Jeong Hyehyun, Ryu Jeongryul, Jeong Jae Ho, Han Sangwon, Hyung Jaewon, Ahn Jin-Hee, Jung Kyung Hae, Kim Sung-Bae, Jeong Byung-Kwan, Lee Hee Jin, Gong Gyungyub, Moon Dae Hyuk
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
Eur J Nucl Med Mol Imaging. 2025 May;52(6):2096-2106. doi: 10.1007/s00259-024-07058-1. Epub 2025 Jan 14.
Estrogen receptor (ER) expression and heterogeneity affect endocrine therapy efficacy. F-fluoroestradiol (F-FES) PET/CT is an effective non-invasive method to analyze systemic ER expression. This study aimed to examine the predictive/prognostic value of F-FES PET/CT for patients treated with endocrine therapy plus cyclin-dependent kinase 4/6 (CDK4/6) inhibitors.
Patients were identified from a prospective cohort for post-marketing surveillance of F-FES enrolled between April 2021 and April 2023 at Asan Medical Center. In this retrospective analysis, patients with ER-positive, HER2-negative recurrent/metastatic breast cancer who underwent CDK4/6 inhibitor-based endocrine therapy and pre-treatment F-FES PET/CT were included.
A total of 127 women were included. The endocrine therapy used was aromatase inhibitors in 96 patients (76%) and fulvestrant in 31 patients (24%). There were 25 (20%) and 102 (80%) patients in the "with FES-negative" (3 completely negative, 22 mixed) and "FES-positive" groups, respectively. F-FES status correlated with progression-free survival (PFS) following endocrine therapy with CDK4/6 inhibitors and overall survival (OS) ("with FES-negative" group: hazard ratio for PFS, 3.9, p < 0.001; for OS, 3.7, p = 0.008). Reduced benefit from endocrine treatment in the "with FES-negative" group was consistent across subgroups including menopausal status, endocrine sensitivity, and treatment regimen.
ER expression determined by F-FES PET/CT predicted the efficacy of CDK4/6 inhibitor-based endocrine therapy and was prognostic for survival in recurrent/metastatic ER-positive, HER2-negative breast cancer.
雌激素受体（ER）的表达及异质性会影响内分泌治疗的疗效。F-氟雌二醇（F-FES）PET/CT是分析全身ER表达的一种有效的非侵入性方法。本研究旨在探讨F-FES PET/CT对接受内分泌治疗联合细胞周期蛋白依赖性激酶4/6（CDK4/6）抑制剂治疗的患者的预测/预后价值。
从2021年4月至2023年4月在峨山医院招募的F-FES上市后监测的前瞻性队列中确定患者。在这项回顾性分析中，纳入了接受基于CDK4/6抑制剂的内分泌治疗且治疗前进行了F-FES PET/CT检查的ER阳性、HER2阴性复发/转移性乳腺癌患者。
共纳入127名女性。所使用的内分泌治疗药物为96例患者（76%）使用芳香化酶抑制剂，31例患者（24%）使用氟维司群。“FES阴性”组（3例完全阴性，22例混合性）和“FES阳性”组分别有25例（20%）和102例（80%）患者。F-FES状态与接受CDK4/6抑制剂内分泌治疗后的无进展生存期（PFS）和总生存期（OS）相关（“FES阴性”组：PFS的风险比为3.9，p<0.001；OS的风险比为3.7，p=0.008）。“FES阴性”组内分泌治疗获益减少在包括绝经状态、内分泌敏感性和治疗方案在内的各亚组中均一致。
F-FES PET/CT测定的ER表达可预测基于CDK4/6抑制剂的内分泌治疗疗效，并对复发/转移性ER阳性、HER2阴性乳腺癌患者的生存具有预后价值。
