51
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Press OW, Eary JF, Appelbaum FR, Bernstein ID. Myeloablative radiolabeled antibody therapy with autologous bone marrow transplantation for relapsed B cell lymphomas. Cancer Treat Res 1995; 76:281-97. [PMID: 7577340 DOI: 10.1007/978-1-4615-2013-9_13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- O W Press
- University of Washington Medical Center, Seattle 98111, USA
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52
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Fleury J, Legros M, Cure H, Tortochaux J, Condat P, Dionet C, Travade P, Belembaogo E, Tavernier F, Kwiatkowski F. The hematopoietic stem cell transplantation in Hodgkin's disease: questions and controversies. Leuk Lymphoma 1994; 15:419-32. [PMID: 7873999 DOI: 10.3109/10428199409049745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Most patients with Hodgkin's disease (HD) are cured with chemotherapy and/or radiotherapy. However, half of those with advanced stage disease (IIIB, IV) do not respond adequately to treatment or relapse. Salvage therapy used in such cases gives from 10% to 50% complete remission but only 10% long term survival. The results of bone marrow transplantation reported in acute leukemia and non-Hodgkin's lymphoma encouraged some authors to develop this new therapeutic strategy in Hodgkin's disease. In the early 1980's promising results were achieved when refractory and relapsed patients were selected to receive myeloablative therapy followed by bone marrow transplantation. Today, high dose chemotherapy with hematopoietic stem cell transplantation (HSCT) is used more and more often in poor prognosis Hodgkin's disease. After a review of the literature concerning the results of transplantation in Hodgkin's disease, we develop the numerous problems associated with this procedure which remain to be solved such as: the optimal indication, the timing of HSCT, the type of graft, the conditioning regimen, the place of radiotherapy and the optimal use of hematopoietic growth factors. We conclude with future prospects.
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Affiliation(s)
- J Fleury
- Centre Jean Perrin, Unité de Transplantation Médullaire, Clermont-Ferrand, France
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53
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Wilder RB, Denardo GL, Denardo SJ. Treatment of cancer with intratumoral infusion of radioisotopes. Int J Radiat Oncol Biol Phys 1994; 30:737-9; discussion 745-6. [PMID: 7928510 DOI: 10.1016/0360-3016(92)90965-k] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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54
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Gripp FM, Quak J, Leverstein H, Schrijvers A, Gerretsen M, Brakenhoff R, Van Dongen G, Snow GB, Rapoport A. Monoclonal antibodies for diagnosis and therapy of squamous cell carcinoma of the head and neck. SAO PAULO MED J 1994; 112:612-21. [PMID: 7638523 DOI: 10.1590/s1516-31801994000300008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- F M Gripp
- Head and Neck Surgery Service of the Hospital Heliópolis, S. Paulo, Brazil
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55
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Larson SM, Divgi CR, Scott A, Sgouros G, Graham MC, Kostakoglu L, Scheinberg D, Cheung NK, Schlom J, Finn RD. Current status of radioimmunotherapy. Nucl Med Biol 1994; 21:785-92. [PMID: 9241655 DOI: 10.1016/0969-8051(94)90050-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Radioimmunotherapy with radiolabeled monoclonal antibodies is increasingly effective for hematopoietic tumors, with a number of investigators reporting persistent major responses. Radioimmunotherapy for solid tumors has been more difficult and only an occasional major response has been reported and these have so far not been persistent. Toxicity is predominantly hematopoietic, with platelets being most sensitive to the effects of radiation. Even at ultra-high doses (up to 28 mCi/kg of 131I), second organ toxicity has not been reached. Rational approaches to dose planning are becoming possible with improvements in dosimetry, based on quantitative SPECT and PET imaging. Current therapeutic indices for tumor/marrow, the most radiosensitive organ, are in the range of 5-10 to 1. This is probably still too low for curative treatment of solid tumors, and further refinements, perhaps based on novel antibody formulations, are needed.
