Department of Breast Surgery And Department of Nuclear Medicine, Fudan University Shanghai Cancer Center,
Approximately 30% of ER-positive breast cancer will unfortunately display primary resistance
to hormonal therapy, and some may develop acquired resistance to the therapy after initial
treatment. Hypoxia is a normal phenomenon in solid tumors that arises, in part, from
uncontrolled proliferation and immature blood vessels. Previous studies have demonstrated
hypoxia significantly reduced both the growth-promoting effects of estradiol (E2) and the
growth-inhibitory effects of an antiestrogen on ER-positive breast cancer cell lines. A
recent study comparing neoadjuvant letrozole with letrozole plus metronomic cyclophosphamide
found that increased levels of HIF-1a were significantly associated with resistance to
treatment. Taken together, these data indicate that hypoxia might be associated with
endocrine resistance in breast cancer.
With PET/CT, radiolabeled hypoxia-avid compounds can be applied to evaluate oxygenation
status in experimental or human tumors. 18F-labeled fluoromisonidazole (1-[2-nitro-
1-imidazolyl]-2-hydroxy-3-fluoropropane [18F-FMISO]) PET/CT is the most widely used one in
the clinic. Studies have demonstrated an excellent correlation between the 18F-FMISO uptake
and oxygenation status of several cancers including breast cancer.
The major aim of our study was to analyze uptake of 18FFMISO as well as the IHC expression
of HIF-1-alpha in ER-positive breast cancers, and to predict the clinical, pathological and
biological response of primary endocrine therapy.
Observational [Patient Registry]
Observational Model: Case Control, Time Perspective: Prospective
Clinical Objective Response
Tumor response was evaluated according to the criteria of the World Health Organization. Clinical tumor progression (PD) was defined as an increase of at least 25% in tumor size; stable disease (SD) as an increase of less than 25% or a reduction of less than 50%; partial response (cPR) as a tumor shrinkage greater than 50%; and complete response (cCR) as the complete disappearance of all clinical signs of disease.
Guangyu Liu, M.D.
Cancer Hospital/Institute,Fudan University
China: Food and Drug Administration