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Background <p>Trastuzumab, pertuzumab, and docetaxel (THP) have represented the standard first-line treatment for HER2-positive metastatic breast cancer (MBC) for over a decade, following the pivotal CLEOPATRA trial. However, interim results from the DESTINY-Breast09 trial suggest that trastuzumab deruxtecan (T-DXd) may soon replace THP as the new first-line standard. Recent developments in treatment have raised new questions about how best to match therapy intensity with individual patient profiles. FDG PET/CT, routinely used for metabolic imaging, might help by identifying patients with differing prognoses based on baseline tumor activity. We investigated the prognostic relevance of baseline FDG PET/CT and its association with treatment outcomes in HER2-positive MBC patients receiving first-line THP.</p> Methods <p>We retrospectively analyzed 194 patients with HER2-positive MBC who underwent baseline FDG PET/CT within 12 months before initiating THP therapy (2017–2024). SUVmax was recorded, and optimal cut-off values for progression-free survival (PFS) was determined by ROC analysis. Cox regression and logistic regression were used to identify independent predictors of PFS, OS, and long-term response (PFS ≥ 35 months).</p> Results <p>Median PFS was 29.1 months; 2-year PFS was 60.3%. SUVmax &gt; 9.6 was associated with significantly shorter PFS (18.9 vs. 43.9 months; <i>p</i> = 0.002) and remained independently prognostic in multivariate analysis (HR 1.98; <i>p</i> = 0.001). Median OS was 85.0 months. Among 162 evaluable patients, 35% were classified as long responders. ER positivity (OR 4.82), oligometastatic disease (OR 2.60), and low SUVmax (≤ 9.6; OR 2.78) were independent predictors of durable benefit.</p> Conclusions <p>Baseline SUVmax derived from FDG PET/CT is an independent predictor of PFS in HER2-positive MBC treated with first-line THP. Integration of metabolic imaging biomarkers with clinical and molecular factors may support more personalized treatment approaches in this evolving therapeutic setting.</p>

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Prognostic value of baseline FDG PET/CT in HER2-positive metastatic breast cancer treated with first-line trastuzumab, pertuzumab, and docetaxel

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月10日

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  • Marcin Kubeczko,
  • Andrea d’Amico,
  • Olgierd Chrabanski,
  • Daria Handkiewicz-Junak,
  • Anna Polakiewicz-Gilowska,
  • Katarzyna Swiderska,
  • Marta Mianowska-Malec,
  • Aleksandra Lesniak,
  • Barbarba Lanoszka,
  • Natalya Lisovska,
  • Damian Borys,
  • Bartlomiej Pycinski,
  • Ewa Chmielik,
  • Slawomir Blamek,
  • Aleix Prat,
  • Michal Jarzab

摘要

Background

Trastuzumab, pertuzumab, and docetaxel (THP) have represented the standard first-line treatment for HER2-positive metastatic breast cancer (MBC) for over a decade, following the pivotal CLEOPATRA trial. However, interim results from the DESTINY-Breast09 trial suggest that trastuzumab deruxtecan (T-DXd) may soon replace THP as the new first-line standard. Recent developments in treatment have raised new questions about how best to match therapy intensity with individual patient profiles. FDG PET/CT, routinely used for metabolic imaging, might help by identifying patients with differing prognoses based on baseline tumor activity. We investigated the prognostic relevance of baseline FDG PET/CT and its association with treatment outcomes in HER2-positive MBC patients receiving first-line THP.

Methods

We retrospectively analyzed 194 patients with HER2-positive MBC who underwent baseline FDG PET/CT within 12 months before initiating THP therapy (2017–2024). SUVmax was recorded, and optimal cut-off values for progression-free survival (PFS) was determined by ROC analysis. Cox regression and logistic regression were used to identify independent predictors of PFS, OS, and long-term response (PFS ≥ 35 months).

Results

Median PFS was 29.1 months; 2-year PFS was 60.3%. SUVmax > 9.6 was associated with significantly shorter PFS (18.9 vs. 43.9 months; p = 0.002) and remained independently prognostic in multivariate analysis (HR 1.98; p = 0.001). Median OS was 85.0 months. Among 162 evaluable patients, 35% were classified as long responders. ER positivity (OR 4.82), oligometastatic disease (OR 2.60), and low SUVmax (≤ 9.6; OR 2.78) were independent predictors of durable benefit.

Conclusions

Baseline SUVmax derived from FDG PET/CT is an independent predictor of PFS in HER2-positive MBC treated with first-line THP. Integration of metabolic imaging biomarkers with clinical and molecular factors may support more personalized treatment approaches in this evolving therapeutic setting.