Evaluation of an internal cyclotron target for the production of 211At via the 209Bi (alpha,2n)211 at reaction

A third generation PSMA-targeted agent [211At]YF2: Synthesis and in vivo evaluation

INTRODUCTION

Targeted α-particle therapy agents have shown promising responses in patients who have developed resistance to β--particle emitting radionuclides, albeit off-target toxicity remains a concern. Astatine-211 emits only one α-particle per decay and may alleviate the toxicity from α-emitting daughter radionuclides. Previously, we developed the low-molecular-weight PSMA-targeted agent [211At]L3-Lu that showed suitable therapeutic efficacy and was well tolerated in mice. Although [211At]L3-Lu had good characteristics, we now have evaluated a closely related analogue, [211At]YF2, to determine the better molecule for clinical translation.

METHODS

The tin precursors and unlabeled iodo standards for [211At]YF2 and [211At]L3-Lu each were synthesized and a new one-step labeling method was developed to produce [211At]YF2 and [211At]L3-Lu from the respective tin precursor. RCY and RCP were determined using RP-HPLC. Cell uptake, internalization and in vitro cell-killing (MTT) assays were performed on PSMA+ PC-3 PIP cells in parallel experiments to compare [211At]YF2 and [211At]L3-Lu directly. A paired-label biodistribution study was performed in athymic mice with subcutaneous PSMA-positive PC-3 PIP xenografts as a head-to-head comparison of [131I]YF2 and [125I]L3-Lu. The tissue distribution of [211At]YF2 and [211At]L3-Lu were determined individually in the same animal model.

RESULTS

The syntheses of tin precursors and unlabeled iodo standards were accomplished in reasonable yields. A streamlined and scalable radiolabeling method (1 h total synthesis time) was developed for the radiosynthesis of both [211At]YF2 and [211At]L3-Lu with 86 ± 7 % (n = 10) and 87 ± 5 % (n = 7) RCY, respectively, and > 95 % RCP for both. The maximum activity of [211At]YF2 produced to date was 666 MBq. An alternative method that did not involve HPLC purification was developed that provided similar RCY and RCP. Significantly higher cell uptake, internalization and cytotoxicity was seen for [211At]YF2 compared with [211At]L3-Lu. Significantly higher uptake and longer retention in tumor was seen for [131I]YF2 than for co-administered [125I]L3-Lu, while considerably higher renal uptake was seen for [131I]YF2. The biodistribution of [211At]YF2 was consistent with that of [131I]YF2.

CONCLUSION

[211At]YF2 exhibited higher cellular uptake, internalization and cytotoxicity than [211At]L3-Lu on PSMA-positive PC3 PIP cells. Likewise, higher uptake and longer retention in tumor was seen for [211At]YF2. Experiments to evaluate the dosimetry and therapeutic efficacy of [211At]YF2 are under way.

211At on gold nanoparticles for targeted radionuclide therapy application

Targeted alpha therapy (TAT) is a methodology that is being developed as a promising cancer treatment using the α-particle decay of radionuclides. This technique involves the use of heavy radioactive elements being placed near the cancer target area to cause maximum damage to the cancer cells while minimizing the damage to healthy cells. Using gold nanoparticles (AuNPs) as carriers, a more effective therapy methodology may be realized. AuNPs can be good candidates for transporting these radionuclides to the vicinity of the cancer cells since they can be labeled not just with the radionuclides, but also a host of other proteins and ligands to target these cells and serve as additional treatment options. Research has shown that astatine and iodine are capable of adsorbing onto the surface of gold, creating a covalent bond that is quite stable for use in experiments. However, there are still many challenges that lie ahead in this area, whether they be theoretical, experimental, and even in real-life applications. This review will cover some of the major developments, as well as the current state of technology, and the problems that need to be tackled as this research topic moves along to maturity. The hope is that with more workers joining the field, we can make a positive impact on society, in addition to bringing improvement and more knowledge to science.

Radiometals in Imaging and Therapy: Highlighting Two Decades of Research

The present article highlights the important progress made in the last two decades in the fields of molecular imaging and radionuclide therapy. Advancements in radiometal-based positron emission tomography, single photon emission computerized tomography, and radionuclide therapy are illustrated in terms of their production routes and ease of radiolabeling. Applications in clinical diagnostic and radionuclide therapy are considered, including human studies under clinical trials; their current stages of clinical translations and findings are summarized. Because the metalloid astatine is used for imaging and radionuclide therapy, it is included in this review. In regard to radionuclide therapy, both beta-minus (β-) and alpha (α)-emitting radionuclides are discussed by highlighting their production routes, targeted radiopharmaceuticals, and current clinical translation stage.

