefit from second line endocrine therapy. This study evaluated the impact of [18F]fluoroestradiol (FES) PET/CT on second line therapeutic decision-making.
METHODS: Patients with progression of ER-positive HER2-negative MBC on first line endocrine therapy were prospectively enrolled in 17 U.S. centers to undergo [18F]FES PET/CT after standard-of-care (SoC) imaging. [18F]FES uptake in MBC lesions was evaluated. Treating oncologists completed questionnaires before and after [18F]FES PET/CT, detailing therapeutic decisions plus their confidence in the decisions. The primary endpoint was the proportion of patients whose therapeutic management changed after [18F]FES PET/CT.
RESULTS: Between January 2023 and May 2024, 45 patients underwent [18F]FES PET/CT. Imaging results led to management changes in 17 patients (37.8%; 95% CI, 23.8%-53.5%). Twenty-five patients avoided further diagnostic testing, while 7 patients received additional tests. Oncologist's confidence in second line treatment decision increased on average from 6.6 before [18F]FES PET/CT to 8.6 afterward on a ten-point scale (P < .0001). In 25 patients (55.6%), lesions visible on SoC imaging were reported as "absent" (FES-negative) on [18F]FES PET/CT, suggesting potential loss or downregulation of ER that functionally binds estrogen.
CONCLUSION: [18F]FES PET/CT altered therapeutic management in 37.8% of patients with MBC progressing on first line endocrine therapy and significantly increased oncologist's confidence in treatment selection. This imaging modality could help prevent unnecessary prolongation of ineffective endocrine therapy and delays in initiation of more effective options. Future studies should investigate potential outcome benefits after [18F]FES PET/CT-informed management changes.
METHODS: Patients with progression of ER-positive HER2-negative MBC on first line endocrine therapy were prospectively enrolled in 17 U.S. centers to undergo [18F]FES PET/CT after standard-of-care (SoC) imaging. [18F]FES uptake in MBC lesions was evaluated. Treating oncologists completed questionnaires before and after [18F]FES PET/CT, detailing therapeutic decisions plus their confidence in the decisions. The primary endpoint was the proportion of patients whose therapeutic management changed after [18F]FES PET/CT.
RESULTS: Between January 2023 and May 2024, 45 patients underwent [18F]FES PET/CT. Imaging results led to management changes in 17 patients (37.8%; 95% CI, 23.8%-53.5%). Twenty-five patients avoided further diagnostic testing, while 7 patients received additional tests. Oncologist's confidence in second line treatment decision increased on average from 6.6 before [18F]FES PET/CT to 8.6 afterward on a ten-point scale (P < .0001). In 25 patients (55.6%), lesions visible on SoC imaging were reported as "absent" (FES-negative) on [18F]FES PET/CT, suggesting potential loss or downregulation of ER that functionally binds estrogen.
CONCLUSION: [18F]FES PET/CT altered therapeutic management in 37.8% of patients with MBC progressing on first line endocrine therapy and significantly increased oncologist's confidence in treatment selection. This imaging modality could help prevent unnecessary prolongation of ineffective endocrine therapy and delays in initiation of more effective options. Future studies should investigate potential outcome benefits after [18F]FES PET/CT-informed management changes.