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Experimental Nuclear Medicine Meets Tumor Biology. Pharmaceuticals (Basel) 2022; 15:ph15020227. [PMID: 35215337 PMCID: PMC8878163 DOI: 10.3390/ph15020227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023] Open
Abstract
Personalized treatment of cancer patients demands specific and validated biomarkers for tumor diagnosis and therapy. The development and validation of such require translational preclinical models that recapitulate human diseases as accurately as possible. Moreover, there is a need for convergence of different (pre)clinical disciplines that openly share their knowledge and methodologies. This review sheds light on the differential perception of biomarkers and gives an overview of currently used models in tracer development and approaches for biomarker discovery.
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Danieli R, Milano A, Gallo S, Veronese I, Lascialfari A, Indovina L, Botta F, Ferrari M, Cicchetti A, Raspanti D, Cremonesi M. Personalized Dosimetry in Targeted Radiation Therapy: A Look to Methods, Tools and Critical Aspects. J Pers Med 2022; 12:205. [PMID: 35207693 PMCID: PMC8874397 DOI: 10.3390/jpm12020205] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
Targeted radiation therapy (TRT) is a strategy increasingly adopted for the treatment of different types of cancer. The urge for optimization, as stated by the European Council Directive (2013/59/EURATOM), requires the implementation of a personalized dosimetric approach, similar to what already happens in external beam radiation therapy (EBRT). The purpose of this paper is to provide a thorough introduction to the field of personalized dosimetry in TRT, explaining its rationale in the context of optimization and describing the currently available methodologies. After listing the main therapies currently employed, the clinical workflow for the absorbed dose calculation is described, based on works of the most experienced authors in the literature and recent guidelines. Moreover, the widespread software packages for internal dosimetry are presented and critical aspects discussed. Overall, a selection of the most important and recent articles about this topic is provided.
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Affiliation(s)
- Rachele Danieli
- Dipartimento di Fisica, Università degli Studi di Pavia, Via Bassi 6, 27100 Pavia, Italy;
| | - Alessia Milano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy;
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy
| | - Salvatore Gallo
- Dipartimento di Fisica “Aldo Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (S.G.); (I.V.)
- INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Ivan Veronese
- Dipartimento di Fisica “Aldo Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (S.G.); (I.V.)
- INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Alessandro Lascialfari
- INFN-Pavia Unit, Department of Physics, University of Pavia, Via Bassi 6, 27100 Pavia, Italy;
| | - Luca Indovina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy;
| | - Francesca Botta
- Medical Physics Unit, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milano, Italy; (F.B.); (M.F.)
| | - Mahila Ferrari
- Medical Physics Unit, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milano, Italy; (F.B.); (M.F.)
| | - Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy;
| | - Davide Raspanti
- Temasinergie S.p.A., Via Marcello Malpighi 120, 48018 Faenza, Italy;
| | - Marta Cremonesi
- Radiation Research Unit, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milano, Italy;
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Blakkisrud J, Løndalen A, Dahle J, Martinsen AC, Kolstad A, Stokke C. Myelosuppression in patients treated with 177Lutetium-lilotomab satetraxetan can be predicted with absorbed dose to the red marrow as the only variable. Acta Oncol 2021; 60:1481-1488. [PMID: 34425735 DOI: 10.1080/0284186x.2021.1959635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to investigate dosimetry data and clinical variables to predict hematological toxicity in non-Hodgkin lymphoma (NHL) patients treated with [177Lutetium]Lu-lilotomab satetraxetan. MATERIAL AND METHODS A total of 17 patients treated with [177Lu]Lu-lilotomab satetraxetan in a first-in-human phase 1/2a study were included. Absorbed dose to the red marrow was explored using SPECT/CT-imaging of the lumbar vertebrae L2-L4 over multiple time points. Percentage reduction of thrombocytes and neutrophils at nadir compared to baseline (PBN) and time to nadir (TTN) were chosen as indicators of myelosuppression and included as dependent variables. Two models were applied in the analysis, a multivariate linear model and a sigmoidal description of toxicity as a function of absorbed dose. A total of 10 independent patient variables were investigated in the multivariate analysis. RESULTS Absorbed dose to the red marrow ranged from 1 to 4 Gy. Absorbed dose to the red marrow was found to be the only significant variable for PBN for both thrombocytes and neutrophils. The sigmoid function gave similar results in terms of accuracy when compared to the linear model. CONCLUSION Myelosuppression in the form of thrombocytopenia and neutropenia in patients treated with [177Lu]Lu-lilotomab satetraxetan can be predicted from the SPECT/CT-derived absorbed dose estimate to the red marrow.
