<sup>18</sup> F-Fluorodeoxyglucose Positron Emission Tomography for Estimating Outcomes After Initial Treatment for Metastatic Breast Cancer

Importance: Optimizing treatment decisions in metastatic breast cancer (MBC) can alleviate patients' burden and improve quality of life. Whether 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used to better estimate outcomes is unknown. Objective: To evaluate clinical utility of early metabolic change on FDG-PET for improving outcome estimation compared with standard diagnostic evaluation in patients with newly diagnosed MBC. Design, Setting, and Participants: The multicenter IMPACT-MBC clinical cohort trial enrolled patients with nonrapidly progressive, newly diagnosed MBC from August 2013 to May 2018, before initiation of first-line systemic therapy. Baseline assessment included metastasis biopsy procedure and FDG-PET and CT imaging. Early FDG-PET was performed after 2 weeks of treatment, and CT response evaluation after 8 weeks. Clinical utility was defined as the ability of early FDG-PET to estimate progressive disease (PD) on CT, progression-free survival (PFS), and overall survival (OS). Data were analyzed from October 19, 2025, to February 13, 2026. Intervention: Early FDG-PET or standard-of-care (SOC) biopsy-based treatment. Main Outcomes and Measures: Clinical utility of molecular imaging to improve outcome estimation of standard diagnostics defined as the capacity to identify poor patient outcomes. Measures were PD at 8 weeks, PFS, and OS. Results: The analysis included 200 patients (median [range] age, 61 [32-84] years; 198 females [99%] and 2 males [1%]). Non-PD on early FDG-PET had a negative predictive value (NPV) of 94.7% (95% CI, 89.5%-97.4%) for non-PD on 8-week CT. This was similar in all MBC subtypes and bone-only disease. Patients with SOC treatment and non-PD on early FDG-PET (n = 133) had a median PFS of 19.4 (95% CI, 15.2-22.8) months and OS of 39.4 (95% CI, 33.7-48.3) months compared to 4.1 (95% CI, 3.3-15.5) months and 18.5 (95% 3 CI, 7.0-33.0) months, respectively (P < .001 for both). Patients with non-PD on 8-week CT but with PD on early FDG-PET had a median (IQR) PFS and OS of 9.5 (4.1-18.1) and 19.4 (8.7-33.0) months compared to 22.3 (15.3-96.1) months and 40.1 (23.4-72.7) months without PD. Conclusions and Relevance: In this clinical cohort trial of patients with nonrapidly progressive, newly diagnosed MBC before initiation of first-line systemic therapy, early FDG-PET after only 2 weeks of treatment identified patients with MBC with distinct long-term outcomes. Incorporating early FDG-PET can improve outcome estimation of standard CT assessment. Trial Registration: ClinicalTrials.gov Identifier: NCT01957332.

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Journal
JAMA Oncology
Published
2026-04-16
DOI
https://doi.org/10.1001/jamaoncol.2026.0767
Primary Topic
Medical Imaging Techniques and Applications
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article
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article

18 F-Fluorodeoxyglucose Positron Emission Tomography for Estimating Outcomes After Initial Treatment for Metastatic Breast Cancer

Wim J.G. Oyen, Sophie L. Gerritse, Albert D. Windhorst, Ellis Barbé et al.
JAMA Oncology
Medical Imaging Techniques and Applications
article

18 F-Fluorodeoxyglucose Positron Emission Tomography for Estimating Outcomes After Initial Treatment for Metastatic Breast Cancer