Therapeutic efficacy of 211At-radiolabeled 2,6-diisopropylphenyl azide in mouse models of human lung cancer

Targeted α-particle therapy (TAT) is an attractive alternative to conventional therapy for cancer treatment. Among the available radionuclides considered for TAT, astatine-211 (211At) attached to a cancer-targeting molecule appears very promising. Previously, we demonstrated that aryl azide derivatives could react selectively with the endogenous acrolein generated by cancer cells to give a diazo compound, which subsequently forms a covalent bond with the organelle of cancer cells in vivo. Herein, we synthesized 211At-radiolabeled 2,6-diisopropylphenyl azide (ADIPA), an α-emitting molecule that can selectively target the acrolein of cancer cells, and investigated its antitumor effect. Our results demonstrate that a single intratumor or intravenous administration of this simple α-emitting molecule to the A549 (human lung cancer) cell-bearing xenograft mouse model, at a low dose (70 kBq), could suppress tumor growth without inducing adverse effects. Furthermore, because acrolein is generally overproduced by most cancer cells, we believe ADIPA is a simple TAT compound that deserves further investigation for application in animal models and humans with various cancer types and stages.

Astatine-211 based radionuclide therapy: Current clinical trial landscape

Astatine-211 (²¹¹At) has physical properties that make it one of the top candidates for use as a radiation source for alpha particle-based radionuclide therapy, also referred to as targeted alpha therapy (TAT). Here, we summarize the main results of the completed clinical trials, further describe ongoing trials, and discuss future prospects.

Production and Supply of α-Particle-Emitting Radionuclides for Targeted α-Therapy

Encouraging results from targeted α-therapy have received significant attention from academia and industry. However, the limited availability of suitable radionuclides has hampered widespread translation and application. In the present review, we discuss the most promising candidates for clinical application and the state of the art of their production and supply. In this review, along with 2 forthcoming reviews on chelation and clinical application of α-emitting radionuclides, The Journal of Nuclear Medicine will provide a comprehensive assessment of the field.

Production, purification and availability of 211At: Near term steps towards global access

The promising characteristics of the 7.2-h radiohalogen 211At have long been recognized; including having chemical properties suitable for labeling targeting vectors ranging from small organic molecules to proteins, and the emission of only one α-particle per decay, providing greater control over off-target effects. Unfortunately, the impact of 211At within the targeted α-particle therapy domain has been constrained by its limited availability. Paradoxically, the most commonly used production method - via the 209Bi(α,2n)211At reaction - utilizes a widely available natural material (bismuth) as the target and straightforward cyclotron irradiation methodology. On the other hand, the most significant impediment to widespread 211At availability is the need for an accelerator capable of generating ≥28 MeV α-particles with sufficient beam intensities to make clinically relevant levels of 211At. In this review, current methodologies for the production and purification of 211At - both by the direct production route noted above and via a 211Rn generator system - will be discussed. The capabilities of cyclotrons that currently produce 211At will be summarized and the characteristics of other accelerators that could be utilized for this purpose will be described. Finally, the logistics of networks, both academic and commercial, for facilitating 211At distribution to locations remote from production sites will be addressed.

Excitation functions for 209Bi reactions induced by threshold to 50 MeV energy alpha particles

Excitation functions for ²⁰⁹Bi(α,2n)²¹¹At, ²⁰⁹Bi(α,3n)²¹⁰At and ²⁰⁹Bi(α,4n)²⁰⁹At reactions were calculated using TALYS-1.95 nuclear code from threshold to 50 MeV by invoking suitable options for level densities, nucleon-nucleus optical model potentials and alpha optical model potentials. Statistical factors were used to verify the quality of matching between theoretical model calculations and the experimental data from the EXFOR database. The TTY of ²¹¹At calculated using the excitation function of ²⁰⁹Bi(a,2n)²¹¹At reaction is compared with existing experimental studies from literature The results of the present study are important for the validation of nuclear model approaches with increased predictive power for ²⁰⁹Bi(α,xn) reactions for the production of ²¹¹At.

