PET/CT in Patients with Breast Cancer Treated with Immunotherapy

SIMPLE SUMMARY: Immunotherapy is beneficial in specific breast cancer types. To monitor the response to immunotherapy, positron emission tomography (PET) is useful. Several criteria to interpret these images are available and it is essential to have knowledge about their characteristics and applications. Furthermore, it is important to recognize imaging patterns of immune-related adverse events. In the metastatic setting in particular, immunotherapy is only administered if the tumor expresses receptors for the specific treatment, for which biopsies are required to determine receptor expression. However, due to the invasive character of the procedure, biopsies are generally not repeated over time and are not performed in multiple lesions. The strength of PET is that it permits whole-body imaging in a noninvasive way. Few studies in humans have been performed up to now. This narrative review summarizes the ongoing research on immunotherapy options for breast cancer and the role of (immuno-) PET in assessing therapy response. ABSTRACT: Significant advances in breast cancer (BC) treatment have been made in the last decade, including the use of immunotherapy and, in particular, immune checkpoint inhibitors that have been shown to improve the survival of patients with triple negative BC. This narrative review summarizes the studies supporting the use of immunotherapy in BC. Furthermore, the usefulness of 2-deoxy-2-[(18)F]fluoro-D-glucose (2-[(18)F]FDG) positron emission/computerized tomography (PET/CT) to image the tumor heterogeneity and to assess treatment response is explored, including the different criteria to interpret 2-[(18)F]FDG PET/CT imaging. The concept of immuno-PET is also described, by explaining the advantages of mapping treatment targets with a non-invasive and whole-body tool. Several radiopharmaceuticals in the preclinical phase are referred too, and, considering their promising results, translation to human studies is needed to support their use in clinical practice. Overall, this is an evolving field in BC treatment, despite PET imaging developments, the future trends also include expanding immunotherapy to early-stage BC and using other biomarkers.