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Affiliation(s)
- S M Larson
- Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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56
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Rowlinson-Busza G, Snook D, Epenetos AA. 90Y-labeled antibody uptake by human tumor xenografts and the effect of systemic administration of EDTA. Int J Radiat Oncol Biol Phys 1994; 28:1257-65. [PMID: 8175414 DOI: 10.1016/0360-3016(94)90503-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE A human tumor xenograft model was used to compare the tumor and normal tissue uptake of a tumor-associated monoclonal antibody radiolabeled with 125I or 90Y. METHODS AND MATERIALS Nude mice bearing SC xenografts of the human colon adenocarcinoma, HT29, were injected with a mixture of 125I- and 90Y-DTPA-labeled AUA1 monoclonal antibody, which recognizes an antigen expressed on the surface of the tumor cells. In addition, the effect of systemic ethylenediaminetetraacetic acid (EDTA) administration on 90Y-labeled antibody clearance, tumor uptake of antibody and bone accumulation of 90Y was studied in a nude mouse model of intraperitoneal cancer. RESULTS Both the absolute amount (%id.g-1) and the tumor:normal tissue ratios were superior for the 90Y-labeled antibody, compared with the iodinated antibody, with the notable exception of bone. These results suggest that 90Y is a preferable isotope to iodine for radioimmunotherapy of solid masses, but that myelotoxicity, due to bone uptake of released 90Y, will limit the radiation dose which can be given when DTPA is used to chelate the 90Y. The 90Y-labeled antibody showed similar serum stability in vitro in the presence or absence of EDTA after incubation for up to 48 h. In vivo, urine excretion of 90Y was significantly enhanced in mice receiving daily injections of 20 mg EDTA for 3 days, commencing 2 h after intraperitoneal antibody administration, compared with control mice. There was no significant difference in the tumor uptake of 90Y-labeled antibody in EDTA-treated and control mice at any time-point up to 9 days postinjection. However, the bone levels of 90Y were significantly reduced in EDTA-treated mice at all times from 1 to 9 days. CONCLUSION Based on these results, it should be possible to increase the amount of 90Y-labeled antibody administered, by chelating the released 90Y with systemic EDTA to facilitate its excretion, without compromising tumor uptake of radiolabeled antibody.
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Affiliation(s)
- G Rowlinson-Busza
- Tumour Targeting Laboratory, Imperial Cancer Research Fund Oncology Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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57
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Mello AM, Pauwels EK, Cleton FJ. Radioimmunotherapy: no news from the newcomer. J Cancer Res Clin Oncol 1994; 120:121-30. [PMID: 8263007 DOI: 10.1007/bf01202189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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58
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Maraveyas A, Snook D, Hird V, Kosmas C, Meares CF, Lambert HE, Epenetos AA. Pharmacokinetics and toxicity of an yttrium-90-CITC-DTPA-HMFG1 radioimmunoconjugate for intraperitoneal radioimmunotherapy of ovarian cancer. Cancer 1994; 73:1067-75. [PMID: 8306249 DOI: 10.1002/1097-0142(19940201)73:3+<1067::aid-cncr2820731346>3.0.co;2-#] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The intracavitary route for the administration of monoclonal antibodies is used in a variety of locally spreading cancers. The authors have been treating patients with ovarian cancer in Phase I and II studies assessing toxicity and response to improved radioimmunoconjugates. METHODS Nineteen patients, 34-65 years of age, were treated with a new radioimmunoconjugate, 90Y-CITC-DTPA-HMFG1, instilled in the peritoneal cavity after second-look laparoscopy. Activity was increased in a stepwise fashion. RESULTS Following the intraperitoneal administration of 90Y-CITC-DTPA-HMFG1, levels of the radioimmunoconjugate in the blood increased, reaching a peak of about 30% of injected activity at around 54 hours posttreatment. Approximately 18% of the radiolabel was excreted in the urine within 96 hours. Bone-marrow toxicity was the dose-limiting factor. Grade III platelet and granulocyte toxicity was observed at 19.3 mCi/m2. A type III immunologic response was observed in a number of patients. CONCLUSIONS A dose of 18.5 mCi/m2 for subsequent treatments is recommended, based on a linear correlation of activity dose-to-body surface area. The clinical profile of a mild to moderate hypersensitivity syndrome is presented and hypotheses regarding its etiology are suggested.