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Affiliation(s)
- Johan Blakkisrud
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Ayca Løndalen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Anne Catrine Martinsen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Arne Kolstad
- Department of Oncology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Caroline Stokke
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
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Chong HS, Chen Y, Kang CS, Sin I, Zhang S, Wang H. Pyridine-containing octadentate ligand NE3TA-PY for formation of neutral complex with 177Lu(III) and 90Y(III) for radiopharmaceutical applications: Synthesis, DFT calculation, radiolabeling, and in vitro complex stability. J Inorg Biochem 2021; 221:111436. [PMID: 33971521 DOI: 10.1016/j.jinorgbio.2021.111436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/20/2021] [Accepted: 03/20/2021] [Indexed: 11/17/2022]
Abstract
Targeted radionuclide therapy is a developing therapeutic modality for cancer and employs a cytotoxic radionuclide bound to a chelating agent and a bioactive molecule with high binding affinity for a specific biomarker in tumors. An optimal chelator is one of the critical components to control therapeutic efficacy and toxicity of targeted radionuclide therapy. We designed a new octadentate ligand NE3TA-PY (7-[2-[(carboxymethyl)(2-pyridylmethyl)amino]ethyl]-1,4,7-triazacyclononane-1,4-diacetic acid) for β-particle-emitting 177Lu and 90Y with targeted radionuclide therapy applications. The pyridine-containing polyaminocarboxylate ligand was proposed to form a neutral complex with Lu(III) and Y(III). The new chelator NE3TA-PY was synthesized and experimentally and theorectically studied for complexation with 177Lu(III) and 90Y(III). DFT-optimized structures of Y(III)-NE3TA-PY and Lu(III)-NE3TA-PY complexes were predicted. NE3TA-PY displayed excellent radiolabeling efficiency with both 177Lu and 90Y. The new chelator (NE3TA-PY) bound to 177Lu was more stable in human serum and better tolerated when challenged by EDTA than 90Y-labeled NE3TA-PY. Our findings suggest that the new chelator (NE3TA-PY) produced excellent Lu-177 radiolabeling and in vitro complex stability profiles.
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Affiliation(s)
- Hyun-Soon Chong
- Department of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, IL, United States of America.
| | - Yunwei Chen
- Department of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, IL, United States of America
| | - Chi Soo Kang
- Department of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, IL, United States of America
| | - Inseok Sin
- Department of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, IL, United States of America
| | - Shuyuan Zhang
- Department of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, IL, United States of America
| | - Haixing Wang
- Department of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, IL, United States of America
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5
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Huda S, Alam MA, Sharma PK. Smart nanocarriers-based drug delivery for cancer therapy: An innovative and developing strategy. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.102018] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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6
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Sun X, Kang CS, Sin I, Zhang S, Ren S, Wang H, Liu D, Lewis MR, Chong HS. New Bifunctional Chelator 3p- C-NEPA for Potential Applications in Lu(III) and Y(III) Radionuclide Therapy and Imaging. ACS OMEGA 2020; 5:28615-28620. [PMID: 33195913 PMCID: PMC7658932 DOI: 10.1021/acsomega.0c03551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
We have developed structurally unique bifunctional chelators in the NETA, NE3TA, and DEPA series for potential radiopharmaceutical applications. As part of our continued research efforts to generate efficient bifunctional chelators for targeted radionuclide therapy and imaging of various diseases, we designed a scorpion-like chelator that is proposed to completely saturate the coordination spheres of Y(III) and Lu(III). We herein report the synthesis and evaluation of a new chelator (3p-C-NEPA) with 10 donor groups for complexation with β-emitting radionuclides 90Y(III), 86Y(III), and 177Lu(III). The chelator was synthesized and evaluated for radiolabeling kinetics with the readily available radioisotopes 90Y and 177Lu, and the corresponding 90Y or 177Lu-radiolabeled complexes were evaluated for in vitro stability in human serum and in vivo complex stability in mice. The new chelator rapidly bound 90Y or 177Lu and formed a stable complex with the radionuclides. The new chelator 3p-C-NEPA radiolabeled with either 90Y or 177Lu remains stable in human serum without dissociation for 10 days. 177Lu-labeled 3p-C-NEPA produced a favorable in vivo biodistribution profile in normal mice.
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Affiliation(s)
- Xiang Sun
- Department
of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, Illinois 60616, United States
| | - Chi Soo Kang
- Department
of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, Illinois 60616, United States
| | - Inseok Sin
- Department
of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, Illinois 60616, United States
| | - Shuyuan Zhang
- Department
of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, Illinois 60616, United States
| | - Siyuan Ren
- Department
of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, Illinois 60616, United States
| | - Haixing Wang
- Department
of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, Illinois 60616, United States
| | - Dijie Liu
- Department
of Veterinary Medicine and Surgery, University
of Missouri-Columbia, Columbia, Missouri 65211, United States
| | - Michael R. Lewis
- Department
of Veterinary Medicine and Surgery, University
of Missouri-Columbia, Columbia, Missouri 65211, United States
| | - Hyun-Soon Chong
- Department
of Chemistry, Lewis College of Science and Letters, Illinois Institute of Technology, Chicago, Illinois 60616, United States
