Bennink Roelof J, van Tienhoven Geertjan, Rijks Leonie J, Noorduyn Arnold L, Janssen Anton G, Sloof Gerrit W
Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands.
J Nucl Med. 2004 Jan;45(1):1-7.
In metastatic breast cancer, the estrogen receptor (ER) is a well-known prognostic factor predictive of response to hormonal treatment in most, but not all, patients. Recently, a receptor-specific radioligand for in vivo imaging of the ER in breast cancer patients was developed: (123)I-labeled cis-11beta-methoxy-17alpha-iodovinyl-estradiol (Z-(123)I-MIVE). It showed high sensitivity and specificity for the in vivo detection of ER-positive breast cancer. The aim of this study was to determine whether Z-(123)I-MIVE scintigraphy is able to predict response or resistance to antiestrogen therapy in patients with metastatic ER-positive breast carcinoma.
Twenty-three patients with first metastases of their breast cancer and positive Z-(123)I-MIVE scintigraphy were included and treated with tamoxifen, 40 mg/d. Scintigraphy was repeated, on average, 4 wk later. The results of these scintigraphies were compared with the clinical outcome.
On baseline scintigraphy, 21 of 23 patients had clear uptake and 2 of 23 patients had faint uptake of Z-(123)I-MIVE. After initiation of antiestrogen treatment, 17 of 21 patients with clear uptake on baseline scintigraphy showed complete blockade of ER activity on the Z-(123)I-MIVE scintigraphy. Four of 21 patients showed mixed or no ER blockade. All patients with faint baseline uptake or mixed or no ER blockade after tamoxifen showed progressive disease despite antiestrogen treatment. Patients with clear baseline uptake and complete ER blockade after tamoxifen had a significantly longer progression-free interval (mean +/- SEM, 14.4 +/- 1.6 vs. 1.8 +/- 0.8 mo; P < 0.01).
Z-(123)I-MIVE scintigraphy seems to be a useful tool to predict response or resistance to antiestrogen treatment in ER-positive metastatic breast cancer patients and to depict nonresponders before the clinical manifestation of progression.
在转移性乳腺癌中，雌激素受体（ER）是一种众所周知的预后因素，可预测大多数（但并非所有）患者对激素治疗的反应。最近，开发了一种用于乳腺癌患者体内ER成像的受体特异性放射性配体：（123）I标记的顺式-11β-甲氧基-17α-碘乙烯基雌二醇（Z-（123）I-MIVE）。它对ER阳性乳腺癌的体内检测显示出高灵敏度和特异性。本研究的目的是确定Z-（123）I-MIVE闪烁扫描是否能够预测转移性ER阳性乳腺癌患者对抗雌激素治疗的反应或耐药性。
纳入23例乳腺癌首次转移且Z-（123）I-MIVE闪烁扫描阳性的患者，给予他莫昔芬治疗，40mg/d。平均4周后重复闪烁扫描。将这些闪烁扫描的结果与临床结局进行比较。
在基线闪烁扫描时，23例患者中有21例Z-（123）I-MIVE摄取清晰，23例中有2例摄取微弱。开始抗雌激素治疗后，21例基线闪烁扫描摄取清晰的患者中有17例在Z-（123）I-MIVE闪烁扫描中显示ER活性完全被阻断。21例患者中有4例显示混合或无ER阻断。他莫昔芬治疗后基线摄取微弱或混合或无ER阻断的所有患者尽管接受了抗雌激素治疗仍显示疾病进展。他莫昔芬治疗后基线摄取清晰且ER完全阻断的患者无进展生存期明显更长（平均±标准误，14.4±1.6对1.8±0.8个月；P<0.01）。
Z-（123）I-MIVE闪烁扫描似乎是预测ER阳性转移性乳腺癌患者对抗雌激素治疗反应或耐药性以及在疾病进展临床表现之前描绘无反应者的有用工具。
