The role of dual-tracer PET imaging with ER and HER2 in patients with metastatic breast cancer: a pilot study

IF 2.5 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Annals of Nuclear Medicine Pub Date : 2025-06-26 DOI:10.1007/s12149-025-02071-2

Cheng Liu, Donghui Pan, Yuyun Sun, Xiaoping Xu, Zhongyi Yang, Min Yang, Shaoli Song

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Abstract

Objective

Accurate and real-time evaluation of tumor ER and HER2 status is essential for improving the clinical management of patients with metastatic breast cancer (MBC). The purpose of this pilot study was to investigate the value of PET imaging with ¹⁸F-FES and ⁶⁸ Ga-HER2 affibody for the noninvasive evaluation of the ER and HER2 status in MBC patients.

Methods

From January 2021 to September 2023, 17 metastatic breast cancer (MBC) patients underwent ¹⁸F-FES and ⁶⁸Ga-HER2-affibody PET/CT within one month, with concurrent ¹⁸F-FDG PET/CT for tumor glycolytic activity evaluation. The imaging data were integrated to detect lesions and analyze intra-patient heterogeneity. The efficacy of lesion detection across different modalities was evaluated, along with an assessment of their potential impact on clinical decision-making.

Results

A total of 174 metastatic lesions were detected: 163 (93.7%) showed high ¹⁸F-FDG uptake, 91 (52.3%) exhibited ¹⁸F-FES positivity, and 104 (59.8%) demonstrated ⁶⁸Ga-HER2-affibody binding. The biopsy correlation revealed significantly higher ¹⁸F-FES and ⁶⁸Ga-HER2-affibody uptake in ER-positive (P < 0.05) and HER2-positive (P < 0.05) lesions, respectively, compared to their negative counterparts. In clinical decision-making influenced by PET findings, 12 of 17 patients (70.6%) had treatment strategies concordant with ¹⁸F-FES and ⁶⁸Ga-HER2-affibody PET results. Among nine dual-positive patients (both tracers positive), 55.6% (5/9) were administered combined endocrine therapy and anti-HER2 targeted regimens, thereby obviating chemotherapy. In single-tracer-positive subgroups, 100% (2/2) of ¹⁸F-FES + /⁶⁸Ga-HER2 − cases received endocrine therapy (with or without CDK4/6 inhibitors), whereas 66.7% (2/3) of ⁶⁸Ga-HER2 + /¹⁸F-FES − patients were treated with anti-HER2 therapy (with or without chemotherapy). Notably, three dual-negative patients were not prescribed antihormonal or anti-HER2 agents; instead, they received chemotherapy (with or without immunotherapy), avoiding inappropriate targeted interventions.

Conclusion

Dual-tracer PET imaging enables noninvasive assessment of ER/HER2 status and intratumoral heterogeneity, providing critical insights for personalized treatment strategies in MBC.

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ER和HER2双示踪PET成像在转移性乳腺癌患者中的作用：一项初步研究

目的：准确、实时地评估肿瘤ER和HER2状态对改善转移性乳腺癌（MBC）患者的临床管理至关重要。本初步研究的目的是探讨18F-FES和68 Ga-HER2粘附体PET成像在无创评估MBC患者ER和HER2状态中的价值。方法：从2021年1月至2023年9月，17例转移性乳腺癌（MBC）患者在1个月内接受1⁸F-FES和6⁸ga - her2 -粘附体PET/CT检查，同时进行1⁸F-FDG PET/CT检查，评估肿瘤糖酵解活性。整合影像学数据以检测病变并分析患者内部异质性。评估了不同模式下病变检测的有效性，以及它们对临床决策的潜在影响。结果：共检测到174例转移灶：163例（93.7%）表现为1⁸F-FDG高摄取，91例（52.3%）表现为1⁸F-FES阳性，104例（59.8%）表现为26⁸ga - her2粘附体结合。活检相关结果显示，er阳性（P 1⁸F-FES和26⁸ga - her2 -粘附体PET结果）的1⁸F-FES和26⁸ga - her2 -粘附体摄取显著更高。在9例双阳性患者（两种示踪剂均阳性）中，55.6%（5/9）的患者接受了内分泌治疗和抗her2靶向治疗联合治疗，从而避免了化疗。在单示踪剂阳性亚组中，100%（2/2）的1⁸F-FES + / 26⁸Ga-HER2 -患者接受了内分泌治疗（加或不加CDK4/6抑制剂），而66.7%（2/3）的6⁸Ga-HER2 + /1⁸F-FES -患者接受了抗her2治疗（加或不加化疗）。值得注意的是，3例双阴性患者未开抗激素或抗her2药物；相反，他们接受化疗（有或没有免疫治疗），避免了不适当的靶向干预。结论：双示踪PET成像能够无创评估ER/HER2状态和肿瘤内异质性，为MBC的个性化治疗策略提供重要见解。

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来源期刊

Annals of Nuclear Medicine 医学-核医学

CiteScore

4.90

自引率

7.70%

发文量

111

审稿时长

4-8 weeks

期刊介绍： Annals of Nuclear Medicine is an official journal of the Japanese Society of Nuclear Medicine. It develops the appropriate application of radioactive substances and stable nuclides in the field of medicine. The journal promotes the exchange of ideas and information and research in nuclear medicine and includes the medical application of radionuclides and related subjects. It presents original articles, short communications, reviews and letters to the editor.