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document
18F-FDG PET/CT for early prediction of response to neoadjuvant lapatinib , trastuzumab , and their combination in HER2-positive breast cancer : results from Neo-ALTTO . UNLABELLED Molecular imaging receives increased attention for selecting patients who will benefit from targeted anticancer therapies . Neo-ALTTO ( Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimisation ) enrolled 455 women with invasive human epidermal growth factor receptor 2 ( HER2 ) -positive breast cancer and compared rates of pathologic complete response ( pCR ) to neoadjuvant lapatinib , trastuzumab , and their combination . Each anti-HER2 therapy was given alone for 6 wk , followed by 12 wk of the same therapy plus weekly paclitaxel . The early metabolic effects of the anti-HER2 therapies on the primary tumors and their predictive values for pCR were assessed in a subset of patients . METHODS Eighty-six patients underwent ( 18 ) F-FDG PET/CT at baseline and weeks 2 and 6 of anti-HER2 treatment . An imaging core laboratory provided central validation , and 2 independent reviewers , masked to assigned treatment arm and clinical outcomes , performed consensus ( 18 ) F-FDG PET/CT readings . Maximum standardized uptake value ( SUVmax ) reductions from baseline were used to measure metabolic response . RESULTS Seventy-seven of the 86 enrolled patients presented an evaluable baseline ( 18 ) F-FDG PET/CT scan ; of these , 68 and 66 were evaluable at weeks 2 and 6 , respectively . Metabolic responses in the primary tumors were evident after 2 wk of targeted therapy and correlated highly with metabolic responses at week 6 ( R ( 2 ) = 0.81 ) . pCRs were associated with greater SUVmax reductions at both time points . Mean SUVmax reductions for pCR and non-pCR , respectively , were 54.3 % versus 32.8 % at week 2 ( P = 0.02 ) and 61.5 % versus 34.1 % at week 6 ( P = 0.02 ) . ( 18 ) F-FDG PET/CT metabolic response rates at weeks 2 and 6 were 71.6 % and 60 % , respectively using European Organization for Research and Treatment of Cancer criteria ; pCR rates were twice as high for ( 18 ) F-FDG PET/CT responders than nonresponders ( week 2 : 42 % vs. 21 % , P = 0.12 ; week 6 : 44 % vs. 19 % , P = 0.05 ) . CONCLUSION Early metabolic assessment using ( 18 ) F-FDG PET/CT can identify patients with an increased likelihood of pCR after neoadjuvant trastuzumab , lapatinib , or their combination when given with chemotherapy .
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Intervention_Pharmacological
neoadjuvant lapatinib
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Intervention_Pharmacological
trastuzumab
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Intervention_Pharmacological
their combination
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Intervention_Pharmacological
Neo-ALTTO
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Intervention_Pharmacological
Neoadjuvant Lapatinib
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Intervention_Pharmacological
Trastuzumab
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Intervention_Pharmacological
neoadjuvant lapatinib
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Intervention_Pharmacological
trastuzumab
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Intervention_Pharmacological
combination
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Intervention_Pharmacological
anti-HER2 therapy
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Intervention_Pharmacological
paclitaxel
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Intervention_Pharmacological
anti-HER2 therapies
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Intervention_Pharmacological
anti-HER2 treatment
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Intervention_Pharmacological
neoadjuvant trastuzumab
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Intervention_Pharmacological
lapatinib
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Intervention_Pharmacological
combination
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Intervention_Pharmacological
chemotherapy
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Outcome_Physical
metabolic effects
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Outcome_Physical
standardized uptake value ( SUVmax ) reductions from baseline
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Outcome_Physical
Metabolic responses
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Outcome_Physical
( 18 ) F-FDG PET/CT metabolic response rates
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Participant_Condition
HER2-positive breast cancer :
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Participant_Condition
patients who will benefit from targeted anticancer therapies .
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Participant_Condition
455 women with invasive human epidermal growth factor receptor 2 ( HER2 ) -positive breast cancer
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Participant_Condition
assessed in a subset of patients .
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Participant_Sample-size
Eighty-six patients underwent ( 18 ) F-FDG PET/CT