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7
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Funase Y, Nakamura E, Kajita M, Saito Y, Oshikiri S, Kitano M, Tokura M, Hino A, Uehara T. Preclinical Characterization of the Radioimmunoconjugate 111In or 90Y-FF-21101 Against a P-Cadherin-Expressing Tumor in a Mouse Xenograft Model and a Nonhuman Primate. J Nucl Med 2020; 62:232-239. [PMID: 32737245 PMCID: PMC8679590 DOI: 10.2967/jnumed.120.245837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/26/2020] [Indexed: 12/24/2022] Open
Abstract
P-cadherin is overexpressed in various cancers and can be a target for radioimmunotherapy. We investigated the preclinical pharmacokinetics and pharmacology of FF-21101, an 111In- or 90Y-conjugated monoclonal antibody against P-cadherin, to evaluate its clinical applications. Methods: The radiochemical purity, binding affinity, and in vitro serum stability of 111In or 90Y-labeled FF-21101 were evaluated. The pharmacokinetics of 111In or 90Y-FF-21101 were compared in normal mice. Tumor accumulation after 111In-FF-21101 administration was investigated in mice bearing subcutaneous tumors with high (NCI-H1373), moderate (EBC-1), or no (A549) P-cadherin expression. The tumor suppression effect after a single intravenous injection of 90Y-FF-21101 was assessed in NCI-H1373 and EBC-1 mouse xenograft models. The relationship between antibody dose and tumor accumulation was investigated in the NCI-H1373 mouse xenograft model. The absorbed radiation dose in humans after injection of 90Y-FF-21101 was estimated using γ-camera images of cynomolgus monkeys. Results: The radiochemical purities of 111In- and 90Y-FF-21101 were 98.2% ± 2.5% (n = 9) and 99.3% ± 0.6% (n = 5), respectively. The dissociation constants were 1.083 nM for 111In-FF-21101 and 1.367 nM for 90Y-FF-21101. Both 111In- and 90Y-FF-21101 were stable in human serum after 96 h of incubation and exhibited similar pharmacokinetics in normal mice. The tumor accumulation of 111In-FF-21101 was closely related to the intensity of P-cadherin expression in the cells. 90Y-FF-21101 showed significant tumor growth inhibition, indicating that NCI-H1373 and EBC-1 recurrence was not observed after intravenous administration of 3.7 and 7.4 MBq, respectively of 90Y-FF-21101 per animal. Tumor uptake in the mouse xenograft model and estimated absorbed radiation doses in the spleen of monkeys decreased with increasing antibody doses of 111In-FF-21101. Conversely, the estimated absorbed radiation dose in the red marrow increased with increasing antibody dose. An antibody dose of 4.8 mg/m2 was considered appropriate for humans, on the basis of efficacy and safety. The maximum tolerated administered activity of 90Y-FF-21101 was estimated to be 2,886 MBq/human. Conclusion: FF-21101 radioimmunotherapy exhibited high antitumor affinity and antitumor efficacy in mouse xenograft models. Extrapolation of the pharmacokinetics in monkeys to humans suggests the potential for clinical application of FF-21101 for treating P-cadherin–expressing tumor.
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Affiliation(s)
- Yuichi Funase
- RI Research Department, Fujifilm Toyama Chemical Co., Ltd., Chiba, Japan .,Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Japan; and
| | - Eri Nakamura
- RI Research Department, Fujifilm Toyama Chemical Co., Ltd., Chiba, Japan
| | - Masamichi Kajita
- RI Research Department, Fujifilm Toyama Chemical Co., Ltd., Chiba, Japan
| | - Yasutaka Saito
- RI Research Department, Fujifilm Toyama Chemical Co., Ltd., Chiba, Japan
| | - Shinobu Oshikiri
- RI Research Department, Fujifilm Toyama Chemical Co., Ltd., Chiba, Japan
| | - Michi Kitano
- RI Research Department, Fujifilm Toyama Chemical Co., Ltd., Chiba, Japan
| | - Masahiko Tokura
- Project Management Department, Fujifilm Toyama Chemical Co., Ltd., Tokyo, Japan
| | - Akihiro Hino
- RI Research Department, Fujifilm Toyama Chemical Co., Ltd., Chiba, Japan
| | - Tomoya Uehara
- Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Japan; and
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8
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Carrozzo M, Eriksen JG, Bensadoun RJ, Boers-Doets CB, Lalla RV, Peterson DE. Oral Mucosal Injury Caused by Targeted Cancer Therapies. J Natl Cancer Inst Monogr 2020; 2019:5551364. [PMID: 31425602 DOI: 10.1093/jncimonographs/lgz012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/14/2019] [Accepted: 05/01/2019] [Indexed: 02/06/2023] Open
Abstract
Targeted cancer therapies have fundamentally transformed the treatment of many types of cancers over the past decade, including breast, colorectal, lung, and pancreatic cancers, as well as lymphoma, leukemia, and multiple myeloma. The unique mechanisms of action of these agents have resulted in many patients experiencing enhanced tumor response together with a reduced adverse event profile as well. Toxicities do continue to occur, however, and in selected cases can be clinically challenging to manage. Of particular importance in the context of this monograph is that the pathobiology for oral mucosal lesions caused by targeted cancer therapies has only been preliminarily investigated. There is distinct need for novel basic, translational, and clinical research strategies to enhance design of preventive and therapeutic approaches for patients at risk for development of these lesions. The research modeling can be conceptually enhanced by extrapolating "lessons learned" from selected oral mucosal conditions in patients without cancer as well. This approach may permit determination of the extent to which pathobiology and clinical management are either similar to or uniquely distinct from oral mucosal lesions caused by targeted cancer therapies. Modeling associated with oral mucosal disease in non-oncology patients is thus presented in this context as well. This article addresses this emerging paradigm, with emphasis on current mechanistic modeling and clinical treatment. This approach is in turn designed to foster delineation of new research strategies, with the goal of enhancing cancer patient treatment in the future.