Overview of the Most Promising Radionuclides for Targeted Alpha Therapy: The "Hopeful Eight"

Among all existing radionuclides, only a few are of interest for therapeutic applications and more specifically for targeted alpha therapy (TAT). From this selection, actinium-225, astatine-211, bismuth-212, bismuth-213, lead-212, radium-223, terbium-149 and thorium-227 are considered as the most suitable. Despite common general features, they all have their own physical characteristics that make them singular and so promising for TAT. These radionuclides were largely studied over the last two decades, leading to a better knowledge of their production process and chemical behavior, allowing for an increasing number of biological evaluations. The aim of this review is to summarize the main properties of these eight chosen radionuclides. An overview from their availability to the resulting clinical studies, by way of chemical design and preclinical studies is discussed.

Realizing Clinical Trials with Astatine-211: The Chemistry Infrastructure

Despite the consensus around the clinical potential of the α-emitting radionuclide astatine-211 (211At), there are only a limited number of research facilities that work with this nuclide. There are three main reasons for this: (1) Scarce availability of the nuclide. Despite a relatively large number of globally existing cyclotrons capable of producing 211At, few cyclotron facilities produce the nuclide on a regular basis. (2) Lack of a chemical infrastructure, that is, isolation of 211At from irradiated targets and the subsequent synthesis of an astatinated product. At present, the research groups that work with 211At depend on custom systems for recovering 211At from the irradiated targets. Setting up and implementing such custom units require long lead times to provide a proper working system. (3) The chemistry of 211At. Compared with radiometals there are no well-established and generally accepted synthesis methods for forming sufficiently stable bonds between 211At and the tumor-specific vector to allow for systemic applications. Herein we present an overview of the infrastructure of producing 211At radiopharmaceuticals, from target to radiolabeled product including chemical strategies to overcome hurdles for advancement into clinical trials with 211At.

Alpha-Emitters and Targeted Alpha Therapy in Oncology: from Basic Science to Clinical Investigations

Alpha-emitters are radionuclides that decay through the emission of high linear energy transfer α-particles and possess favorable pharmacologic profiles for cancer treatment. When coupled with monoclonal antibodies, peptides, small molecules, or nanoparticles, the excellent cytotoxic capability of α-particle emissions has generated a strong interest in exploring targeted α-therapy in the pre-clinical setting and more recently in clinical trials in oncology. Multiple obstacles have been overcome by researchers and clinicians to accelerate the development of targeted α-therapies, especially with the recent improvement in isotope production and purification, but also with the development of innovative strategies for optimized targeting. Numerous studies have demonstrated the in vitro and in vivo efficacy of the targeted α-therapy. Radium-223 (²²³Ra) dichloride (Xofigo®) is the first α-emitter to have received FDA approval for the treatment of prostate cancer with metastatic bone lesions. There is a significant increase in the number of clinical trials in oncology using several radionuclides such as Actinium-225 (²²⁵Ac), Bismuth-213 (²¹³Bi), Lead-212 (²¹²Pb), Astatine (²¹¹At) or Radium-223 (²²³Ra) assessing their safety and preliminary activity. This review will cover their therapeutic application as well as summarize the investigations that provide the foundation for further clinical development.

Evaluation of astatine-211-labeled octreotide as a potential radiotherapeutic agent for NSCLC treatment

Octreotide is a somatostatin (SST) analogue currently used in the treatment of neuroendocrine tumors (NETs) with high binding affinity for the somatostatin receptor-2 (SSTR2) that is also overexpressed in non-small cell lung cancer cell (NSCLC). Alpha-particle-emitting astatine-211 (²¹¹At) is a promising radionuclide with appropriate physical and chemical properties for use in targeted anticancer therapies. To obtain an additional pharmacological agent for the treatment of NSCLC, we present the first investigation of the possible use of ²¹¹At-labeled octreotide as a potential alpha-radionuclide therapeutic agent for NSCLC treatment. ²¹¹At-SPC-octreotide exhibited observable higher uptake in lung, spleen, stomach and intestines than in other tissues. Through histological examination, ²¹¹At-SPC-octreotide demonstrated much more lethal effect than control groups (PBS, octreotide and free ²¹¹At). These promising preclinical results suggested that ²¹¹At labeled octreotide deserved to be further developed as a new anticancer agent for NSCLC.

