双示踪剂PET成像联合雌激素受体（ER）和人表皮生长因子受体2（HER2）在转移性乳腺癌患者中的作用：一项初步研究。

The role of dual-tracer PET imaging with ER and HER2 in patients with metastatic breast cancer: a pilot study.

作者信息

Liu Cheng, Pan Donghui, Sun Yuyun, Xu Xiaoping, Yang Zhongyi, Yang Min, Song Shaoli

机构信息

Shanghai Institute of Medical Imaging, Shanghai, 200032, China.

Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.

出版信息

Ann Nucl Med. 2025 Jun 26. doi: 10.1007/s12149-025-02071-2.

DOI:10.1007/s12149-025-02071-2

PMID:40569557

Abstract

OBJECTIVE

Accurate and real-time evaluation of tumor ER and HER2 status is essential for improving the clinical management of patients with metastatic breast cancer (MBC). The purpose of this pilot study was to investigate the value of PET imaging with F-FES and Ga-HER2 affibody for the noninvasive evaluation of the ER and HER2 status in MBC patients.

METHODS

From January 2021 to September 2023, 17 metastatic breast cancer (MBC) patients underwent ⁸F-FES and ⁶⁸Ga-HER2-affibody PET/CT within one month, with concurrent ⁸F-FDG PET/CT for tumor glycolytic activity evaluation. The imaging data were integrated to detect lesions and analyze intra-patient heterogeneity. The efficacy of lesion detection across different modalities was evaluated, along with an assessment of their potential impact on clinical decision-making.

RESULTS

A total of 174 metastatic lesions were detected: 163 (93.7%) showed high ⁸F-FDG uptake, 91 (52.3%) exhibited ⁸F-FES positivity, and 104 (59.8%) demonstrated ⁶⁸Ga-HER2-affibody binding. The biopsy correlation revealed significantly higher ⁸F-FES and ⁶⁸Ga-HER2-affibody uptake in ER-positive (P < 0.05) and HER2-positive (P < 0.05) lesions, respectively, compared to their negative counterparts. In clinical decision-making influenced by PET findings, 12 of 17 patients (70.6%) had treatment strategies concordant with ⁸F-FES and ⁶⁸Ga-HER2-affibody PET results. Among nine dual-positive patients (both tracers positive), 55.6% (5/9) were administered combined endocrine therapy and anti-HER2 targeted regimens, thereby obviating chemotherapy. In single-tracer-positive subgroups, 100% (2/2) of ⁸F-FES + /⁶⁸Ga-HER2 - cases received endocrine therapy (with or without CDK4/6 inhibitors), whereas 66.7% (2/3) of ⁶⁸Ga-HER2 + /⁸F-FES - patients were treated with anti-HER2 therapy (with or without chemotherapy). Notably, three dual-negative patients were not prescribed antihormonal or anti-HER2 agents; instead, they received chemotherapy (with or without immunotherapy), avoiding inappropriate targeted interventions.

CONCLUSION

Dual-tracer PET imaging enables noninvasive assessment of ER/HER2 status and intratumoral heterogeneity, providing critical insights for personalized treatment strategies in MBC.

摘要

目的

准确、实时评估肿瘤雌激素受体（ER）和人表皮生长因子受体2（HER2）状态对于改善转移性乳腺癌（MBC）患者的临床管理至关重要。本初步研究的目的是探讨¹⁸F-氟雌二醇（¹⁸F-FES）和⁶⁸Ga-HER2亲和体正电子发射断层显像（PET）对MBC患者ER和HER2状态进行无创评估的价值。

方法

2021年1月至2023年9月，17例转移性乳腺癌患者在1个月内接受了¹⁸F-FES和⁶⁸Ga-HER2亲和体PET/CT检查，并同时进行¹⁸F-氟代脱氧葡萄糖（¹⁸F-FDG）PET/CT以评估肿瘤糖酵解活性。整合影像数据以检测病变并分析患者体内的异质性。评估了不同检查方法检测病变的效能，以及它们对临床决策的潜在影响。

结果

共检测到174个转移病灶：163个（93.7%）表现为¹⁸F-FDG高摄取，91个（52.3%）显示¹⁸F-FES阳性，104个（59.8%）表现为⁶⁸Ga-HER2亲和体结合。活检相关性显示，与ER阴性和HER2阴性病变相比，ER阳性（P＜0.05）和HER2阳性（P＜0.05）病变中¹⁸F-FES和⁶⁸Ga-HER2亲和体摄取分别显著更高。在受PET检查结果影响的临床决策中，17例患者中有12例（70.6%）的治疗策略与¹⁸F-FES和⁶⁸Ga-HER2亲和体PET结果一致。在9例双阳性患者（两种示踪剂均为阳性）中，55.6%（5/9）接受了内分泌联合抗HER2靶向治疗方案，从而避免了化疗。在单示踪剂阳性亚组中，¹⁸F-FES阳性/⁶⁸Ga-HER2阴性病例中有100%（2/2）接受了内分泌治疗（联合或不联合细胞周期蛋白依赖性激酶4/6抑制剂），而⁶⁸Ga-HER2阳性/¹⁸F-FES阴性患者中有66.7%（2/3）接受了抗HER2治疗（联合或不联合化疗）。值得注意的是，3例双阴性患者未使用抗激素或抗HER2药物；相反，他们接受了化疗（联合或不联合免疫治疗），避免了不适当的靶向干预。