{"title":"生长抑素受体靶向治疗雌激素受体阳性转移性乳腺癌——一项前瞻性探索性研究","authors":"Kunal Ramesh Chandekar, Swayamjeet Satapathy, Yamini Dharmashaktu, Sanjana Ballal, Piyush Ranjan, Atul Batra, Ajay Gogia, Sandeep Mathur, Chandrasekhar Bal","doi":"10.1007/s10549-025-07651-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Somatostatin receptor (SSTR) expression has been reported in estrogen receptor-positive (ER +) metastatic breast cancer (mBC) by pathology and immunohistochemistry studies. We aimed to investigate whether SSTR could be a viable target for PET imaging and potential theranostics in ER + mBC.</p><p><strong>Methods: </strong>Thirty prospectively recruited patients with ER + mBC underwent PET/CT imaging with [<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-DOTATATE (within three weeks). Detection rates (per-patient, per-region), number of lesions detected, SUVmax values, Krenning scores, SSTR-FDG visual scores, and PET-based staging with both radiotracers were compared.</p><p><strong>Results: </strong>[<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-DOTATATE PET/CT had similar per-patient detection rates (100% vs 96.7%, P = 1.0). Per-region and per-lesion analyses revealed comparable detection of local/breast lesions, nodal, and skeletal metastases. However, [<sup>18</sup>F]FDG outperformed [<sup>68</sup>Ga]Ga-DOTATATE in detecting visceral/other metastases (235 vs 128 lesions, P = 0.003). [<sup>68</sup>Ga]Ga-DOTATATE resulted in a lower PET-based M-stage compared to [<sup>18</sup>F]FDG in 10% of patients, although T-/N-stages were concordant in all patients. HER2- patients showed a trend of higher [<sup>68</sup>Ga]Ga-DOTATATE lesional SUVmax values compared to the HER2 + sub-group (median 9.0 vs 3.8, P = 0.078). 3/30 (10%) participants had a patient-level Krenning score ≥ 3 ([<sup>68</sup>Ga]Ga-DOTATATE uptake higher than liver background in majority of the lesions), potentially making them suitable for SSTR-targeted radionuclide therapy.</p><p><strong>Conclusions: </strong>SSTR-targeted theranostics may represent a novel potential alternative in a subset of patients with ER + mBC. Its generalized applicability is limited by poor sensitivity for visceral metastases and significant inter-lesion heterogeneity. Future studies must identify how tumor subtype, proliferation, and prior systemic therapies impact SSTR expression levels in these patients to ensure meaningful clinical translation.</p><p><strong>Clinical trial registration: </strong>Clinical Trials Registry-India: CTRI/2023/03/051025 (prospectively registered on 23.03.2023).</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"363-373"},"PeriodicalIF":3.0000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Somatostatin receptor-targeted theranostics in patients with estrogen receptor-positive metastatic breast cancer-a prospective exploratory study.\",\"authors\":\"Kunal Ramesh Chandekar, Swayamjeet Satapathy, Yamini Dharmashaktu, Sanjana Ballal, Piyush Ranjan, Atul Batra, Ajay Gogia, Sandeep Mathur, Chandrasekhar Bal\",\"doi\":\"10.1007/s10549-025-07651-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Somatostatin receptor (SSTR) expression has been reported in estrogen receptor-positive (ER +) metastatic breast cancer (mBC) by pathology and immunohistochemistry studies. We aimed to investigate whether SSTR could be a viable target for PET imaging and potential theranostics in ER + mBC.</p><p><strong>Methods: </strong>Thirty prospectively recruited patients with ER + mBC underwent PET/CT imaging with [<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-DOTATATE (within three weeks). Detection rates (per-patient, per-region), number of lesions detected, SUVmax values, Krenning scores, SSTR-FDG visual scores, and PET-based staging with both radiotracers were compared.</p><p><strong>Results: </strong>[<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-DOTATATE PET/CT had similar per-patient detection rates (100% vs 96.7%, P = 1.0). Per-region and per-lesion analyses revealed comparable detection of local/breast lesions, nodal, and skeletal metastases. However, [<sup>18</sup>F]FDG outperformed [<sup>68</sup>Ga]Ga-DOTATATE in detecting visceral/other metastases (235 vs 128 lesions, P = 0.003). [<sup>68</sup>Ga]Ga-DOTATATE resulted in a lower PET-based M-stage compared to [<sup>18</sup>F]FDG in 10% of patients, although T-/N-stages were concordant in all patients. HER2- patients showed a trend of higher [<sup>68</sup>Ga]Ga-DOTATATE lesional SUVmax values compared to the HER2 + sub-group (median 9.0 vs 3.8, P = 0.078). 