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Affiliation(s)
- A Maraveyas
- Department of Clinical Oncology, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
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Abstract
With the advent of monoclonal antibody techniques, there has been renewed interest in RIT as a treatment modality in patients with a variety of tumour types. There has been a considerable research effort to increase understanding of the scientific basis of such therapy at all levels. Antibody, chelator and radioisotope factors are all the subject of research aimed at producing a potent effector system capable of maximal target cell kill with acceptable normal tissue toxicity. Improved knowledge of the host and tumour factors which limit access to the target cell offers the possibility of optimizing targeting and increasing the therapeutic index. Target cell factors that influence response to low dose rate RIT have been elucidated and provide an opportunity to integrate the treatment modality into radical therapy regimens. A number of Phase I and II trials have now been performed in various tumour types. The results have been promising but, as yet, the prospect of radical RIT remains a research goal. Before it can be achieved it will be necessary to improve specific tumour cell targeting and to increase both the initial dose rates and the total dose delivered to tumour deposits. Until such time, it is likely that RIT will be incorporated into multimodality protocols to deliver a moderate (10-20 Gy) tumour boost, or in an adjuvant setting in patients with minimal residual disease.
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Affiliation(s)
- K J Harrington
- Department of Clinical Oncology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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60
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Torti FM, Torti SV. Cytokines, iron homeostasis, and cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1994; 354:161-70. [PMID: 8067284 DOI: 10.1007/978-1-4899-0939-8_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- F M Torti
- Department of Medicine, Stanford University, CA
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61
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Press OW, Eary JF, Appelbaum FR, Martin PJ, Badger CC, Nelp WB, Glenn S, Butchko G, Fisher D, Porter B. Radiolabeled-antibody therapy of B-cell lymphoma with autologous bone marrow support. N Engl J Med 1993; 329:1219-24. [PMID: 7692295 DOI: 10.1056/nejm199310213291702] [Citation(s) in RCA: 474] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Radiolabeled monoclonal antibodies recognizing B-lymphocyte surface antigens represent a potentially effective new therapy for lymphomas. We assessed the biodistribution, toxicity, and efficacy of anti-CD20 (B1 and 1F5) and anti-CD37 (MB-1) antibodies labeled with iodine-131 in 43 patients with B-cell lymphoma in relapse. METHODS Sequential biodistribution studies were performed with escalating doses of antibody (0.5, 2.5, and 10 mg per kilogram of body weight) trace-labeled with 5 to 10 mCi of 131I. The doses of radiation absorbed by tumors and normal organs were estimated by serial gamma-camera imaging and tumor biopsies. Patients whose tumors were estimated to receive greater doses of radiation than the liver, lungs, or kidneys (i.e., patients with a favorable biodistribution) were eligible for therapeutic infusion of 131I-labeled antibodies according to a phase 1 dose-escalation protocol. RESULTS Twenty-four patients had a favorable biodistribution, and 19 received therapeutic infusions of 234 to 777 mCi of 131I-labeled antibodies (58 to 1168 mg) followed by autologous marrow reinfusion, resulting in complete remission in 16, a partial response in 2, and a minor response (25 to 50 percent regression of tumor) in 1. Nine patients have remained in continuous complete remission for 3 to 53 months. Toxic effects included myelosuppression, nausea, infections, and two episodes of cardiopulmonary toxicity, and were moderate in patients treated with doses of 131I-labeled antibodies that delivered less than 27.25 Gy to normal organs. CONCLUSIONS High-dose radioimmunotherapy with 131I-labeled antibodies is associated with a high response rate in patients with B-cell lymphoma in whom antibody biodistribution is favorable.
