Z-endoxifen is the most potent of the metabolites of tamoxifen, and has the potential to be more effective than tamoxifen because it bypasses potential drug resistance mechanisms attributable to patient variability in the expression of the hepatic microsomal enzyme CYP2D6. 18F-FES is a positron emission tomography (PET) imaging agent which selectively binds to estrogen receptor alpha (ER-α) and has been used for non-invasive in vivo assessment of ER activity in tumors. This study utilizes 18F-FES PET imaging as a pharmacodynamic biomarker in patients with ER+ tumors treated with Z-endoxifen.
Fifteen patients were recruited from a parent therapeutic trial of Z-endoxifen and underwent imaging with 18FFES PET at baseline. Eight had positive lesions on the baseline scan and underwent follow-up imaging with 18F-FES 1– 5 days post administration of Z-endoxifen.