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We hypothesized that functional imaging with 64 Cu-DOTA-trastuzumab PET/CT would predict the response to the antibody-drug conjugate trastuzumab-emtansine (T-DM1). Methods: Ten women with metastatic human epidermal growth factor receptor 2-positive breast cancer underwent 18 F-FDG PET/CT and 64 Cu-DOTA-trastuzumab PET/CT on days 1 and 2 before treatment with T-DM1. Results: T-DM1-responsive patients had higher uptake than nonresponsive patients. Day 1 minimum SUV max (5.6 vs. 2.8, P &lt; 0.02), day 2 minimum SUV max (8.1 vs. 3.2, P &lt; 0.01), and day 2 average SUV max (8.5 vs. 5.4, P &lt; 0.05) for 64 Cu-DOTA-trastuzumab all favored responding patients. Tumor-level response suggested threshold dependence on SUV max Patients with a day 2 minimum SUV max above versus below the threshold had a median time to treatment failure of 28 mo versus 2 mo ( P &lt; 0.02). Conclusion: Measurement of trastuzumab uptake in tumors via PET/CT is promising for identifying patients with metastatic breast cancer who will benefit from T-DM1.

the journal of nuclear medicine

Use of <sup>64</sup>Cu-DOTA-Trastuzumab PET to Predict Response and Outcome of Patients Receiving Trastuzumab Emtansine for Metastatic Breast Cancer: A Pilot Study

Use of 64Cu-DOTA-Trastuzumab PET to Predict Response and Outcome of Patients Receiving Trastuzumab Emtansine for Metastatic Breast Cancer: A Pilot Study

Use of ⁶⁴Cu-DOTA-Trastuzumab PET to Predict Response and Outcome of Patients Receiving Trastuzumab Emtansine for Metastatic Breast Cancer: A Pilot Study