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MESH Headings
- Antibodies, Monoclonal
- Antigens, CD/immunology
- Antigens, CD20
- Antigens, Differentiation, B-Lymphocyte/immunology
- Antigens, Neoplasm
- Bone Marrow Transplantation
- Combined Modality Therapy
- Glycoproteins/immunology
- Humans
- Iodine Radioisotopes/administration & dosage
- Iodine Radioisotopes/adverse effects
- Iodine Radioisotopes/pharmacokinetics
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/physiopathology
- Lymphoma, B-Cell/radiotherapy
- Lymphoma, B-Cell/therapy
- Middle Aged
- Radioimmunotherapy
- Remission Induction
- Spleen/physiopathology
- Tetraspanins
- Transplantation, Autologous
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Affiliation(s)
- O W Press
- Department of Medicine, University of Washington, Seattle
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62
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Macklis RM, Beresford BA, Palayoor S, Sweeney S, Humm JL. Cell cycle alterations, apoptosis, and response to low-dose-rate radioimmunotherapy in lymphoma cells. Int J Radiat Oncol Biol Phys 1993; 27:643-50. [PMID: 8226159 DOI: 10.1016/0360-3016(93)90391-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE In an attempt to elucidate some aspects of the radiobiological basis of radioimmunotherapy, we have evaluated the in vitro cellular response patterns for malignant lymphoma cell lines exposed to high- and low-dose-rate radiation administered within the physiological context of antibody cell-surface binding. METHODS AND MATERIALS We used two different malignant lymphoma cell lines, a Thy1.2+ murine T-lymphoma line called EL-4 and a CD20+ human B-lymphoma line called Raji. Cells were grown in suspension cultures and exposed to high-dose-rate gamma radiation from an external 137Cs source or low-dose-rate beta radiation from DTPA-solubilized 90Y in solution. In some experiments, cells were pre-incubated with an excess of nonradioactive antibody in order to assess the effects of immunoglobulin surface binding during radiation exposure. Irradiated cells were evaluated for viability, cell-cycle changes, patterns of post-radiation morphologic changes, and biochemical hallmarks of radiation-associated necrosis and programmed cell death. RESULTS The EL-4 line was sensitive to both high-dose-rate and low-dose-rate irradiation, while the Raji showed efficient cell kill only after high-dose-rate irradiation. Studies of radiation-induced cell cycle changes demonstrated that both cell lines were efficiently blocked at the G2/M interface by high-dose-rate irradiation, with the Raji cells appearing somewhat more susceptible than the EL-4 cells to low-dose-rate radiation-induced G2/M block. Electron microscopy and DNA gel electrophoresis studies showed that a significant proportion of the EL-4 cells appeared to be dying by radiation-induced programmed cell death (apoptosis) while the Raji cells appeared to be dying primarily by classical radiation-induced cellular necrosis. CONCLUSION We propose that the unusual clinical responsiveness of some high and low grade lymphomas to modest doses of low-dose-rate radioimmunotherapy may be explained in part by the induction of apoptosis. The unusual dose-response characteristics observed in some experimental models of radiation-induced apoptosis may require a reappraisal of standard linear quadratic and alpha/beta algorithms used to predict target tissue cytoreduction after radioimmunotherapy.