Wim J.G. Oyen, Sophie L. Gerritse, Albert D. Windhorst, Ellis Barbé, Daniëlle J. Vugts, Bert van der Vegt, Otto C. Boerman, Wim Mali, Jelle Overbosch, Erik van Helden, Evelien J. M. Kuip, Jorianne Boers, Monique D. Dorrius, Gonda de Jonge, Harm van Tinteren, Sigrid Stroobants, Jasper JL van Geel, Bertha Eisses, Özgül Ekmekçioğlu, Frederike Bensch, Mieke C. Zwager, Eline Boon, Marcel Janssen, Adrienne H. Brouwers, Jasper Emmering, Erik Buskens, Katja van Rij, Carolina P. Schröder, Anne I.J. Arens, Ton Velleman, Jaco Kraan, Lindsay Angus, Sarah R. Verhoeff, Suzanne van Es, Schuuring, Jolien Tol, Astrid van der Veldt, Harry Hendrikse, Carla van Herpen, Winette van der Graaf, Marc Huisman, John Martens, Guus van Dongen, Otto Hoekstra, Eric Visser, Rudy Dierckx, Henk Verheul, Theo Kok, Peter Bult, Geke Hospers, Anita Siewerts, Elisabeth G. E. de Vries, Stefan Sleijffer, Karl Moons, Annemarie Jorritsma, Ronald Boellaard, Marjolijn N. Lub-de Hooge, Agnes Jager, Sjoerd G. Elias, C. Willemien Menke-van der Houven van Oord, Martijn Dekker, Shekar Mahesh, Daniela E. Oprea-Lager, Andor W. J. M. Glaudemans, Thomas Kwee, Jeroen Janssen, Lioe-Fee de Geus-Oei
article en

Abstract

Importance: Optimizing treatment decisions in metastatic breast cancer (MBC) can alleviate patients' burden and improve quality of life. Whether 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used to better estimate outcomes is unknown. Objective: To evaluate clinical utility of early metabolic change on FDG-PET for improving outcome estimation compared with standard diagnostic evaluation in patients with newly diagnosed MBC. Design, Setting, and Participants: The multicenter IMPACT-MBC clinical cohort trial enrolled patients with nonrapidly progressive, newly diagnosed MBC from August 2013 to May 2018, before initiation of first-line systemic therapy. Baseline assessment included metastasis biopsy procedure and FDG-PET and CT imaging. Early FDG-PET was performed after 2 weeks of treatment, and CT response evaluation after 8 weeks. Clinical utility was defined as the ability of early FDG-PET to estimate progressive disease (PD) on CT, progression-free survival (PFS), and overall survival (OS). Data were analyzed from October 19, 2025, to February 13, 2026. Intervention: Early FDG-PET or standard-of-care (SOC) biopsy-based treatment. Main Outcomes and Measures: Clinical utility of molecular imaging to improve outcome estimation of standard diagnostics defined as the capacity to identify poor patient outcomes. Measures were PD at 8 weeks, PFS, and OS. Results: The analysis included 200 patients (median [range] age, 61 [32-84] years; 198 females [99%] and 2 males [1%]). Non-PD on early FDG-PET had a negative predictive value (NPV) of 94.7% (95% CI, 89.5%-97.4%) for non-PD on 8-week CT. This was similar in all MBC subtypes and bone-only disease. Patients with SOC treatment and non-PD on early FDG-PET (n = 133) had a median PFS of 19.4 (95% CI, 15.2-22.8) months and OS of 39.4 (95% CI, 33.7-48.3) months compared to 4.1 (95% CI, 3.3-15.5) months and 18.5 (95% 3 CI, 7.0-33.0) months, respectively (P < .001 for both). Patients with non-PD on 8-week CT but with PD on early FDG-PET had a median (IQR) PFS and OS of 9.5 (4.1-18.1) and 19.4 (8.7-33.0) months compared to 22.3 (15.3-96.1) months and 40.1 (23.4-72.7) months without PD. Conclusions and Relevance: In this clinical cohort trial of patients with nonrapidly progressive, newly diagnosed MBC before initiation of first-line systemic therapy, early FDG-PET after only 2 weeks of treatment identified patients with MBC with distinct long-term outcomes. Incorporating early FDG-PET can improve outcome estimation of standard CT assessment. Trial Registration: ClinicalTrials.gov Identifier: NCT01957332.

JAMA Oncology
University Medical Center Groningen (NL), Humanitas University (IT), Radboud University Nijmegen (NL), University of Groningen (NL), Breast Cancer Research Foundation (US), Erasmus MC (NL), Radboud University Medical Center (NL), University Medical Center Utrecht (NL), Maasstad Ziekenhuis (NL), Oncode Institute (NL), Metastatic Breast Cancer Network (US), Erasmus MC Cancer Institute (NL), Amsterdam University Medical Centers (NL), Rijnstate Hospital (NL), Erasmus University Rotterdam (NL)
Openalex Percentile: Top 18%
Medical Imaging Techniques and Applications
DOIOpen Access PDFOpenAlex
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