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Affiliation(s)
- M Carrozzo
- Center for Oral Health Research, Oral Medicine Department, School of Dental Sciences, Newcastle University, UK
| | - J Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R-J Bensadoun
- Institut Niçois de Cancérologie (INC), Centre de Haute Energie, Nice, France
| | - C B Boers-Doets
- CancerMed, Department of Medical Strategy, Wormer, The Netherlands.,Impaqtt Foundation, Department of Adverse Event Research & Valorisation, Wormer, The Netherlands
| | - R V Lalla
- Section of Oral Medicine, Department of Oral Health & Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT
| | - D E Peterson
- Section of Oral Medicine, Department of Oral Health & Diagnostic Sciences, School of Dental Medicine & Neag Comprehensive Cancer Center, UConn Health, Farmington, CT
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9
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Yonekura Y, Mattsson S, Flux G, Bolch WE, Dauer LT, Fisher DR, Lassmann M, Palm S, Hosono M, Doruff M, Divgi C, Zanzonico P. ICRP Publication 140: Radiological Protection in Therapy with Radiopharmaceuticals. Ann ICRP 2019; 48:5-95. [PMID: 31565950 DOI: 10.1177/0146645319838665] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiopharmaceuticals are increasingly used for the treatment of various cancers with novel radionuclides, compounds, tracer molecules, and administration techniques. The goal of radiation therapy, including therapy with radiopharmaceuticals, is to optimise the relationship between tumour control probability and potential complications in normal organs and tissues. Essential to this optimisation is the ability to quantify the radiation doses delivered to both tumours and normal tissues. This publication provides an overview of therapeutic procedures and a framework for calculating radiation doses for various treatment approaches. In radiopharmaceutical therapy, the absorbed dose to an organ or tissue is governed by radiopharmaceutical uptake, retention in and clearance from the various organs and tissues of the body, together with radionuclide physical half-life. Biokinetic parameters are determined by direct measurements made using techniques that vary in complexity. For treatment planning, absorbed dose calculations are usually performed prior to therapy using a trace-labelled diagnostic administration, or retrospective dosimetry may be performed on the basis of the activity already administered following each therapeutic administration. Uncertainty analyses provide additional information about sources of bias and random variation and their magnitudes; these analyses show the reliability and quality of absorbed dose calculations. Effective dose can provide an approximate measure of lifetime risk of detriment attributable to the stochastic effects of radiation exposure, principally cancer, but effective dose does not predict future cancer incidence for an individual and does not apply to short-term deterministic effects associated with radiopharmaceutical therapy. Accident prevention in radiation therapy should be an integral part of the design of facilities, equipment, and administration procedures. Minimisation of staff exposures includes consideration of equipment design, proper shielding and handling of sources, and personal protective equipment and tools, as well as education and training to promote awareness and engagement in radiological protection. The decision to hold or release a patient after radiopharmaceutical therapy should account for potential radiation dose to members of the public and carers that may result from residual radioactivity in the patient. In these situations, specific radiological protection guidance should be provided to patients and carers.
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10
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Okoye NC, Baumeister JE, Najafi Khosroshahi F, Hennkens HM, Jurisson SS. Chelators and metal complex stability for radiopharmaceutical applications. RADIOCHIM ACTA 2019. [DOI: 10.1515/ract-2018-3090] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Diagnostic and therapeutic nuclear medicine relies heavily on radiometal nuclides. The most widely used and well-known radionuclide is technetium-99m (99mTc), which has dominated diagnostic nuclear medicine since the advent of the 99Mo/99mTc generator in the 1960s. Since that time, many more radiometals have been developed and incorporated into potential radiopharmaceuticals. One critical aspect of radiometal-containing radiopharmaceuticals is their stability under in vivo conditions. The chelator that is coordinated to the radiometal is a key factor in determining radiometal complex stability. The chelators that have shown the most promise and are under investigation in the development of diagnostic and therapeutic radiopharmaceuticals over the last 5 years are discussed in this review.
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Affiliation(s)
| | | | | | - Heather M. Hennkens
- Department of Chemistry , University of Missouri , Columbia, MO 65211 , USA
- University of Missouri Research Reactor Center , Columbia, MO 65211 , USA
| | - Silvia S. Jurisson
- Department of Chemistry , University of Missouri , Columbia, MO 65211 , USA
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11
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O'Donoghue JA, Danila DC, Pandit-Taskar N, Beylergil V, Cheal SM, Fleming SE, Fox JJ, Ruan S, Zanzonico PB, Ragupathi G, Lyashchenko SK, Williams SP, Scher HI, Fine BM, Humm JL, Larson SM, Morris MJ, Carrasquillo JA. Pharmacokinetics and Biodistribution of a [ 89Zr]Zr-DFO-MSTP2109A Anti-STEAP1 Antibody in Metastatic Castration-Resistant Prostate Cancer Patients. Mol Pharm 2019; 16:3083-3090. [PMID: 31117485 DOI: 10.1021/acs.molpharmaceut.9b00326] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A six-transmembrane epithelial antigen of prostate-1 (STEAP1) is a newly identified target in prostate cancer. The use of radio-labeled STEAP1-targeting antibodies with positron emission tomography (PET) may allow for detection of sites of metastatic prostate cancer and may refine patient selection for antigen-directed therapies. This was a prospective study in seven patients with metastatic castration-resistant prostate cancer who had at least one archival biopsy that was STEAP1-positive by immunohistochemistry. Patients received intravenous injections of ∼185 MBq and 10 mg of [89Zr]Zr-DFO-MSTP2109A, a humanized IgG1 monoclonal antibody directed against STEAP1. PET/CT images, blood samples, and whole-body counts were monitored longitudinally in six patients. Here, we report on safety, biodistribution, pharmacokinetics, dose estimates to normal tissues, and initial tumor targeting for this group of patients. There was no significant acute or subacute toxicity. Favorable biodistribution and enhanced lesion uptake (in both bone and soft tissue) were observed on imaging using a mass of 10 mg of DFO-MSTP2109A. The best lesion discrimination was seen at the latest imaging time, a median of 6 days postadministration. Pharmacokinetics showed a median serum T1/2 β of 198 h, volume of central compartment of 3.54 L (similar to plasma volume), and clearance of 19.7 mL/h. The median biologic T1/2 for whole-body retention was 469 h. The highest mean absorbed doses to normal organs (mGy/MBq) were 1.18, 1.11, 0.78, 0.73, and 0.71 for liver, heart wall, lung, kidney, and spleen, respectively. Excellent targeting of metastatic prostate sites in both bone and soft tissue was observed, with an optimal imaging time of 6 days postadministration. The liver and heart were the normal organs that experienced the highest absorbed doses. The pharmacokinetics were similar to other antibodies without major cross-reactivity with normal tissues. A more detailed analysis of lesion targeting in a larger patient population with correlation to immunohistology and standard imaging modalities has been reported.
