Response monitoring of metastatic breast cancer

International guidelines do not provide clear recommendations on the choice of imaging method for the diagnosis of metastatic breast cancer, and different methods are therefore used depending on local practice. However, there is evidence that the method called FDG-PET/CT (“fluordeoxyglucose-positron emissions tomography/computer tomography”) can be used to diagnose distant metastases in patients with metastatic breast cancer. It can therefore also help to improve the monitoring of the patient's response to treatment, but research in this area has been sparse.

A recent prospective study of 87 metastatic breast cancer patients suggested that FDG-PET/CT could detect the first progression up to six months earlier than contrast-enhanced computed tomography (CE-CT). FDG-PET/CT has also been shown to be a superior predictor of progression-free and disease-specific survival than CE-CT in patients, and response monitoring with FDG/PET-CT may therefore improve patient management and clinical decision-making. However, the cost of using FDG-PET/CT for response monitoring has been a concern for healthcare providers. No clear economic evaluation comparing the two diagnostic methods has been done.

AIM

The aim of the PhD project was to compare response categories and their clinical effect, survival and cost-effectiveness of FDG-PET/CT versus CE-CT.

RESULTS

Patients treated for metastatic breast cancer who had treatment effect monitored with FDG-PET/CT, either alone or in combination with CE-CT, had an improved overall survival of 14-24 months compared to patients monitored with CE-CT alone. When using CE-CT, stable disease was more often reported, while FDG-PET/CT detected changes more frequently.

FDG-PET/CT appears to be a more sensitive and cost-effective method than CE-CT for monitoring treatment response in patients with metastatic breast cancer. However, these results need to be verified, preferably in a prospective multicentre randomised trial.

PARTNERS

The project was a PhD project by Mohammad Naghavi-Behzad.

The main supervisor on the project was Malene Grubbe Hildebrandt. Co-supervisors were Annette Raskov Kodahl, Kristian Kidholm and Wolfgang Weber.

EXTERNAL FINANCING

The project was financed by Odense University Hospital and the Faculty of Health Sciences at the University of Southern Denmark.

Additional funding came from Dagmar Marshall's Foundation, GE Healthcare Company.