Human epidermal growth factor receptor 2 (HER2) PET imaging of HER2-Low breast Cancer with [68Ga] Ga-ABY-025: results from a pilot study

R Altena, S af Burén, A Blomgren… - Journal of Nuclear …, 2024 - Soc Nuclear Med
R Altena, S af Burén, A Blomgren, E Karlsson, A Tzortzakakis, N Brun, MM Moein, E Jussing…
Journal of Nuclear Medicine, 2024Soc Nuclear Med
Patients with HER2-low metastatic breast cancer (mBC), defined as an
immunohistochemistry (IHC) score of 1+ or 2+ without HER2 gene amplification, may benefit
from HER2 antibody–drug conjugates. Identifying suitable candidates is a clinical challenge
because of spatial and temporal heterogeneity in HER2 expression and discrepancies in
pathologic reporting. We aimed to investigate the feasibility and safety of HER2-specific PET
imaging with [68Ga] Ga-ABY-025 for visualization of HER2-low mBC. Methods: A …
Patients with HER2-low metastatic breast cancer (mBC), defined as an immunohistochemistry (IHC) score of 1+ or 2+ without HER2 gene amplification, may benefit from HER2 antibody–drug conjugates. Identifying suitable candidates is a clinical challenge because of spatial and temporal heterogeneity in HER2 expression and discrepancies in pathologic reporting. We aimed to investigate the feasibility and safety of HER2-specific PET imaging with [68Ga]Ga-ABY-025 for visualization of HER2-low mBC.
Methods
A prospective pilot study was done with 10 patients who had HER2-low mBC, as part of a phase 2 basket imaging study with [68Ga]Ga-ABY-025 in HER2-expressing solid tumors. Patients were recruited at the Breast Clinic at the Karolinska University Hospital, Stockholm, Sweden. PET/CT images were acquired 3 h after injection of 200 MBq of [68Ga]Ga-ABY-025. The SUVmax was used to quantify tracer uptake. Ultrasound-guided tumor biopsies were guided by results from the HER2 PET. The main outcome—the safety and feasibility of HER2 PET in patients with HER2-low mBC, measured the occurrence of possible procedure-related adverse events.
Results
Ten patients with HER2-low mBC underwent [68Ga]Ga-ABY-025 PET/CT with paired tumor biopsies. No adverse events occurred. In all patients, [68Ga]Ga-ABY-025–avid lesions with substantial intra- and interindividual heterogeneity in tracer uptake were noted. In 8 of 10 patients with ABY-025–avid lesions, the HER2-low status of the corresponding lesions was confirmed by IHC or in situ hybridization. Two patients had an IHC score of 0 in the tumor biopsies:1 in a cutaneous lesion with a low SUVmax and 1 in a liver metastasis with a high SUVmax but a “cold” core.
Conclusion
The visualization of HER2-low mBC with [68Ga]Ga-ABY-025 PET/CT was feasible and safe. Areas of tracer uptake showed varying levels of HER2 expression on IHC. The observed intra- and interindividual heterogeneity in [68Ga]Ga-ABY-025 uptake suggested that HER2 PET might be used as a tool for the noninvasive assessment of disease heterogeneity and has the potential to identify patients in whom HER2-targeted drugs can have a clinical benefit.
Society of Nuclear Medicine and Molecular Imaging
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