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Affiliation(s)
| | - Daniel C Danila
- Department of Medicine , Joan and Sanford I. Weill College of Medicine of Cornell University , New York , New York 10065 , United States
| | - Neeta Pandit-Taskar
- Department of Radiology , Joan and Sanford I. Weill Cornell Medical Center , New York , New York 10065 , United States
| | | | | | | | | | | | | | | | | | - Simon P Williams
- Genentech , South San Francisco , California 94080 , United States
| | - Howard I Scher
- Department of Medicine , Joan and Sanford I. Weill College of Medicine of Cornell University , New York , New York 10065 , United States
| | - Bernard M Fine
- Genentech , South San Francisco , California 94080 , United States
| | | | - Steven M Larson
- Department of Radiology , Joan and Sanford I. Weill Cornell Medical Center , New York , New York 10065 , United States.,Center for Targeted Radioimmunotherapy and Diagnosis of the Ludwig Center for Cancer Immunotherapy , New York , New York 10065 , United States
| | - Michael J Morris
- Department of Medicine , Joan and Sanford I. Weill College of Medicine of Cornell University , New York , New York 10065 , United States
| | - Jorge A Carrasquillo
- Department of Radiology , Joan and Sanford I. Weill Cornell Medical Center , New York , New York 10065 , United States.,Center for Targeted Radioimmunotherapy and Diagnosis of the Ludwig Center for Cancer Immunotherapy , New York , New York 10065 , United States
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12
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Morschhauser F, Dekyndt B, Baillet C, Barthélémy C, Malek E, Fulcrand J, Bigot P, Huglo D, Décaudin B, Simon N, Odou P. A new pharmacokinetic model for 90Y-ibritumomab tiuxetan based on 3-dimensional dosimetry. Sci Rep 2018; 8:14860. [PMID: 30291297 PMCID: PMC6173718 DOI: 10.1038/s41598-018-33160-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/07/2018] [Indexed: 02/01/2023] Open
Abstract
Monoclonal antibodies (mAbs) are key components in several therapies for cancer and inflammatory diseases but current knowledge of their clinical pharmacokinetics and distribution in human tissues remains incomplete. Consequently, optimal dosing and scheduling in clinics are affected. With sequential radiolabeled mAb-based imaging, radiation dosing in tissues/organs can be calculated to provide a better assessment of mAb concentrations in tissues. This is the first pharmacokinetic model of 90Y-Ibritumomab tiuxetan (90Y-IT) in humans to be described, based on three-dimensional (3D) dosimetry using single-photon emission computed-tomography coupled with computed-tomography. 19 patients with follicular lymphoma were treated initially with 90Y-IT in the FIZZ trial. Based on a compartmental approach individualising the vascular compartment within studied organs, this study proposes a reliable pharmacokinetic (PK) five-compartment model replacing the currently used two-compartment model and constitutes a new direction for further research. This model provides exchange constants between the different tissues, Area Under the Curve of 111In-IT in blood (AUC) and Mean Residence Time (MRT) that have not been reported so far for IT. Finally, the elimination process appears to occur in a compartment other than the liver or the spleen and suggests the metabolism of mAbs may take place mainly on the vascular compartment level.