Radiopharmaceutical chemistry of targeted radiotherapeutics, part 4: Strategies for 211At labeling at high activities and radiation doses of 211At α-particles

INTRODUCTION

Alpha particles are radiation of high energy and short range, properties that can lead to radiolysis-mediated complications in labeling chemistry at the high radioactivity levels required for clinical application. In previous papers in this series, we have shown that radiation dose has a profound effect on the astatine species that are present in the labeling reaction and their suitability for the synthesis of N-succinimidyl 3-[211At]astatobenzoate. The purpose of this study was to evaluate the effects of adding N-chlorosuccinimide (NCS) to the methanol solution used for initial isolation of 211At after distillation, a process referred to as 211At stabilization, on 211At chemistry after exposure to high radiation doses.

METHODS

High performance liquid chromatography was used to evaluate the distribution of 211At species present in methanol in the 500-65,000Gy radiation dose range and the synthesis of SAB from N-succinimidyl 3-(tri-n-butylstannyl)benzoate in the 500-120,000Gy radiation dose range using different 211At timeactivity combinations under conditions with/without 211At stabilization.

RESULTS

In the absence of NCS stabilization, a reduced form of astatine, At(2), increased with increasing radiation dose, accounting for about half the total activity by about 15,000Gy, while with stabilization, At(2) accounted for <10% of 211At activity even at doses >60,000Gy. SAB yields without stabilization rapidly declined with increasing dose, falling to ~20% at about 5000Gy while with stabilization, yields >80% were obtained with 211At solutions stored for more than 23h and receiving radiation doses >100,000Gy.

CONCLUSIONS

Adding NCS to the methanol solution used for initial isolation of 211At is a promising strategy for countering the deleterious effects of radiolysis on 211At chemistry.

ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE

This strategy could facilitate the ability to perform 211At labeling at sites remote from its production and at the high activity levels required for clinical applications.

Preliminary production of 211At at the Texas A&M University Cyclotron Institute

A feasibility study for the production of the alpha particle-emitting radionuclide At was performed at the Texas A&M University Cyclotron Institute as part of the Interdisciplinary Radioisotope Production and Radiochemistry Program. The mission of this program centers upon the production of radionuclides for use in diagnostic and therapeutic nuclear medicine with the primary focus on development of novel therapeutic strategies. As a first step in establishing this program, two goals were outlined: (i) verify production of At and compare results to published data, and (ii) evaluate shielding and radiological safety issues for large-scale implementation using an external target. The radionuclide At was produced via the Bi (α, 2n) At reaction using the K500 cyclotron. Two experiments were conducted, using beam energies of 27.8 MeV and 25.3 MeV, respectively. The resulting yields for At were found to be 36.0 MBq μA h and 12.4 MBq μA h, respectively, which fall within the range of published yield data. Strategies for increasing absolute yield and production efficiency were also evaluated, which focused chiefly on using a new target designed for use with the K150 cyclotron, which will enable the use of a higher beam current. Finally, neutron and gamma dose rates during production were evaluated by using the Monte Carlo code MCNPX. It was determined that a simple structure consisting of 4-in thick borated polyethylene will reduce the neutron dose rate within the cyclotron production vault by approximately a factor of 2, thereby decreasing activation of equipment.

Production of α-particle emitting ²¹¹At using 45 MeV α-beam

Among the α-particle emitting radionuclides, (211)At is considered to be a promising radionuclide for targeted cancer therapy due to its decay properties. The range of alpha particles produced by the decay of (211)At are less than 70 µm in water with a linear energy transfer between 100 and 130 keV µm(-1), which are about the maximum relative biological effectiveness for heavy ions. It is important to note that at the present time, only a few of cyclotrons routinely produce (211)At. The direct production method is based on the nuclear reactions (209)Bi(α,2n)(211)At. Production of the radionuclide (211)At was carried out using the MC-50 cyclotron at the Korea Institute of Radiological and Medical Sciences (KIRAMS). To ensure high beam current, the α-beam was extracted with an initial energy of 45 MeV, which was degraded to obtain the appropriate α-beam energy. The calculations of beam energy degradation were performed utilizing the MCNPX. Alumina-baked targets were prepared by heating the bismuth metal powder onto a circular cavity in a furnace. When using an E(α, av) of 29.17 MeV, the very small contribution of (210)At confirms the right choice of the irradiation energy to obtain a pure production of (211)At isotope.

