Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS.
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Curr Opin Oncol. 2022 Nov 1;34(6):606-613. doi: 10.1097/CCO.0000000000000908. Epub 2022 Sep 12.
Nuclear medicine has the potential to explore and illuminate several pathways in breast cancer (BC) offering different radiopharmaceuticals for positron emission tomography (PET) designed to target specific tumor characteristics. The aim of this critical review is to give an overview about emerging opportunities in PET imaging, underlining the future potential contribution in the management of BC patients.
Beside 2-deoxy-2-[ 18 F]-fluoro- d -glucose (FDG), new generation tracers for PET imaging have been recently proposed to investigate specific characteristics in breast cancer, both targeting tumor cells and the tumor micro-environment (TME).
FDG-PET is a procedure that received extensive clinical validation. However, its role in BC is still suboptimal due to the low-FDG avidity of specific tumor subtypes. Human epidermal growth receptor-2 and integrin targeted PET radiotracers might provide useful information selecting patients more likely to respond to target therapy. FluoroEstradiol (FES) is a FDA-approved PET radiotracer targeting the estrogen receptor (ER), useful to investigate metastatic ER+ patients, to assess in vivo ER heterogeneity and to evaluate hormonal therapy efficacy. Inhibitors of the fibroblast activation protein (FAPi) targeting the cancer-associated fibroblast can explore the TME with PET imaging. FAPi is also proposed a theranostic agent for radio-ligand therapy.
核医学有可能探索和阐明乳腺癌（BC）中的多个途径，提供用于正电子发射断层扫描（PET）的不同放射性药物，旨在针对特定的肿瘤特征。本文批判性地综述了 PET 成像中出现的新机遇，强调了其在 BC 患者管理中的未来潜在贡献。
除了 2-脱氧-2-[18F]-氟-d-葡萄糖（FDG）外，最近还提出了新一代用于 PET 成像的示踪剂，以研究乳腺癌的特定特征，既针对肿瘤细胞又针对肿瘤微环境（TME）。
FDG-PET 是一种已广泛接受临床验证的程序。然而，由于特定肿瘤亚型对 FDG 的亲和力低，其在 BC 中的作用仍然不尽如人意。人表皮生长因子受体-2 和整合素靶向 PET 放射性示踪剂可能提供有用的信息，选择更有可能对靶向治疗有反应的患者。氟雌二醇（FES）是一种经美国食品和药物管理局（FDA）批准的用于靶向雌激素受体（ER）的 PET 放射性示踪剂，可用于研究转移性 ER+患者，评估体内 ER 异质性，并评估激素治疗的疗效。成纤维细胞激活蛋白（FAPi）抑制剂靶向癌相关成纤维细胞，可通过 PET 成像探索肿瘤微环境。FAPi 也被提议作为放射性配体治疗的治疗剂。