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Affiliation(s)
- R M Macklis
- Harvard Joint Center for Radiation Therapy, Boston, MA 02115
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Huijgens PC, Jonkhoff AR, Hoekstra OS, Ossenkoppele GJ, Teule GJ. Therapeutic potential of intravenous 67-gallium in non-Hodgkin's lymphoma. Eur J Haematol 1993; 51:206-8. [PMID: 8243608 DOI: 10.1111/j.1600-0609.1993.tb00631.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
67-gallium accumulates rather selectively in malignant lymphoid tissue. The isotope has a substantial cytotoxic effect in human-derived cell-lines. 67-gallium was given intravenously to 3 patients with end-stage, resistant large-cell lymphoma. Evaluation of tumour response was done by physical measurements, and CT-scanning together with gallium scintigraphy. Three weekly doses of 20, 40 and 60 mCi respectively caused persistent pancytopenia in 1 patient. Pancytopenia was not observed in 2 other patients given two 40 mCi doses 4 weeks apart. In all 3 patients, some response was noted, be it shortlived and different from site to site. 67-gallium has some cytostatic effect in large cell lymphoma. It seems feasible to start a phase I study to find a tolerable dose to be given every 4 weeks.
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Affiliation(s)
- P C Huijgens
- Department of Haematology, Free University Hospital, Amsterdam, The Netherlands
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64
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Quadri SM, Shao Y, Blum JE, Leichner PK, Williams JR, Vriesendorp HM. Preclinical evaluation of intravenously administered 111In- and 90Y-labeled B72.3 immunoconjugate (GYK-DTPA) in beagle dogs. Nucl Med Biol 1993; 20:559-70. [PMID: 8358341 DOI: 10.1016/0969-8051(93)90024-o] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
B72.3, a monoclonal antibody with reactivity against human adenocarcinomas was obtained from the Cytogen Corporation in the form of an immunoconjugate coupled with linker-chelator GYK-DTPA by using proprietary carbohydrate directed site specific chemistry. The immunoconjugate was radiolabeled with indium-111 or yttrium-90. A preclinical analysis was performed in 10 normal beagle dogs. The pharmacokinetics of intravenously administered indium- and yttrium-labeled immunoconjugates were compared serially in blood, bone marrow and urine samples. Compared to 90Y less of the 111In label ended up in urine and more was found in blood and bone marrow. Indium-labeled B72.3 GYK-DTPA had relatively higher uptake in most glandular tissues than 111In-labeled antiferritin immunoconjugate. Bone marrow toxicity was the dose limiting side effect after intravenous infusion of 90Y-labeled B72.3 GYK-DTPA. Toxicity was also observed in the liver but not in other organ systems. Recently other investigators obtained similar results with these immunoconjugates in human patients. A preclinical pharmacokinetic analysis of radioimmunoconjugates in beagle dogs provided useful information regarding bone marrow toxicity, liver toxicity and in vivo instability of the immunoconjugate. Data suggest that for future trials in human patients, a more stable chelated immunoconjugate for yttrium is needed to achieve less liver uptake and a better correlation with the 111In-labeled product than the 90Y-labeled B72.3 GYK-DTPA used in this investigation.
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Affiliation(s)
- S M Quadri
- Johns Hopkins Oncology Center, Section of Radiobiology, Baltimore, MD 21205
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65
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66
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Jonkhoff AR, Huijgens PC, Versteegh RT, van Dieren EB, Ossenkoppele GJ, Martens HJ, Teule GJ. Gallium-67 radiotoxicity in human U937 lymphoma cells. Br J Cancer 1993; 67:693-700. [PMID: 8471427 PMCID: PMC1968343 DOI: 10.1038/bjc.1993.128] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Promising clinical results have been obtained with radiolabeled antibodies in lymphoma patients. The higher uptake by lymphomas of 67Gallium (67Ga) compared with monoclonal antibodies makes selective radiotherapy by the widely available 67Ga appealing. However, the gamma radiation of 67Ga used in scintigraphy is considered to be almost non-toxic to lymphoma cells. However, in addition to photon radiation 67Ga emits low energy Auger electrons and 80-90 keV conversion electrons which could be cytotoxic. The objective of the present study was the assessment of radiotoxicity of 67Ga on a lymphoid cell line: U937. Proliferation (MTT-assay) and clonogenic capacity (CFU-assay) were measured after 3 and 6 days incubation with 10, 20 and 40 microCi ml-1 67Ga. Growth inhibition was 36% after 3 days incubation and 63% after 6 days incubation with 40 microCi 67Ga ml-1. Clonogenic capacity was reduced by 51% after 3 days and 72% after 6 days incubation with 40 microCi ml-1 67Ga. A survival curve showed an initial shoulder and became steeper beyond 200-250 pCi cell-1 (low linear energy transfer type). Iso-effect doses of 67Ga and 90Yttrium (90Y) were determined. The iso-effect dose of 40 microCi 67Ga ml-1 (cumulative dose of conversion electrons 306 cGy) was 2.5 microCi 90Y ml-1 (cumulative dose 494 cGy) and the iso-effect dose of 80 microCi 67Ga ml-1 was 5.0 microCi 90Y/ml. The main cytotoxic effect of 67Ga seems to be induced by the 80 keV conversion electrons. We conclude that the conversion electrons of 67Ga have a cytotoxic effect on U937 cells and that in our experiments a 16-fold higher microCi-dose of 67Ga than of 90Y was needed for the same cytotoxic effect. We believe that 67Ga holds promise for therapeutic use.
