PET/CT molecular imaging has been imposed in clinical oncological practice over the past 20 years, driven by its two well-grounded foundations: quantification and radiolabeled molecular probe vectorization. From basic visual interpretation to more sophisticated full kinetic modeling, PET technology provides a unique opportunity to characterize various biological processes with different levels of analysis. In clinical practice, many efforts have been made during the last two decades to standardize image analyses at the international level, but advanced metrics are still under use in practice. In parallel, the integration of PET imaging with radionuclide therapy, also known as radiolabeled theranostics, has paved the way towards highly sensitive radionuclide-based precision medicine, with major breakthroughs emerging in neuroendocrine tumors and prostate cancer. PET imaging of tumor immunity and beyond is also emerging, emphasizing the unique capabilities of PET molecular imaging to constantly adapt to emerging oncological challenges. However, these new horizons face the growing complexity of multidimensional data. In the era of precision medicine, statistical and computer sciences are currently revolutionizing image-based decision making, paving the way for more holistic cancer molecular imaging analyses at the whole-body level.

The CRP concentration only moderately reflects the F-FDG PET vascular positivity in TAK, suggesting dissociated information. Standardized longitudinal prospective studies are necessary to assess the value ofF-FDG PET as an independent biomarker for subtle vascular wall inflammation detection.

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Supplementation of cancer cells exposed to 5-fluorouracil (FUra) and folinic acid (FA) with high concentration pyridoxal 5′-phosphate, the cofactor of vitamin B6, potentiates the cytotoxicity of FUra in a synergistic interaction mode. We report a pilot study in 13 patients with previously untreated advanced carcinoma of the digestive tract to assess the impact of high-dose pyridoxine (PN) on the antitumor activity of regimens comprising FUra and FA. Five patients had colorectal adenocarcinoma (CRC); 5 had pancreas adenocarcinoma (PC); and 3 had squamous cell carcinoma of the esophagus (EC). Patients with CRC and with PC received oxaliplatin, irinotecan, FUra and FA, and patients with EC had paclitaxel, carboplatin, FUra and FA. PN iv from 1000 to 3000 mg/day preceded each administration of FA and FUra. Eleven patients responded. Two patients with CRC attained CRs and 3 had PRs with reduction rates ≥ 78%. Two patients with PC attained CRs, and 2 had PRs with reduction rates ≥ 79%. Responders experienced disappearance of most metastases. Of 3 patients with EC, 2 attained CRs. Median time to attain a response was 3 months. Unexpected toxicity did not occur. Results suggest that high-dose vitamin B6 enhances antitumor potency of regimens comprising FUra and FA.

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International audienceTakayasu disease is a large-vessels vasculitis involving the aorta and its main branches. The main symptoms are constitutionals signs and those in relation to vascular damage. Acute phase reactants can be discordant with the disease activity and imaging tools are crucial to determine the affected arterial sites and the vascular complications. The active inflammatory nature of arterial lesions can be difficult to determine, and the value of functional imaging such as FDG PET should be discussed. The treatment includes the immunosuppressive treatment in case of active disease, cardiovascular risk prevention and management of adverse events related to immunosuppressive drugs. The arterial revascularization should also be considered if necessary and regular monitoring is mandatory.La maladie de Takayasu est une vascularite des gros vaisseaux touchant l’aorte et ses branches principales. Les signes principaux sont les signes généraux et les signes en rapport avec l’atteinte vasculaire. Le syndrome inflammatoire peut être discordant avec l’activité de la maladie et l’imagerie est primordiale pour déterminer les sites artériels touchés et les complications éventuelles. Le caractère inflammatoire des lésions artérielles peut être difficile à déterminer, et la place des méthodes d’imagerie fonctionnelle telle que la TEP-FDG peut se discuter. La prise en charge comprend le traitement immunosuppresseur si la maladie est active, les traitements symptomatiques à visée cardiovasculaire et en prévention des effets secondaires des immunosuppresseurs, ainsi qu’en cas de nécessité la revascularisation artérielle. La surveillance régulière est nécessaire pour dépister une progression artérielle et les complications vasculaires

Background Capecitabine is an anticancer agent, pro drug of 5 fluorouracil (5-FU) administered orally and with a narrow therapeutic index, licensed for the treatment of breast and gastrointestinal cancers. 5-FU is metabolised by dihydopyrimydine dehydrogenase (DPD). Patients with a DPD deficiency can experience severe toxicity of 5-FU. Purpose To evaluate if DPD deficiency investigations were positive for patients who presented severe toxicity following capecitabine administration. Materials and methods Electronic medical record review (chemotherapy prescription database ONCOBASS®) for toxic death-cases after capecitabine administration to investigate results for DPD deficiency test. Results The authors identified three toxic death-cases after capecitabine administration. Case 1: 77-year-old man diagnosed in Sep 2008 with colorectal cancer with indication of neoadjuvant chemotherapy who presented signs of major toxicity (grade 4 neutropenia, grade 4 thrombocytopenia, grade 4 mucositis and encephalopathy) two days after capecitabine initiation. After been tested for DPD deficiency, the result was negative. Case 2: 67-year-old woman diagnosed in Sep 2006 with bilateral breast cancer. She received adjuvant therapy for six courses and radiotherapy, which resulted in good response with a patient being without treatment until Dec 2008, when she presented relapse and initiated a course of chemotherapy based on capecitabine. After two courses, the patient suffered signs of severe toxicity (Grade 4 neutropenia, Grade 3 thrombocytopenia, Grade 3 mucositis). The test for DPD deficiency showed that the patient was heterozygous for a mutant DPD allele. Case 3: 78-year-old woman diagnosed in Dec 2008 with metastatic colorectal cancer. She received the first course of Capecitabine and oxaliplatin (XELOX) as first-line treatment. Nine days after capecitabine initiation she presented Grade 2 diarrhoea, Grade 3 mucositis, neutropenia and thrombocytopenia). Investigations showed that she had DPD deficiency. Conclusions DPD deficiency was tested in all patients with toxic death after capecitabine administration. Pharmacists have an important role in prospective identification of potentially toxic patients in order to reduce the number of patients with severe, life-threatening side effects to capecitabine treatment.