Condensed astatine: monatomic and metallic

The condensed matter properties of the nominal terminating element of the halogen group with atomic number 85, astatine, are as yet unknown. In the intervening more than 70 years since its discovery significant advances have been made in substrate cooling and the other techniques necessary for the production of the element to the point where we might now enquire about the key properties astatine might have if it attained a condensed phase. This subject is addressed here using density functional theory and structural selection methods, with an accounting for relativistic physics that is essential. Condensed astatine is predicted to be quite different in fascinating ways from iodine, being already at 1 atm a metal, and monatomic at that, and possibly a superconductor (as is dense iodine).

A Bridge not too Far: Personalized Medicine with the use of Theragnostic Radiopharmaceuticals

This article deals primarily with the selection criteria, production, and the nuclear, physical, and chemical properties of certain dual-purpose radionuclides, including those that are currently being used, or studied and evaluated, and those that warrant future investigations. Various scientific and practical issues related to the production and availability of these radionuclides is briefly addressed. At brookhaven national laboratory (BNL), we have developed a paradigm that involves specific individual ‘dual-purpose’ radionuclides or radionuclide pairs with emissions suitable for both imaging and therapy, and which when molecularly (selectively) targeted using appropriate carriers, would allow pre-therapy low-dose imaging plus higher-dose therapy in the same patient. We have made an attempt to sort out and organize a number of such theragnostic radionuclides and radionuclide pairs that may thus potentially bring us closer to the age-long dream of personalized medicine for performing tailored low-dose molecular imaging (SPECT/CT or PET/CT) to provide the necessary pretherapy information on biodistribution, dosimetry, the limiting or critical organ or tissue, and the maximum tolerated dose (MTD), etc., followed by performing higher-dose targeted molecular therapy in the same patient with the same radiopharmaceutical. As an example, our preclinical and clinical studies with the theragnostic radionuclide Sn-117m are covered in somewhat greater detail.

A troublesome problem that remains yet to be fully resolved is the lack of availability, in sufficient quantities and at reasonable cost, of a majority of the best candidate theragnostic radionuclides in a no-carrier-added (NCA) form. In this regard, a summary description of recently developed new or modified methods at BNL for the production of five theragnostic radionuclide/radionuclide pair items, whose nuclear, physical, and chemical characteristics seem to show promise for therapeutic oncology and for treating other disorders that respond to radionuclide therapy, is provided.

How to cite this article

Srivastava SC. A Bridge not too Far: Personalized Medicine with the use of Theragnostic Radiopharmaceuticals. J Postgrad Med Edu Res 2013;47(1):31-46.

Radiological safety concerns for the accelerator production of diagnostic and therapeutic radionuclides in a university setting

Accelerator production of radionuclides for diagnostic and therapeutic research at a university has many advantages. Radionuclides not commonly available through commercial suppliers may be readily produced for innovative research applications. Loss of material due to decay in transit is minimized, and product lead times may be significantly reduced. Furthermore, graduate students and research assistants have the opportunity to gain considerable hands-on experience during the production, extraction, and processing operations. However, the benefits of implementing accelerator production into an existing radiological protection program must be balanced against increased safety procedures and maintenance of as-low-as-reasonably-achievable work practices. This article outlines the basics for radioactive material production and corresponding issues in radiological protection associated with the production, use, and disposal on a college campus.

Astatine-211: production and availability

The 7.2-h half life radiohalogen (211)At offers many potential advantages for targeted α-particle therapy; however, its use for this purpose is constrained by its limited availability. Astatine-211 can be produced in reasonable yield from natural bismuth targets via the (209)Bi(α,2n)(211)At nuclear reaction utilizing straightforward methods. There is some debate as to the best incident α-particle energy for maximizing 211At production while minimizing production of (210)At, which is problematic because of its 138.4-day half life α-particle emitting daughter, (210)Po. The intrinsic cost for producing (211)At is reasonably modest and comparable to that of commercially available (123)I. The major impediment to (211)At availability is attributed to the need for a medium energy α-particle beam for its production. On the other hand, there are about 30 cyclotrons in the world that have the beam characteristics required for (211)At production.