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Affiliation(s)
- A R Jonkhoff
- Department of Haematology, Free University Hospital, Amsterdam, The Netherlands
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67
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Buchsbaum DJ, Lawrence TS, Roberson PL, Heidorn DB, Ten Haken RK, Steplewski Z. Comparison of 131I- and 90Y-labeled monoclonal antibody 17-1A for treatment of human colon cancer xenografts. Int J Radiat Oncol Biol Phys 1993; 25:629-38. [PMID: 8454481 DOI: 10.1016/0360-3016(93)90009-k] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The choice of radionuclide remains an important question in clinical radioimmunotherapy. Therefore, a study was initiated, using an in vivo model system, to assess the relative merits of 131I- and 90Y-labeled 17-1A monoclonal antibody as therapeutic agents in the treatment of colon cancer. 131Iodine- and 90Y-labeled 17-1A were assessed in animal therapy trials using athymic nude mice bearing LS174T human colon cancer xenografts. 131Iodine-labeled 17-1A decreased tumor growth in a dose-dependent fashion without lethality. In contrast, the doses of 90Y-labeled 17-1A which were required to produce a significant increase in tumor doubling time also caused marked toxicity. Although similar tumor growth inhibition was produced by 250 microCi 90Y- and 150 microCi 131I-labeled 17-1A, Medical Internal Radiation Dose calculations based on biodistribution data estimated that the dose delivered by 90Y was greater than that delivered by 131I. To investigate this discrepancy, 3-dimensional dose distributions within LS174T tumors were assessed using autoradiography and 3-dimensional calculational techniques. It was found that a greater fraction of the dose was deposited in the tumor after treatment with 131I- compared to 90Y-labeled 17-1A. When the Medical Internal Radiation Dose calculations were adjusted using the 3-dimensional dose distributions, 250 microCi of 90Y- and 150 microCi of 131I-labeled 17-1A were found to deliver similar tumor doses. These studies suggest that 131I-labeled 17-1A is superior to 90Y-labeled 17-1A, since 131I-labeled antibody produced less hematological and animal toxicity and was more effective at inhibiting LS174T tumor growth than 90Y-labeled antibody across the range of radionuclide doses tested. Furthermore, they suggest that it will be necessary to perform 3-dimensional dose calculations in addition to Medical Internal Radiation Dose calculations in order to interpret tumor dosimetry.
