Pre-treatment SUVmax for Bone Mets and Prognosis

bydand

I recently read that patients who have high SUV scores for their bone mets on the pre-treatment PET scan have significantly worse progression free survival and prognosis.

Now I’m worried about my mom who was diagnosed de novo stage IV with bone mets in April. She has only 4 mets but the most active one had a SUV with 12.78 which seems quite high! She is likely luminal B ER+ PR weakly pos (20%) HER2- with a ki67 %25.

We were feeling hopeful because she got to NED after neoadjuvant AC+T, mastectomy and lymph node dissection with the bone mets showing complete metabolic response. Now on Arimidex and Kisqali.

I can’t stop worrying about her initial SUV score although things have gone smoothly so far. Just wanted to see if anyone has any insights... Any other bone metsers with high SUV scores out there? Happy Thanksgiving

Piggy99

Hi bydand,

I have bone mets with a high SUV (>13) that have showed complete metabolic response to Ibrance/letrozole. I don't know if we were looking at the same article - the one I saw for breast cancer, specifically, seems to suggest that a high SUV is correlated with shorter time to a skeletal related event, like a fracture (which would make sense, since it probably shows more initial damage to the bone), not necessarily progression. It also says that a big decrease in SUV in the first ~17 months is associated with a better time to progression. Even if high SUV were associated with progression, your mom now has a good prognostic factor and a not so good prognostic factor, and there's no way to know which one will carry the day.

When I read studies like that I try to focus on the good part - maybe not the most rational way to approach things, but it helps me to think about the chances I have, rather than the chances I don't. There's nothing I can do to change the odds either way, so I try very hard (not always successfully) to push away the "what ifs" and not let them take away the joy of the "now".

I'm sure others will chime in with stories of hope - just wanted to let you know you are not alone, and there are reasons to be hopeful.

jobur

bydand - After my first progression on Arimidex, I had some areas of bone with an SUV of 12. My 2nd line of tx was Faslodex with Ibrance and it brought me to NEAD for 2 years. I'm not aware of the study you cited, but my experience shows this is not necessarily true. I have had MBC for 5+ years and am doing fine right now.

bydand

Thank you so much both for the encouraging words! I will try not to dwell on it and focus on the positive that her treatment is going so well!

Here are the studies that I was referring to:

https://www.omicsonline.org/open-access/the-prognostic-role-of-pretreatment-18ffdg-petct-maximum-standardized-uptake-value-in-multiple-or-oligometastatic-breast-cancer-patients-2155-9619-1000236.php?aid=57233

https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-13-42

https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.27579

First one shows that patients with oligomets limited to bone have greater PFS and OS if SUVmax < 4.4. Second one similarly shows that high baseline SUVmax is associated with decreased PFS and OS with most of these patients benign luminal B.

Finally the last study shows that for newly diagnosed patients with bone mets increasing SUVmax is associated with poor survival, with those in the highest quartile 11.2 (9.3‐29.6) having more than 3 times risk or death.