A proposed methodology to select radioisotopes for use in radionuclide therapy

The American Journal of Neuroradiology has played a seminal role in the history of vertebral augmentation (VA). Because VA is increasingly being included in the multidisciplinary management of malignant vertebral compression fractures (VCFs), combined therapeutic approaches that include strategies to treat metastatic disease along with the fracture have become appealing options for patients. To that end, we recently investigated the dosimetric feasibility of treating malignant VCFs with radionuclide therapy. The goal would be to provide local control of the systemic disease beyond the pain relief and structural support provided by polymethylmethacrylate cement. The purpose of this article is to propose a methodology for evaluating radionuclides for use in radiation therapy that takes into account a number of factors including radiation characteristics, biochemical effects, production capacity, and safety. The goal of such a methodology is to introduce a systematic approach to selecting radionuclides in designing treatment regimens and future investigations and also to stimulate discussion and experimentation involving new radionuclides that may provide more effective treatments than the current isotopes in widespread use.

11C-methane production in small volume, high pressure gas targets

The parameters affecting the production of11C-methane, in situ, in small volume, high-pressure gas targets include target chamber size and material. The results are based on experiments that varied the target gas composition, the target material and geometry. Methane production yields were typically 65% of the yields of11CO2in the same target chamber.

Astatine Radiopharmaceuticals: Prospects and Problems

For the treatment of minimum residual diseases such micrometastases and residual tumor margins that remain after debulking of the primary tumor, targeted radiotherapy using radiopharmaceuticals tagged with alpha-particle-emitting radionuclides is very attractive. In addition to the their short range in tissue, which helps minimize harmful effects on adjacent normal tissues, alpha-particles, being high LET radiation, have several radiobiological advantages. The heavy halogen, astatine-211 is one of the prominent alpha-particle-emitting radionuclides in practice. Being a halogen, it can often be incorporated into biomolecules of interest by adapting radioiodination chemistry. A wide spectrum of compounds from the simple [(211)At]astatide ion to small organic molecules, peptides, and large proteins labeled with (211)At have been investigated with at least two reaching the stage of clinical evaluation. The chemistry, cytotoxic advantages, biodistribution studies, and microdosimetry/pharmacokinetic modeling of some of these agents will be reviewed. In addition, potential problems such as the harmful effect of radiolysis on the synthesis, lack of sufficient in vivo stability of astatinated compounds, and possible adverse effects when they are systemically administered will be discussed.

Direct procedure for the production of 211At-labeled antibodies with an epsilon-lysyl-3-(trimethylstannyl)benzamide immunoconjugate

(211)At-labeled tumor-specific antibodies have long been considered for the treatment of disseminated cancer. However, the limited availability of the nuclide and the poor efficacy of labeling procedures at clinical activity levels present major obstacles to their use. This study evaluated a procedure for the direct astatination of antibodies for the production of clinical activity levels.

METHODS

The monoclonal antibody trastuzumab was conjugated with the reagent N-succinimidyl-3-(trimethylstannyl)benzoate, and the immunoconjugate was labeled with astatine. Before astatination of the conjugated antibody, the nuclide was activated with N-iodosuccinimide. The labeling reaction was evaluated in terms of reaction time, volume of reaction solvent, immunoconjugate concentration, and applied activity. The quality of the astatinated antibodies was determined by in vitro analysis and biodistribution studies in nude mice.

RESULTS

The reaction proceeded almost instantaneously, and the results indicated a low dependence on immunoconjugate concentration and applied activity. Radiochemical labeling yields were in the range of 68%-81%, and a specific radioactivity of up to 1 GBq/mg could be achieved. Stability and radiochemical purity were equal to or better than those attained with a conventional 2-step procedure. Dissociation constants for directly astatinated, conventionally astatinated, and radioiodinated trastuzumab were 1.0+/-0.06 (mean+/-SD), 0.44+/-0.06, and 0.29+/-0.02 nM, respectively. The tissue distribution in non-tumor-bearing nude mice revealed only minor differences in organ uptake relative to that obtained with the conventional method.

CONCLUSION

The direct astatination procedure enables the high-yield production of astatinated antibodies with radioactivity in the amounts required for clinical applications.

Clinical experience with alpha-particle emitting 211At: treatment of recurrent brain tumor patients with 211At-labeled chimeric antitenascin monoclonal antibody 81C6

alpha-Particle-emitting radionuclides, such as (211)At, with a 7.2-h half-life, may be optimally suited for the molecularly targeted radiotherapy of strategically sensitive tumor sites, such as those in the central nervous system. Because of the much shorter range and more potent cytotoxicity of alpha-particles than of beta-particles, (211)At-labeled agents may be ideal for the eradication of tumor cells remaining after surgical debulking of malignant brain tumors. The main goal of this study was to investigate the feasibility and safety of this approach in patients with recurrent malignant brain tumors.

