Charles N. Weber MD, Presenter: Nothing to Disclose

Susan Pae Weinstein MD, Abstract Co-Author: Nothing to Disclose

Harvey Leonard Nisenbaum MD, Abstract Co-Author: Nothing to Disclose

Paul Zhang MD, PhD, Abstract Co-Author: Nothing to Disclose

Elizabeth Fitzpatrick, Abstract Co-Author: Nothing to Disclose

Jeanne Kobilnyk, Abstract Co-Author: Nothing to Disclose

Brian J. Czerniecki MD,PHD, Abstract Co-Author: Nothing to Disclose

Susan G. Roth MD, Abstract Co-Author: Nothing to Disclose

The HER-2/neu pulsed dendritic cell vaccine is currently an investigational therapy for treatment of HER-2/neu over-expressing DCIS. The purpose of this study is to evaluate the utility of breast MRI in predicting treatment response in patients undergoing vaccine therapy prior to definitive surgery.

Patients with HER-2/neu over-expressing DCIS tumors participated in a vaccine trial. Each patient underwent a contrast enhanced breast MRI prior to and at the end of the vaccine therapy. After completion of the vaccination protocol, the patients had definitive surgical therapy. The patient’s pre- and post-vaccination MRI studies were reviewed to assess for response to vaccine therapy. The degree of contrast enhancement in the region of the DCIS was qualitatively assessed. The imaging findings were correlated with the pathology results.

58 patients were included in our study. Following vaccination, 9 demonstrated decreased enhancement on MRI, 10 demonstrated increased enhancement, 27 demonstrated no change, and 12 were negative for suspicious findings. 6 (50%) of the negative studies were proven to have no tumor at resection, while an additional 2 (16.7%) were found to have HER-2/neu negative tumor. 6 (66.7%) of 9 patients with decreased enhancement had correlating interval decreased HER-2/neu receptor activity, however only 1 (11.1%) of 9 patients with increased enhancement had interval increased HER-2/neu receptor activity. A correlation with estrogen receptor (ER) and progesterone receptor (PR) status was noted. 7 (87.5%) of the 8 patients found to have decreased enhancement were ER+ and 4 (66.7%) of 6 were PR+. Conversely, 8 (88.9%) of 9 patients with increased enhancement were ER-/PR-. There was a false positive rate of 8.7% on post-vaccination MRI.

Breast MRI may be useful in evaluating treatment response during HER-2/neu pulsed dendritic cell vaccine therapy for DCIS. Greatest response was seen in cases of tumor eradication or conversion to HER-2/neu negative status. There is suggestion of positive correlations between decreased and increased post-vaccination enhancement with ER+/PR+ and ER-/PR- receptor status respectively, which may be related to differing immune responses in these groups.

Breast MRI may be useful in predicting treatment response in patients undergoing HER-2/neu pulsed dendritic cell vaccine therapy for DCIS.

Weber, C, Weinstein, S, Nisenbaum, H, Zhang, P, Fitzpatrick, E, Kobilnyk, J, Czerniecki, B, Roth, S, Treatment Response in Patients Receiving HER-2/neu Pulsed Dendritic Cell Vaccine for DCIS: Can Breast MRI Predict Response?.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044454.html