Background: Neoadjuvant chemotherapy (NACT) is the main treatment approach for the 20,000 patients diagnosed annually with locally advanced breast cancer. However, after months of difficult-to-tolerate NACT treatment, only 8-50% of patients achieve a pathologic complete response (pCR), the only clinical outcome demonstrated to improve overall survival. There is a need and opportunity for the development of monitoring methods and biomarkers, especially those targeting the functional status of cancerous tissue, for the early and accurate prediction of NACT outcomes to tailor treatment on an individual basis.

Methods: We leveraged a multimodal contrast MRI, diffusion-weighted imaging, MR elastography (MRE), and diffuse optical tomography (DOT) imaging platform to simultaneously assess changes in several functional biomarkers of breast tumors to NACT. Two multimodal imaging sessions were performed on one patient with a triple-negative invasive ductal carcinoma, one before the initiation of NACT and the other before the 3rd cycle of the treatment.

Results: The patient achieved pCR after receiving 4 cycles of treatment. Imaging results of this patient show concordant changes in tumor size, apparent diffusion coefficient, stiffness, and total hemoglobin concentration with eventual pathologic outcome.

Conclusions: Multiparametric MRI, MRE, and DOT imaging has great potential to predict pCR at an early time point.