Triple negative breast cancer: imaging for better patient care

The nuclear medicine team at the Curie Institute, led by Dr. Lawrence Champion (St. Cloud site), in collaboration with the Laboratory for Translational Imaging in Oncology (Inserm U1288), led by Dr. Irene Bova, evaluated the contribution of metabolic imaging obtained by positron emission tomography (PET) combined with computed tomography (CT), known as “PET-scanner,” which is performed before neoadjuvant therapy in patients with early-stage triple-negative breast cancer.

This study showed that metabolic characteristics of the tumor, measured from a PET image, make it possible to predict complete histologic response (CHR), a good prognostic factor associated with a lower risk of recurrence.

The RHC rate was 53% in 91 patients treated with chemotherapy alone and 70% in 100 patients treated with chemotherapy plus immunotherapy. The greater the metabolic activity of the tumor that is measurable on a PET image, and the lower the metabolic volume of the tumor, the greater the likelihood of RHC. Combining these metabolic data therefore makes it possible to determine the likelihood of RHC, by prioritizing the level of risk.

Furthermore, patients’ thyroid metabolic activity before the start of treatment was associated with the occurrence of eventual immunotherapy-induced hypothyroidism, requiring subsequent replacement with thyroid hormones.

Thus, this work highlights the ability of positron emission tomography (PET) to adapt and improve patient care based on their metabolic characteristics.

Until now, positron emission tomography (PET) has been primarily used to evaluate the extent of disease and rule out potential metastases. This multidisciplinary research work demonstrates that FDG PET can also predict treatment effectiveness and potential side effects.

Dr. Romain David Siban, a nuclear physician at the St. Cloud site and first author of the study, explains.

These results confirm the predominant role of positron emission tomography (PET) and suggest that it should be taken into account in order to develop more personalized treatment strategies for patients, which are also more effective and better.

Reference: Prof. Dr. Sipan et al.
[18F]FDG PET/CT to predict triple-negative breast cancer outcomes after neoadjuvant chemotherapy with or without pembrolizumab
European Journal of Nuclear Medicine and Molecular Imaging (2023)