New Imaging Test to Help Doctors Predict Cancer Patients Who Can Benefit from Hormone Therapy

Women who have cancer cells carrying estrogen receptors are usually given hormonal therapy as a targeted treatment. However, this treatment is not effective in all patients. However, a good method of accurately predicting which patients will benefit from the treatment and which will not hasn’t existed — until now.

Enter a study conducted by researchers from the Washington University School of Medicine, St. Louis. The researchers have found that they can differentiate between patients who may or may not benefit from hormone therapy through the use of an imaging test that measures the estrogen receptor function in the patients’ cancer cells.

The researchers demonstrated this during their phase 2 clinical trial, which found that cancer patients who had working estrogen receptors either improved or remained stable on hormone therapy while the cancer progressed in the patients who had estrogen receptors that were not functioning.

Dr. Marilyn J. Siegel, a professor of radiology at the Mallinckrodt Institute of Radiology, along with Dr. Barry A. and Farrokh Dehdashti, who was the senior author of the study, stated that if a patient’s breast cancer was estrogen receptor positive, doctors usually recommended hormone therapy despite knowing that it would only work for some patients and not all. They further explained that hormone therapy was quite effective when it worked, in addition to having pretty mild side effects in comparison with other therapies.

Nearly 250,000 cases of breast cancer in the United States are annually classified as estrogen receptor positive. These numbers translate to roughly four out of five breast cancers. This classification means that the estrogen receptors are carried by the cancer cells, with the cancerous tumor growing following the continuous production of estrogen, which is a hormone that occurs naturally in the female body.

For purposes of the study, the researchers had forty-three women who had already undergone menopause and had been diagnosed with estrogen receptor positive breast cancer, undergo an FFNP-PET scan followed up by the administration of three estrogen doses over a 24-hour period. This was then followed up by another PET scan 24 hours after the estrogen treatment had been administered.

Of the study’s participants, 14% had locally recurrent or locally advanced disease while the remaining had metastatic disease. More than 70% (72%) of them had also undergone some treatment prior to the study’s commencement, with the treatment often being a hormone therapy-based regimen.

The researchers found that in 28 women, the tumor’s PET signal grew significantly after being exposed to estrogen, which showed that their estrogen receptors were not only responding to the hormone by prompting an increase in the numbers of progesterone receptors but were also working. The remaining 15 women demonstrated little to no change in the number of progesterone receptors after the estrogen treatment had been administered.

The participants were then followed for an average of six months as they underwent hormone therapy that was prescribed by their oncologists. The researchers noted that of the individuals whose tumors had responded to the estrogen treatment, fifteen improved while thirteen remained stable. On the other hand, the condition of the remaining fifteen whose tumors did not respond to the treatment worsened in the same period.

The study’s results were reported in “Nature Communications.”

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