NCCN Clinical Practice Guidelines Recommend FES PET Imaging for ER+ Breast Cancer

The latest National Comprehensive Cancer Network (NCCN) clinical practice guidelines have added fluoroestradiol F18 (FES) PET scan to its list of considerations for patients with recurrent or metastatic ER breast cancer. The NCCN guideline now recommends clinicians consider the use of FES PET for ER-positive disease during work-up of patients with recurrent or metastatic breast cancer.

The guideline update follows the publication of the Society of Nuclear Medicine and Molecular Imaging’s appropriate use criteria statement on ER-targeted PET imaging in March of 2023, which noted that FES PET is appropriate when a clinician is considering endocrine therapy and assessing ER status at initial diagnosis of metastatic breast cancer, when the disease progresses after endocrine therapy, when lesions are challenging or dangerous to biopsy, and/or when other tests evaluating ER status are inconclusive.

The addition to FES PET in the NCCN guidelines in addition to fluorodeoxyglucose gives clinicians an opportunity to assess ER function in all tumor sites in patients with ER-positive metastatic breast cancer.

FES was approved by the FDA for use as an adjunct to biopsy in patients with recurrent or metastatic breast cancer in May 2020 and is currently the only imaging agent approved by the agency for that indication.

“This is a helpful tool for diagnostic confirmation and may have the ability to aid in prognosis and prediction of clinical benefit from endocrine based therapies, including with CDK 4/6 inhibitors. We have many endocrine options now, and FES PET may identify patients who remain ER+ and thus potentially benefit from endocrine based therapy.”

- Hannah M. Linden, MD, a breast medical oncologist at the University of Washington and Fred Hutchinson Cancer Center.

References:

https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1419

https://jnm.snmjournals.org/content/64/3/351

https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trial-snapshot-cerianna#:~:text=The%20FDA%20approved%20CERIANNA%20based,the%20side%20effects%20of%20CERIANNA.

https://www.gehealthcare.com/about/newsroom/press-releases/ge-healthcare-announces-fes-pet-imaging-recommendation-in-nccn-clinical-practice-guidelines-in-oncology-nccn-guidelines

By Jeff Craven, MD /alert Contributor

Photo Credit: Getty Images.

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