¹⁸F-Fluoroestradiol PET

This course has been approved for 1.75 Category A credits.
No discipline-specific Targeted CE credit is currently offered by this course.

Outline

1. Introduction
2. ¹⁸F-FES Structure, Synthesis, Pharmacokinetics, and Safety
3. Correlation of ¹⁸F-FES Uptake and Tumor ER Expression
4. Baseline ¹⁸F-FES Uptake as a Predictor of Response to Endocrine Safety
5. Ability of ¹⁸F-FES PET to Assess Whole-body Tumor Burden and Heterogeneity of Disease
6. Utility of ¹⁸F-FES PET in Assessing In Vivo Pharmacodynamics
7. Non-Breast Cancer Uses of ¹⁸F-FES
   1. Uterine Endometrium and Myometrium
   2. Epithelial Ovarian Cancer
   3. Other Uses
8. Potential Clinical Uses
   1. Breast Cancer Detection and Staging
   2. Predicting Response to Endocrine Therapy
   3. Barriers to Widespread Clinical Use of ¹⁸F-FES PET
9. Conclusion

Objectives

Upon completion of this course, students will:

1. know the traditional assessment method for ER expression in breast cancer
2. understand the importance of determining a breast tumor’s ER status
3. know when ¹⁸F-FDG PET/CT is recommended for breast cancer assessment
4. know the potential use cases for ¹⁸F-FES PET when used in conjunction with ¹⁸F-FDG PET
5. be familiar with the elements that were part of early efforts to develop an ER-targeting radiotracer
6. know the properties that make ¹⁸F an optimal PET imaging radiotracer
7. identify a major issue with ¹⁸F-moxestrol in comparison to ¹⁸F-FES
8. be familiar with the uptake process of ¹⁸F-FES
9. know the critical organ for ¹⁸F-FES dose
10. be familiar with the early studies demonstrating associations between ¹⁸F-FES uptake and various lab results
11. be familiar with the methods of the Peterson et al. studies and their findings
12. know the factors that can affect tumor ¹⁸F-FES uptake, as well as those shown to not have an effect on its uptake
13. know the suggested specific activity of ¹⁸F-FES for patient injection
14. understand the advantages of endocrine therapy for patients with ER-positive breast cancer
15. be familiar with ¹⁸F-FES PET study findings for use as a predictor of response to endocrine therapy
16. understand the role of ¹⁸F-FES PET in the assessment of the theory that long-term antiestrogen therapy may induce estrogen hypersensitivity
17. be familiar with the use of ¹⁸F-FDG PET for predicting endocrine therapy response
18. know the advantages of both serial ¹⁸F-FDG and pre-therapy ¹⁸F-FES to predict endocrine responsiveness
19. know the value and meaning of determining discordant ¹⁸F-FDG and ¹⁸F-FES uptake upon PET imaging
20. know why determining discordant in vitro ER expression and ¹⁸F-FES uptake is important
21. understand the meaning behind a finding for a patient who has both ¹⁸F-FES positive and negative lesions
22. understand why ¹⁸F-FES PET could represent an important adjunct for ER expression monitoring at time of disease progression or throughout a course of treatment
23. be familiar with the various breast cancer treatment methods and how they affect ER and in turn affect ¹⁸F-FES uptake
24. be familiar with the findings from a study of fulvestrant dose levels in murine xenographs that suggest that changes in ER availability occur before detectable changes in tumor metabolism and growth
25. be familiar with the uptake patterns of ¹⁸F-FES and ¹⁸F-FDG in uterine endometrial hyperplasia, as well as in both low-grade and high-grade endometrial cancers
26. know the utility for ¹⁸F-FES PET in the differentiation of benign uterine leiomyomas from malignant uterine sarcomas
27. be familiar with the various potential roles for ¹⁸F-FES PET imaging for epithelial ovarian cancers
28. know the reasons why ¹⁸F-FES PET is unlikely to supersede ¹⁸F-FDG PET as the primary PET tool for breast cancer staging
29. understand how clinicians currently often base their choice of endocrine therapy and how ¹⁸F-FES PET can better inform their therapeutic approach
30. know the barriers to more widespread use of ¹⁸F-FES PET