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Affiliation(s)
- D J Buchsbaum
- Department of Radiation Oncology, University of Alabama, Birmingham 35233
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68
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Abstract
Anticancer antibodies have had a long history in the management of cancer, with major applications having been shown in the immunohistochemistry and immunoassay of tumor-associated antigen markers. With the advent of hybridoma-derived monoclonal antibodies, attempts to use these more reproducible reagents in vivo for cancer detection and therapy have intensified. Radiolabeled monoclonal antibodies appear to be gaining a role in the management of cancer by means of imaging methods to detect sites of increased radioactivity, and several products have been developed and tested clinically. In the area of radioimmunotherapy, a number of problems still need to be solved, including low tumor uptake of the radioimmunoconjugate, dose-limiting myelotoxicity, and the induction of an immune response to repeated doses of murine (foreign) immunoglobulins. Similar problems exist for toxin and drug immunoconjugates, but these also fail to benefit from the "bystander" effect of the ionizing radiation delivered with radioimmunoconjugates, and plant and bacterial toxin molecules appear to have additional immunogenicity that restricts repeated injections. Despite these limitations, recombinant engineering and other chemical approaches are making progress in developing second-generation immunoconjugates that may be more efficacious and less immunogenic as cancer-selective therapeutics. Although nonconjugated, "naked", murine monoclonal antibodies have shown limited success in the therapy of human neoplasms, human and "humanized" forms may be more effective, particularly in lymphatic tumors. Some evidence also suggests that anti-idiotype antibodies (antiantibodies) may serve as surrogate antigens in cancer vaccines. Thus, a number of promising immunologic approaches for cancer diagnosis, detection, and therapy have made important progress in recent years.
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Affiliation(s)
- D M Goldenberg
- Garden State Cancer Center, Center for Molecular Medicine and Immunology, Newark, New Jersey 07103
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69
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Press OW, Eary J, Appelbaum FR, Badger CC, Bernstein ID. Radiolabeled antibody therapy of lymphoma. Cancer Treat Res 1993; 66:127-145. [PMID: 8102859 DOI: 10.1007/978-1-4615-3084-8_9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- O W Press
- Fred Hutchinson Cancer Center, Seattle, WA 98104
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70
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Maraveyas A, Epenetos AA. Targeted immunotherapy. An update with special emphasis on ovarian cancer. Acta Oncol 1993; 32:741-6. [PMID: 8305221 DOI: 10.3109/02841869309096130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An overview of antibody-guided immunotherapy for neoplasia is presented. The diversity of the antibody molecule is highlighted, through the many sophisticated strategies proposed and employed, to overcome a number of problems impeding successful targeting. An update of radioimmunotherapy of ovarian cancer is presented and the exciting concepts that are introduced to the field of targeted cancer therapy by molecular biology and genetic engineering are addressed.
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Affiliation(s)
- A Maraveyas
- Department of Clinical Oncology, Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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71
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Abstract
Since the breakthrough in producing monoclonal antibodies was achieved, this new tool has opened up numerous avenues in basic science and clinical investigation. In the area of oncology, monoclonal antibodies were initially seen as offering new hopes of a cure and many investigations in the last decade therefore focused on applying these reagents in tumour diagnosis and therapy. The results to date have been less encouraging and have served as a basis for understanding current limitations in the application of monoclonal antibodies and designing future strategies to overcome these problems. Advances in molecular biology now offer the possibility of better understanding tumour antigens and of constructing recombinant antibody fragments and fusion proteins with novel effector functions. Furthermore, advances in chelate and isotope chemistry have enabled the use of more potent and stable radiolabelled immunoconjugates. Better understanding of tumour biology and the mechanisms of tumour escape from current therapeutic approaches in opening up the intriguing possibility of combining monoclonal antibody-based therapy with chemotherapy, radiotherapy, and biological response modifiers.