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Affiliation(s)
- F Morschhauser
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France. .,Haematology Department, Hôpital Claude Huriez, CHU Lille, F-59000, Lille, France.
| | - B Dekyndt
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France.,Pharmacy Institute, CHU Lille, F-59000, Lille, France
| | - C Baillet
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France.,Nuclear Medicine department, Hôpital Claude Huriez, CHU Lille, F-59000, Lille, France
| | - C Barthélémy
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France
| | - E Malek
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France
| | - J Fulcrand
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France
| | - P Bigot
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France
| | - D Huglo
- Nuclear Medicine department, Hôpital Claude Huriez, CHU Lille, F-59000, Lille, France
| | - B Décaudin
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France.,Pharmacy Institute, CHU Lille, F-59000, Lille, France
| | - N Simon
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France.,Pharmacy Institute, CHU Lille, F-59000, Lille, France
| | - P Odou
- Univ. Lille, CHU Lille, EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France.,Pharmacy Institute, CHU Lille, F-59000, Lille, France
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13
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Zhu S, Gu Z, Zhao Y. Harnessing Tumor Microenvironment for Nanoparticle-Mediated Radiotherapy. ADVANCED THERAPEUTICS 2018. [DOI: 10.1002/adtp.201800050] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Shuang Zhu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety; Institute of High Energy Physics; Chinese Academy of Sciences; Beijing 100049 China
| | - Zhanjun Gu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety; Institute of High Energy Physics; Chinese Academy of Sciences; Beijing 100049 China
- College of Materials Science and Optoelectronic Technology; University of Chinese Academy of Sciences; Beijing 100049 China
| | - Yuliang Zhao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety; Institute of High Energy Physics; Chinese Academy of Sciences; Beijing 100049 China
- CAS Center for Excellence in Nanoscience; National Center for Nanoscience and Technology of China; Chinese Academy of Sciences; Beijing 100190 China
- College of Materials Science and Optoelectronic Technology; University of Chinese Academy of Sciences; Beijing 100049 China
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14
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Ranganath SH. Bioengineered cellular and cell membrane-derived vehicles for actively targeted drug delivery: So near and yet so far. Adv Drug Deliv Rev 2018; 132:57-80. [PMID: 29935987 DOI: 10.1016/j.addr.2018.06.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/31/2018] [Accepted: 06/18/2018] [Indexed: 12/16/2022]
Abstract
Cellular carriers for drug delivery are attractive alternatives to synthetic nanoparticles owing to their innate homing/targeting abilities. Here, we review molecular interactions involved in the homing of Mesenchymal stem cells (MSCs) and other cell types to understand the process of designing and engineering highly efficient, actively targeting cellular vehicles. In addition, we comprehensively discuss various genetic and non-genetic strategies and propose futuristic approaches of engineering MSC homing using micro/nanotechnology and high throughput small molecule screening. Most of the targeting abilities of a cell come from its plasma membrane, thus, efforts to harness cell membranes as drug delivery vehicles are gaining importance and are highlighted here. We also recognize and report the lack of detailed characterization of cell membranes in terms of safety, structural integrity, targeting functionality, and drug transport. Finally, we provide insights on future development of bioengineered cellular and cell membrane-derived vesicles for successful clinical translation.
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Affiliation(s)
- Sudhir H Ranganath
- Bio-INvENT Lab, Department of Chemical Engineering, Siddaganga Institute of Technology, B.H. Road, Tumakuru, 572103, Karnataka, India.
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15
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Le Fur M, Beyler M, Molnár E, Fougère O, Esteban-Gómez D, Tircsó G, Platas-Iglesias C, Lepareur N, Rousseaux O, Tripier R. Stable and Inert Yttrium(III) Complexes with Pyclen-Based Ligands Bearing Pendant Picolinate Arms: Toward New Pharmaceuticals for β-Radiotherapy. Inorg Chem 2018; 57:2051-2063. [PMID: 29400452 DOI: 10.1021/acs.inorgchem.7b02953] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mariane Le Fur
- Université de Bretagne Occidentale, UMR-CNRS 6521, IBSAM, UFR des Sciences et Techniques, 6 avenue
Victor le Gorgeu, C.S. 93837, 29238 BREST Cedex 3, France
| | - Maryline Beyler
- Université de Bretagne Occidentale, UMR-CNRS 6521, IBSAM, UFR des Sciences et Techniques, 6 avenue
Victor le Gorgeu, C.S. 93837, 29238 BREST Cedex 3, France
| | - Enikő Molnár
- Department
of Inorganic and Analytical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Olivier Fougère
- Groupe Guerbet, Centre de Recherche d’Aulnay-sous-Bois, BP 57400, 95943 Roissy CdG Cedex, France
| | - David Esteban-Gómez
- Departamento de Química, Facultade de Ciencias & Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15071 A Coruña, Spain
| | - Gyula Tircsó
- Department
of Inorganic and Analytical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Carlos Platas-Iglesias
- Departamento de Química, Facultade de Ciencias & Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15071 A Coruña, Spain
| | - Nicolas Lepareur
- Département
de Médecine Nucléaire, Centre Eugène Marquis, INSERM U1241, Avenue de la Bataille Flandres, Dunkerque CS 44229, 35042 Rennes, Cedex, France
| | - Olivier Rousseaux
- Groupe Guerbet, Centre de Recherche d’Aulnay-sous-Bois, BP 57400, 95943 Roissy CdG Cedex, France
| | - Raphaël Tripier
- Université de Bretagne Occidentale, UMR-CNRS 6521, IBSAM, UFR des Sciences et Techniques, 6 avenue
Victor le Gorgeu, C.S. 93837, 29238 BREST Cedex 3, France
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16