METHODS

Chimeric antitenascin monoclonal antibody 81C6 (ch81C6) (10 mg) was labeled with 71-347 MBq of (211)At by use of N-succinimidyl 3-[(211)At]astatobenzoate. Eighteen patients were treated with (211)At-labeled ch81C6 ((211)At-ch81C6) administered into a surgically created resection cavity (SCRC) and then with salvage chemotherapy. Serial gamma-camera imaging and blood sampling over 24 h were performed.

RESULTS

A total of 96.7% +/- 3.6% (mean +/- SD) of (211)At decays occurred in the SCRC, and the mean blood-pool percentage injected dose was < or = 0.3. No patient experienced dose-limiting toxicity, and the maximum tolerated dose was not identified. Six patients experienced grade 2 neurotoxicity within 6 wk of (211)At-ch81C6 administration; this neurotoxicity resolved fully in all but 1 patient. No toxicities of grade 3 or higher were attributable to the treatment. No patient required repeat surgery for radionecrosis. The median survival times for all patients, those with glioblastoma multiforme, and those with anaplastic astrocytoma or oligodendroglioma were 54, 52, and 116 wk, respectively.

CONCLUSION

This study provides proof of concept for regional targeted radiotherapy with (211)At-labeled molecules in oncology. Specifically, the regional administration of (211)At-ch81C6 is feasible, safe, and associated with a promising antitumor benefit in patients with malignant central nervous system tumors.

Targeted alpha-particle radiotherapy with 211At-labeled monoclonal antibodies

An attractive feature of targeted radionuclide therapy is the ability to select radionuclides and targeting vehicles with characteristics that are best suited for a particular clinical application. One combination that has been receiving increasing attention is the use of monoclonal antibodies (mAbs) specifically reactive to receptors and antigens that are expressed in tumor cells to selectively deliver the alpha-particle-emitting radiohalogen astatine-211 (211At) to malignant cell populations. Promising results have been obtained in preclinical models with multiple 211At-labeled mAbs; however, translation of the concept to the clinic has been slow. Impediments to this process include limited radionuclide availability, the need for suitable radiochemistry methods operant at high activity levels and lack of data concerning the toxicity of alpha-particle emitters in humans. Nonetheless, two clinical trials have been initiated to date with 211At-labeled mAbs, and others are planned for the near future.

The bioinorganic and medicinal chemistry of carboranes: from new drug discovery to molecular imaging and therapy

The role of carboranes in medicinal chemistry has diversified in recent years and now extends into areas of drug discovery, molecular imaging, and targeted radionuclide therapy. An introduction to carborane chemistry is provided to familiarize the non-expert with some key properties of these molecules, followed by an overview of current medicinally-orientated research involving carboranes. The broad-ranging nature of this research is illustrated, with emphasis placed on recent highlights and advances in this field.

Cancer radioimmunotherapy with alpha-emitting nuclides

In lymphoid malignancies and in certain solid cancers such as medullary thyroid carcinoma, somewhat mixed success has been achieved when applying radioimmunotherapy (RIT) with beta-emitters for the treatment of refractory cases. The development of novel RIT with alpha-emitters has created new opportunities and theoretical advantages due to the high linear energy transfer (LET) and the short path length in biological tissue of alpha-particles. These physical properties offer the prospect of achieving selective tumoural cell killing. Thus, RIT with alpha-emitters appears particularly suited for the elimination of circulating single cells or cell clusters or for the treatment of micrometastases at an early stage. However, to avoid non-specific irradiation of healthy tissues, it is necessary to identify accessible tumoural targets easily and rapidly. For this purpose, a small number of alpha-emitters have been investigated, among which only a few have been used for in vivo preclinical studies. Another problem is the availability and cost of these radionuclides; for instance, the low cost and the development of a reliable actinium-225/bismuth-213 generator were probably determining elements in the choice of bismuth-213 in the only human trial of RIT with an alpha-emitter. This article reviews the literature concerning monoclonal antibodies radiolabelled with alpha-emitters that have been developed for possible RIT in cancer patients. The principal radio-immunoconjugates are considered, starting with physical and chemical properties of alpha-emitters, their mode of production, the possibilities and difficulties of labelling, in vitro studies and finally, when available, in vivo preclinical and clinical studies.