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Affiliation(s)
- C Kosmas
- Department of Clinical Oncology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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Papanastassiou V, Pizer BL, Coakham HB, Bullimore J, Zananiri T, Kemshead JT. Treatment of recurrent and cystic malignant gliomas by a single intracavity injection of 131I monoclonal antibody: feasibility, pharmacokinetics and dosimetry. Br J Cancer 1993; 67:144-51. [PMID: 8427774 PMCID: PMC1968224 DOI: 10.1038/bjc.1993.25] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A pilot study was undertaken to determine the feasibility of infusing 131I labelled monoclonal antibodies (MoAbs) into either the cavity remaining after resection of malignant glioma or into glioma cysts. Of the seven patients recruited into the study, two had cystic lesions and five resection cavities. Six of the seven were treated after relapse from primary therapy. All patients apart from one, were given a single injection of 131I conjugated to a MoAb (ERIC-1) recognising the human neural cell adhesion molecule (NCAM). One patient received a further injection of 131I-MoAb after regrowth of their disease. Pharmacokinetic studies revealed that the MoAb remained predominantly in the tumour cavity with little leakage into the systemic compartment. This resulted in a high calculated dose of radiation being delivered to the tumour cells either lining or within close proximity to the cavity/cyst wall. In such a small study, it is not possible to determine accurately response rates, but individual patient responses were observed. This, along with the low toxicity noted, demonstrates the feasibility of using 131I-MoAbs in this way. With 131I, radiation dose is deposited in tissue to a depth of 1 mm from the source. The possibility of applying isotopes such as 90Yttrium which will irradiate tumour/tissue to a greater depth (6 mm) is discussed in context with the biology of glioma infiltration into normal brain parenchyma.
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Affiliation(s)
- T M Kuzel
- Northwestern University Medical School, Robert H. Lurie Cancer Center, Chicago, IL 60611
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74
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Press OW, Eary J, Badger CC, Appelbaum FR, Wiseman G, Matthews D, Martin PJ, Bernstein ID. High-dose radioimmunotherapy of lymphomas. Cancer Treat Res 1993; 68:13-22. [PMID: 8105847 DOI: 10.1007/978-1-4615-3076-3_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- O W Press
- University of Washington, School of Medicine, Seattle 98195
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Russell SJ, Llewelyn MB, Hawkins RE. Principles of antibody therapy. BMJ (CLINICAL RESEARCH ED.) 1992; 305:1424-9. [PMID: 1486312 PMCID: PMC1883914 DOI: 10.1136/bmj.305.6866.1424] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The success of monoclonal antibodies in clinical practice is dependent on good design. Finding a suitable target is the most important part as other properties of the antibody can be altered by genetic engineering. Antibodies that target lymphocyte antigens offer less toxic immunosuppressive treatment than currently available drugs and the first monoclonal antibody approved for human use is an immunosuppressive agent for treating rejection of renal transplants. Human trails of monoclonal antibodies to treat septic shock have been done and antibodies are also being developed to target common pathogens such as herpes simplex virus. Although monoclonal antibodies against cancer have been much heralded, their success has been limited by the poor access to the inside of tumours. Treatment of blood cancers has been more successful and a human antibody against B cell malignancies is being clinically tested. As knowledge about natural immune responses and antibody engineering increases many more monoclonals are likely to feature in clinical practice.
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Affiliation(s)
- A F LoBuglio
- University of Alabama, Comprehensive Cancer Center, Birmingham 35294-3300
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77
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Affiliation(s)
- G A Pietersz
- Austin Research Institute, Austin Hospital, Heidelberg, Victoria, Australia
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78
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Abstract
Tumor-associated antigens can be seen as unique targets for the delivery of anti-cancer therapy. Monoclonal antibodies directed at such antigens are increasingly being seen as important biologic reagents that will complement the group of existing cytotoxic drugs. This report briefly overviews recent advances in the field of monoclonal antibody therapy of cancer and provides insight regarding the promises and limitations of this novel therapeutic approach.
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Affiliation(s)
- A F LoBuglio
- University of Alabama, Comprehensive Cancer Center, Birmingham 35294-3300
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79
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Chapter 19. Monoclonal Antibodies in Therapy. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 1992. [DOI: 10.1016/s0065-7743(08)60417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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80
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Order SE. In response to erratum. Int J Radiat Oncol Biol Phys 1991. [DOI: 10.1016/0360-3016(91)90351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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