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Solanki JH, Tritt T, Pasternack JB, Kim JJ, Leung CN, Domogauer JD, Colangelo NW, Narra VR, Howell RW. Cellular Response to Exponentially Increasing and Decreasing Dose Rates: Implications for Treatment Planning in Targeted Radionuclide Therapy. Radiat Res 2017; 188:221-234. [PMID: 28541775 PMCID: PMC5669265 DOI: 10.1667/rr14766.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The treatment of cancer using targeted radionuclide therapy is of interest to nuclear medicine and radiation oncology because of its potential for killing tumor cells while minimizing dose-limiting toxicities to normal tissue. The ionizing radiations emitted by radiopharmaceuticals deliver radiation absorbed doses over protracted periods of time with continuously varying dose rates. As targeted radionuclide therapy becomes a more prominent part of cancer therapy, accurate models for estimating the biologically effective dose (BED) or equieffective dose (EQD2α/β) will become essential for treatment planning. This study examines the radiobiological impact of the dose rate increase half-time during the uptake phase of the radiopharmaceutical. MDA-MB-231 human breast cancer cells and V79 Chinese hamster lung fibroblasts were irradiated chronically with 662 keV γ rays delivered with time-varying dose rates that are clinically relevant. The temporal dose-rate patterns were: 1. acute, 2. exponential decrease with a half-time of 64 h (Td = 64 h), 3. initial exponential increase to a maximum (half time Ti = 2, 8 or 24 h) followed by exponential decrease (Td = 64 h). Cell survival assays were conducted and surviving fractions were determined. There was a marked reduction in biological effect when Ti was increased. Cell survival data were tested against existing dose-response models to assess their capacity to predict response. Currently accepted models that are used in radiation oncology overestimated BED and EQD2α/β at low-dose rates and underestimated them at high-dose rates. This appears to be caused by an adaptive response arising as a consequence of the initial low-dose-rate phase of exposure. An adaptive response function was derived that yields more accurate BED and EQD2α/β values over the spectrum of dose rates and absorbed doses delivered. Our experimental data demonstrate a marked increase in cell survival when the dose-rate-increase half-time is increased, thereby suggesting an adaptive response arising as a consequence of this phase of exposure. We have modified conventional radiobiological models used in the clinic for brachytherapy and external beams of radiation to account for this phenomenon and facilitate their use for treatment planning in targeted radionuclide therapy.
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Affiliation(s)
- Jay H. Solanki
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Thomas Tritt
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Jordan B. Pasternack
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Julia J. Kim
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Calvin N. Leung
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Jason D. Domogauer
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Nicholas W. Colangelo
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Venkat R. Narra
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Roger W. Howell
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, Rutgers, The State University of New Jersey, Newark, New Jersey
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17
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Le Fur M, Beyler M, Lepareur N, Fougère O, Platas-Iglesias C, Rousseaux O, Tripier R. Pyclen Tri-n-butylphosphonate Ester as Potential Chelator for Targeted Radiotherapy: From Yttrium(III) Complexation to 90Y Radiolabeling. Inorg Chem 2016; 55:8003-12. [PMID: 27486673 DOI: 10.1021/acs.inorgchem.6b01135] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Mariane Le Fur
- Université de Bretagne Occidentale, UMR-CNRS 6521, UFR des Sciences et Techniques, 6 Avenue Victor le Gorgeu, CS 93837, 29238 Brest Cedex 3, France
| | - Maryline Beyler
- Université de Bretagne Occidentale, UMR-CNRS 6521, UFR des Sciences et Techniques, 6 Avenue Victor le Gorgeu, CS 93837, 29238 Brest Cedex 3, France
| | - Nicolas Lepareur
- Département de Médecine Nucléaire, Centre Eugène Marquis, INSERM U991, Avenue de la Bataille Flandres-Dunkerque,
CS 44229, 35042 Rennes Cedex, France
| | - Olivier Fougère
- Guerbet Group, Centre de Recherche d’Aulnay-sous-Bois, BP 57400, 95943 Roissy CdG Cedex, France
| | - Carlos Platas-Iglesias
- Centro de Investigaciones
Científicas Avanzadas (CICA) and Departamento de Química
Fundamental, Universidade da Coruña, Campus da Zapateira-Rúa da
Fraga 10, 15008 A Coruña, Spain
| | - Olivier Rousseaux
- Guerbet Group, Centre de Recherche d’Aulnay-sous-Bois, BP 57400, 95943 Roissy CdG Cedex, France
| | - Raphaël Tripier
- Université de Bretagne Occidentale, UMR-CNRS 6521, UFR des Sciences et Techniques, 6 Avenue Victor le Gorgeu, CS 93837, 29238 Brest Cedex 3, France
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18
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Meckel M, Kubíček V, Hermann P, Miederer M, Rösch F. A DOTA based bisphosphonate with an albumin binding moiety for delayed body clearance for bone targeting. Nucl Med Biol 2016; 43:670-678. [PMID: 27560354 DOI: 10.1016/j.nucmedbio.2016.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/19/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022]
Abstract
Radiolabeled bisphosphonates are commonly used in the diagnosis and therapy of bone metastases. Blood clearance of bisphosphonates is usually fast and only 30%-50% of the injected activity is retained in the skeleton, while most of the activity is excreted by the urinary tract. A longer blood circulation may enhance accumulation of bisphosphonate compounds in bone metastases. Therefore, a chemically modified macrocyclic bisphosphonate derivative with an additional human albumin binding entity was synthesized and pharmacokinetics of its complex was evaluated. The DOTA-bisphosphonate conjugate BPAMD was compared against the novel DOTAGA-derived albumin-binding bisphosphonate DOTAGA(428-d-Lys)MBP (L1). The ligands were labeled with 68Ga(III) and were evaluated in in vitro binding studies to hydroxyapatite (HA) as well as to human serum albumin. The compounds were finally compared in in vivo PET and ex vivo organ distribution studies in small animals over 6h. Binding studies revealed a consistent affinity of both bisphosphonate tracers to HA. Small animal PET and ex vivo organ distribution studies showed longer blood retention of [68Ga]L1. [68Ga]BPAMD is initially more efficiently bound to the bone but skeletal accumulation of the modified compound and [68Ga]BPAMD equalized at 6h p.i. Ratios of femur epiphyseal plate to ordinary bone showed to be more favorable for [68Ga]L1 than for [68Ga]BPAMD due to the longer circulation time of the new tracer. Thus, the chemical modification of BPAMD toward an albumin-binding bisphosphonate, L1, resulted in a novel PET tracer which conserves advantages of both functional groups within one and the same molecule. The properties of this new diagnostic tracer are expected to be preserved in 177Lu therapeutic agent with the same ligand (a theranostic pair).
