Novel PET and SPECT radioligands for visualization of diseased regulatory pathways in breast carcinoma

Many new breast-cancer treatment strategies are not based on traditional anti-proliferative effects and thus, standard clinical methods for assessing the efficacy of these agents may not be useful. Consequently, new methodologies are necessary which will enable on the one hand, researchers to explore the full potential of novel anti-cancer strategies and on the other hand, clinicians to monitor more accurately treatment response based on more directive and specific endpoints. Functional imaging by means of positron emission tomography (PET) or single photon emission computerized tomography (SPECT) facilitates the evaluation of tumour physiology, metabolism, and proliferation, providing parameters more closely related to the site of action of these anti-cancer drugs. Alterations in these parameters will do often precede volume changes observed with effective cancer therapy and thus may provide more sensitive and earlier markers of tumour cell death or growth inhibition than gross anatomical changes as currently measured by X-rays, CT or MRI. This paper describes the potential role of recently developed radioligands for both SPECT and PET imaging as molecular imaging markers for the in vivo assessment of the following diseased regulatory pathways in breast cancer: cell surface receptor signalling pathways; oestrogen action; cell death pathways; multidrug resistance and invasion-, metastasis and angiogenesis.