Annovazzi Alessio, Rea Sandra, Maccora Daria, Pizzuti Laura, Ferretti Gianluigi, Vici Patrizia, Cappuzzo Federico, Sciuto Rosa
Nuclear Medicine Unit - IRCCS, Regina Elena National Cancer Institute, Rome, Italy.
Division of Medical Oncology 2 - IRCCS, Regina Elena National Cancer Institute, Rome, Italy.
Front Oncol. 2023 Jul 14;13:1193174. doi: 10.3389/fonc.2023.1193174. eCollection 2023.
The addition of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) to endocrine therapy impressively improved the outcome of patients with hormone receptor-positive metastatic breast cancer. Despite their great efficacy, not all patients respond to treatment and many of them develop acquired resistance. The aim of this retrospective study was to assess the role of [18F]-FDG PET/CT in predicting PFS and OS in breast cancer patients treated with CDK4/6i.
114 patients who performed an [18F]-FDG PET/CT scan before (PET1) and 2-6 months (PET2) after starting treatment were retrospectively enrolled. Metabolic response was evaluated by EORTC, PERCIST and Deauville Score and correlated to PFS and OS.
In patients who did not progress at PET2 (n = 90), PFS rates were not significantly different between classes of response by EORTC and PERCIST. Conversely, patients showing a Deauville score ≤3 had a longer PFS (median PFS 42 vs 21.0 months; p = 0.008). A higher total metabolic tumor volume at PET1 (TMTV1) was also associated with a shorter PFS (median 18 vs 42 months; p = 0.0026). TMTV1 and Deauville score were the only independent prognostic factors for PFS at multivariate analysis and their combination stratified the population in four definite classes of relapse risk. Conversely, the above parameters did not affect OS which was only influenced by a progressive metabolic disease at PET2 (3-years survival rate 29.8 vs 84.9%; p<0.0001).
TMTV and metabolic response by Deauville score were significant prognostic factors for PFS in patients with breast cancer treated with CDK4/6i. Their determination could help physicians to select patients who may need a closer follow up.
在内分泌治疗中添加细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6i）显著改善了激素受体阳性转移性乳腺癌患者的预后。尽管其疗效显著，但并非所有患者都对治疗有反应，许多患者会产生获得性耐药。这项回顾性研究的目的是评估[18F]-FDG PET/CT在预测接受CDK4/6i治疗的乳腺癌患者无进展生存期（PFS）和总生存期（OS）方面的作用。
回顾性纳入114例在开始治疗前（PET1）和开始治疗后2 - 6个月（PET2）进行了[18F]-FDG PET/CT扫描的患者。通过欧洲癌症研究与治疗组织（EORTC）、实体瘤疗效评价标准（PERCIST）和多维尔评分（Deauville Score）评估代谢反应，并将其与PFS和OS相关联。
在PET2时未进展的患者（n = 90）中，EORTC和PERCIST反应类别之间的PFS率无显著差异。相反，多维尔评分为≤3的患者PFS更长（中位PFS 42个月对21.0个月；p = 0.008）。PET1时更高的总代谢肿瘤体积（TMTV1）也与较短的PFS相关（中位18个月对42个月；p = 0.0026）。在多因素分析中，TMTV1和多维尔评分是PFS的唯一独立预后因素，它们的组合将人群分为四个明确的复发风险类别。相反，上述参数不影响OS，OS仅受PET2时进行性代谢疾病的影响（3年生存率29.8%对84.9%；p<0.0001）。
TMTV和多维尔评分的代谢反应是接受CDK4/6i治疗的乳腺癌患者PFS的重要预后因素。对它们的测定有助于医生选择可能需要更密切随访的患者。