A new internal target system for production of (211)At on the cyclotron U-120M

The alpha emitter (211)At is a radionuclide with good potential for use in the therapy of smaller tumours and metastases. However, limited availability of this radionuclide hinders development of this application and the research of astatine chemistry in general. In this general context we have designed and tested a new internal target system. A thin bismuth layer (3-5 microm) was evaporated onto a light target backing (7.5 g) and irradiated at 0.5-1.5 degrees angles with 29.5 MeV alpha particles beam of intensity up to 30 microA. The backing was then released from the target holder and used directly for astatine separation via dry distillation. Astatine condensed on the Teflon capillary walls was then eluted into 150-250 microl of methanol. The saturation yield was found to be ca. 400 MBq/microA, and the radionuclidic purity of (211)At acceptable for medical applications (activity ratio (210)At/(211)At<10(-3) at EOB). The overall separation yield was 65-75%.

Experimental study of the cross-sections of alpha-particle induced reactions on 209Bi

alpha-particle-induced nuclear reactions for generation of (211)At used in therapeutic nuclear medicine and possible contaminants were investigated with the stacked foil activation technique on natural bismuth targets up to E(alpha)=39 MeV. Excitation functions are reported for the reactions (209)Bi(alpha,2n)(211)At, (209)Bi(alpha,3n)(210)At and (209)Bi(alpha,x)(210)Po. Results obtained from direct alpha-emission measurements and gamma-spectra from decay products are compared and correspond well with earlier literature values. Thick target yields have been deduced from the experimental cross-sections and optimised production pathways for minimal contamination are presented. A comparison with the results of the theoretical model code ALICE-IPPE is discussed.

External targets for the production of 211At--review and status of the target development at the Hannover cyclotron

211At is an alpha emitter which can be produced with cyclotrons capable of accelerating helium-4 ions to at least 28 MeV in case of external targets. Different targets were used and improved to increase the yield of 211At to amounts considered to be suitable for alpha therapy of tumours.

N-succinimidyl 3-[211At]astato-4-guanidinomethylbenzoate: an acylation agent for labeling internalizing antibodies with alpha-particle emitting 211At

The objective of this study was to develop a method for labeling internalizing monoclonal antibodies (mAbs) such as those reactive to the anti-epidermal growth factor receptor variant III (EGFRvIII) with the alpha-particle emitting radionuclide (211)At. Based on previous work utilizing the guanidine-containing acylation agent, N-succinimidyl 4-guanidinomethyl-3-[(131)I]iodobenzoate ([(131)I]SGMIB), we have now investigated the potential utility of its astato analogue for labeling the anti-EGFRvIII mAb L8A4. N-succinimidyl 3-[(211)At]astato-4-guanidinomethylbenzoate ([(211)At]SAGMB) in its Boc-protected form was prepared from a tin precursor in 61.7 +/- 13.1% radiochemical yield, in situ deprotected to [(211)At]SAGMB, which was coupled to L8A4 in 36.1 +/- 1.9% yield. Paired-label internalization assays demonstrated that tumor cell retention of radioactivity for L8A4 labeled using [(211)At]SAGMB was almost identical to L8A4 labeled using [(131)I]SGMIB, and 3-4-fold higher than for mAb radioiodinated using Iodogen. Paired-label biodistribution of L8A4 labeled using [(211)At]SAGMB and [(131)I]SGMIB in athymic mice hosting U87MGdeltaEGFR xenografts resulted in identical uptake of both (211)At and (131)I in tumor tissues over 24 h. Although higher levels of (211)At compared with (131)I were sometimes seen in tissues known to sequester free astatide, these (211)At/(131)I uptake ratios were considerably lower than those seen with other labeling methods. These results suggest that [(211)At]SAGMB may be a useful acylation agent for labeling internalizing mAbs with (211)At.

Dry-distillation of astatine-211 from irradiated bismuth targets: a time-saving procedure with high recovery yields

Astatine-211 was produced via the 209Bi(alpha,2n) 211At reaction. The radionuclide was isolated with a novel procedure employing dry-distillation of the irradiated target material. The astatine was condensed as a dry residue in a PEEK-capillary cryotrap. Distillation was completed within 1-2 min with isolation yields of 92 +/- 3%. Subsequent work-up of the nuclide resulted in final recovery yields of 79 +/- 3%.