Response to low-dose oral capecitabine monotherapy in an elderly frail patient with metastatic breast carcinoma and impaired renal function: documentation by fluorodeoxyglucose positron emission tomography

The effi cacy of chemotherapy with drugs used alone (monotherapy) or in sequence (serial single-agent therapy) has been recently highlighted in the literature with the viewpoint of being both safe and better tolerated and hence applicable to elderly patients with poor health status and who are intolerant to cytotoxic chemotherapy. In a case vignette, we describe the clinical value of fl uorodeoxyglucose positron emission tomography (FDGPET) imaging for monitoring and documenting a response to a novel approach. It involves using the better-tolerated capecitabine monotherapy in an elderly, frail female patient with metastatic breast carcinoma who demonstrated progressive disease 5 years after a modifi ed radical mastectomy. She could not be administered other cytotoxic complex chemotherapy regimens because of her poor health status and impaired renal function. The patient was a 78-year-old woman with a referral diagnosis of infi ltrating ductal carcinoma of the right breast. The baseline FDG-PET demonstrated large-volume metastatic disease in the liver, abdominal nodes, and mediastinum, the left chest and lung, the right arm subcutaneous tissue, and the left femur trochanteric region (Fig. 1). She was administered low-dose oral capecitabine (500 mg/m/day), a fl uoropyrimidine carbamate with antineoplastic activity, for three cycles before a repeat FDG-PET study. The second series of FDG-PET scans (Fig. 2) demonstrated a signifi cant reduction in the overall disease burden, particularly in the liver and abdomen. The foci in the subcutaneous tissue of the right arm and in the left femur trochanteric region were no longer visualized. The FDG-PET studies were acquired following standard protocol: The patient fasted for at least 6 h before the injection. At 60 min after intravenous injection of 444 MBq FDG, the scan was undertaken using a whole-body single-ring dedicated bismuth germinate (BGO) detector crystal-based GE Advance PET scanner (General Electric Medical Systems, Milwaukee, WI, USA). Images were reconstructed using the attenuation weighted Ordered Subsets Expectation Maximization (OSEM) algorithm. Novel therapeutics are being continuously explored in oncology and by functional imaging, with FDG-PET playing a pivotal role. The obvious benefi t of early documentation of a therapeutic response with FDG-PET imaging makes this the modality of choice for monitoring disease activity when a patient is being treated with Received: September 13, 2010 / Accepted: November 3, 2010 © Japan Radiological Society 2011