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Imaging of ER Density to Guide and Improve Tailored Therapy for Acquired Anti-hormonal Resistant Breast Cancer

U

University Medical Center Groningen (UMCG)

Status

Completed

Conditions

Breast Cancer

Treatments

Other: Diagnostic intervention: Positron Emission Tomography with 16-alpha-[18-fluoro]-17betaestradiol

Study type

Observational

Funder types

Other

Identifiers

NCT01088477
RUG 2009-4529

Details and patient eligibility

About

In 50 breast cancer patients, heavily pretreated with anti-hormonal therapy, the investigators will evaluate the use of 16-alpha[18-fluoro]-17beta-estradiol positron emission tomography (FES-PET)as predictive biomarker for response to estrogen therapy.

Full description

The estrogen receptor (ER) is expressed in approximately 70% of the breast carcinomas. In general, for these patients anti-hormonal therapy is the therapy of first choice. Despite good responses in 50-60% of the patients, unfortunately all patients develop (acquired) resistance. Patients with acquired anti-hormonal resistance can be subdivided into three different groups: (1) patients that have lost ER-expression (~25%), (2) patients with preserved ER-expression (~55%) and (3) patients with enhanced ER-expression (~30%). Several studies suggest different treatment strategies for these three different ER-phenotypes in antihormonal resistant breast cancer. In patients with acquired anti-hormonal resistance, ~30% of the patients still respond to hormone-additive therapy with estrogens. In vitro studies have shown estrogen-induced apoptosis in long-treated estrogen deprived cells (simulating aromatase inhibitor resistance). It is suggested that this estrogen-hypersensitivity is accompanied by increased ER-expression.

Whole-body imaging of ER-density is now possible with positron emission tomography with the 16-alpha[18-fluoro]-17beta-estradiol tracer (FES-PET). FES-PET has shown to be a predictive biomarker for response to first line anti-hormonal therapy.

In this study we will include 50 patients, heavily pretreated with anti-hormonal therapy. All patients will undergo FES-PET at baseline and start estrogen therapy. Investigators and patients will be blinded for FES-PET results. Responders and non-responders will be defined using RECIST criteria and clinical follow-up. After response has been determined, FES-PET results will be analyzed. We hypothesize that patients responding to estrogen therapy can be identified on basis of high ER-expression determined by FES-PET.

Enrollment

21 patients

Sex

Female

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  1. Patients with the diagnosis of acquired anti-hormonal resistant advanced breast cancer showing progression after two or more lines of antihormonal treatment;
  2. Treatment with estradiol will be started;
  3. Age> 18 years;
  4. ECOG performance status 0-2.

Exclusion criteria

  1. Life Expectancy <3 months;
  2. Uncontrolled CNS metastases;
  3. History of thrombosis;
  4. Uncontrolled hypercalcemia;
  5. Treatment with any investigational drug within 30 days before start of study;
  6. Serious uncontrolled concurrent illness, e.g. autoimmune disorders;
  7. New York Hearth Association (NYHA) class III/IV congestive heart failure;
  8. Dyspnea at rest due to any cause;
  9. Pregnant or lactating women. Documentation of a negative pregnancy test must be available for pre-menopausal women with intact reproductive organs and for women less than two years after menopause;
  10. Women of childbearing potential unless a) surgically sterile or b) using adequate measures of contraception.
  11. Diabetes Mellitus

Trial design

21 participants in 1 patient group

Breast cancer patients with acquired anti-hormonal resistance
Treatment:
Other: Diagnostic intervention: Positron Emission Tomography with 16-alpha-[18-fluoro]-17betaestradiol

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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