Noninvasive Imaging Signatures to Predict Response and Guide Neoadjuvant Therapy Selection in High-Risk HR+/HER2- Breast Cancer
This study aims to use quantitative imaging to characterize tumor microenvironment heterogeneity in high-risk hormone receptor–positive/HER2-negative (HR+/HER2-) breast cancer, to better predict patient treatment outcomes. While endocrine therapies benefit many patients, those with high-risk disease often relapse, and only a small proportion achieve complete response after neoadjuvant therapy. Immunotherapy shows promise for a subset of highly proliferative tumors, improving outcomes when combined with chemotherapy, but can cause serious side effects and may not be necessary for all patients. Breast multiparametric MRI offers noninvasive measurements of tumor physiology, including tissue cellularity and vascularity. Prior work has demonstrated the integration of multiparametric MRI with informatics techniques to reveal distinct microenvironmental subregions linked to therapeutic sensitivity, using a computational approach known as “habitat imaging.” Here we apply habitat imaging to clinical HR+/HER2- breast cancer, using pre-treatment breast MRI to identify habitat signatures associated with improved treatment response. These signatures may be able to stratify patients with differential outcome and identify those who may benefit from the addition of immunotherapy to their neoadjuvant regimen. This approach could help oncologists tailor therapy and avoid overtreatment, while minimize side effects and improve outcomes for the individual patient.