3/30 (10%) participants had a patient-level Krenning score ≥ 3 ([<sup>68</sup>Ga]Ga-DOTATATE uptake higher than liver background in majority of the lesions), potentially making them suitable for SSTR-targeted radionuclide therapy.</p><p><strong>Conclusions: </strong>SSTR-targeted theranostics may represent a novel potential alternative in a subset of patients with ER + mBC. Its generalized applicability is limited by poor sensitivity for visceral metastases and significant inter-lesion heterogeneity. Future studies must identify how tumor subtype, proliferation, and prior systemic therapies impact SSTR expression levels in these patients to ensure meaningful clinical translation.</p><p><strong>Clinical trial registration: </strong>Clinical Trials Registry-India: CTRI/2023/03/051025 (prospectively registered on 23.03.2023).</p>\",\"PeriodicalId\":9133,\"journal\":{\"name\":\"Breast Cancer Research and Treatment\",\"volume\":\" \",\"pages\":\"363-373\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Breast Cancer Research and Treatment\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10549-025-07651-4\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast Cancer Research and Treatment","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10549-025-07651-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/26 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：通过病理和免疫组织化学研究发现，生长抑素受体（SSTR）在雌激素受体阳性（ER +）转移性乳腺癌（mBC）中表达。我们的目的是研究SSTR是否可以作为PET成像的可行靶点以及ER + mBC的潜在治疗方法。方法：30例ER + mBC患者（3周内）采用[18F]FDG和[68Ga]Ga-DOTATATE进行PET/CT成像。比较两种放射性示踪剂的检出率（每个患者，每个地区），检测到的病变数量，SUVmax值，Krenning评分，ssr - fdg视觉评分以及基于pet的分期。结果：[18F]FDG和[68Ga]Ga-DOTATATE PET/CT的每例检出率相似（100% vs 96.7%, P = 1.0）。每个区域和每个病灶的分析显示了可比较的局部/乳房病变，淋巴结和骨骼转移的检测。然而，[18F]FDG在检测内脏/其他转移方面优于[68Ga]Ga-DOTATATE （235 vs 128, P = 0.003）。[68Ga]Ga-DOTATATE导致10%的患者pet - m期低于[18F]FDG，尽管所有患者的T-/ n期一致。与HER2 +亚组相比，HER2-患者表现出更高的[68Ga]Ga-DOTATATE病变SUVmax值的趋势（中位数9.0 vs 3.8, P = 0.078）。3/30（10%）的参与者患者水平的Krenning评分≥3 （[68Ga]Ga-DOTATATE摄取高于大多数病变的肝脏背景），可能使他们适合针对ssr的放射性核素治疗。结论：针对sstr的治疗可能是ER + mBC患者亚群的一种新的潜在选择。由于对内脏转移的敏感性较差，且病变间异质性显著，限制了其广泛适用性。未来的研究必须确定肿瘤亚型、增殖和先前的全身治疗如何影响这些患者的SSTR表达水平，以确保有意义的临床转化。临床试验注册：印度临床试验注册中心：CTRI/2023/03/051025（预期于2023年3月23日注册）。
Somatostatin receptor-targeted theranostics in patients with estrogen receptor-positive metastatic breast cancer-a prospective exploratory study.
Purpose: Somatostatin receptor (SSTR) expression has been reported in estrogen receptor-positive (ER +) metastatic breast cancer (mBC) by pathology and immunohistochemistry studies. We aimed to investigate whether SSTR could be a viable target for PET imaging and potential theranostics in ER + mBC.
Methods: Thirty prospectively recruited patients with ER + mBC underwent PET/CT imaging with [18F]FDG and [68Ga]Ga-DOTATATE (within three weeks). Detection rates (per-patient, per-region), number of lesions detected, SUVmax values, Krenning scores, SSTR-FDG visual scores, and PET-based staging with both radiotracers were compared.
Results: [18F]FDG and [68Ga]Ga-DOTATATE PET/CT had similar per-patient detection rates (100% vs 96.7%, P = 1.0). Per-region and per-lesion analyses revealed comparable detection of local/breast lesions, nodal, and skeletal metastases. However, [18F]FDG outperformed [68Ga]Ga-DOTATATE in detecting visceral/other metastases (235 vs 128 lesions, P = 0.003). [68Ga]Ga-DOTATATE resulted in a lower PET-based M-stage compared to [18F]FDG in 10% of patients, although T-/N-stages were concordant in all patients. HER2- patients showed a trend of higher [68Ga]Ga-DOTATATE lesional SUVmax values compared to the HER2 + sub-group (median 9.0 vs 3.8, P = 0.078). 3/30 (10%) participants had a patient-level Krenning score ≥ 3 ([68Ga]Ga-DOTATATE uptake higher than liver background in majority of the lesions), potentially making them suitable for SSTR-targeted radionuclide therapy.
Conclusions: SSTR-targeted theranostics may represent a novel potential alternative in a subset of patients with ER + mBC. Its generalized applicability is limited by poor sensitivity for visceral metastases and significant inter-lesion heterogeneity. Future studies must identify how tumor subtype, proliferation, and prior systemic therapies impact SSTR expression levels in these patients to ensure meaningful clinical translation.
期刊介绍：
Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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