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Affiliation(s)
- Marian Meckel
- Institute of Nuclear Chemistry, Johannes-Gutenberg-University Mainz, Germany
| | - Vojtěch Kubíček
- Department of Inorganic Chemistry, Charles University, Prague, Czech Republic
| | - Petr Hermann
- Department of Inorganic Chemistry, Charles University, Prague, Czech Republic
| | | | - Frank Rösch
- Institute of Nuclear Chemistry, Johannes-Gutenberg-University Mainz, Germany
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19
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Lin Y. Internal radiation therapy: a neglected aspect of nuclear medicine in the molecular era. J Biomed Res 2015; 29:345-55. [PMID: 26445567 PMCID: PMC4585428 DOI: 10.7555/jbr.29.20140069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/06/2014] [Accepted: 10/13/2014] [Indexed: 11/25/2022] Open
Abstract
With increasing evidence, internal radiation therapy, also known as brachytherapy, has become a neglected aspect of nuclear medicine in the molecular era. In this paper, recent developments regarding internal radiation therapy, including developments in radioiodine-131 (131I) and thyroid, radioimmunotherapy (RIT) for non-Hodgkin lymphoma (NHL), and radiopharmaceuticals for bone metastases. Relevant differences and status of their applications in China were mentioned as well. These molecular mediated internal radiation therapies are gaining increasing importance by providing palliative and curative treatments for an increasing number of diseases and becoming one of the important parts of molecular nuclear medicine.
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Affiliation(s)
- Yansong Lin
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Beijing 100730 , China
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20
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Brill DA, MacKay JA. Image-driven pharmacokinetics: nanomedicine concentration across space and time. Nanomedicine (Lond) 2015; 10:2861-79. [PMID: 26370694 DOI: 10.2217/nnm.15.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Clinical pharmacokinetics (PK) primarily measures the concentration of drugs in the blood. For nanomedicines it may be more relevant to determine concentration within a target tissue. The emerging field of image-driven PK, which utilizes clinically accepted molecular imaging technology, empirically and noninvasively, measures concentration in multiple tissues. Image-driven PK represents the intersection of PK and biodistribution, combining to provide models of concentration across space and time. Image-driven PK can be used both as a research tool and in the clinic. This review explores the history of pharmacokinetics, technologies used in molecular imaging (especially positron emission tomography) and research using image-driven pharmacokinetic analysis. When standardized, image-driven PK may have significant implications in preclinical development as well as clinical optimization of targeted nanomedicines.
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Affiliation(s)
- Dab A Brill
- Department of Pharmacology & Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA
| | - J Andrew MacKay
- Department of Pharmacology & Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
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21
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Monte Carlo Calculation of Radioimmunotherapy with (90)Y-, (177)Lu-, (131)I-, (124)I-, and (188)Re-Nanoobjects: Choice of the Best Radionuclide for Solid Tumour Treatment by Using TCP and NTCP Concepts. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:284360. [PMID: 26136812 PMCID: PMC4469173 DOI: 10.1155/2015/284360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/27/2014] [Indexed: 12/26/2022]
Abstract
Radioimmunotherapy has shown that the use of monoclonal antibodies combined with a radioisotope like 131I or 90Y still remains ineffective for solid and radioresistant tumour treatment. Previous simulations have revealed that an increase in the number of 90Y labelled to each antibody or nanoobject could be a solution to improve treatment output. It now seems important to assess the treatment output and toxicity when radionuclides such as 90Y, 177Lu, 131I, 124I, and 188Re are used. Tumour control probability (TCP) and normal tissue complication probability (NTCP) curves versus the number of radionuclides per nanoobject were computed with MCNPX to evaluate treatment efficacy for solid tumours and to predict the incidence of surrounding side effects. Analyses were carried out for two solid tumour sizes of 0.5 and 1.0 cm radius and for nanoobject (i.e., a radiolabelled antibody) distributed uniformly or nonuniformly throughout a solid tumour (e.g., Non-small-cell-lung cancer (NSCLC)). 90Y and 188Re are the best candidates for solid tumour treatment when only one radionuclide is coupled to one carrier. Furthermore, regardless of the radionuclide properties, high values of TCP can be reached without toxicity if the number of radionuclides per nanoobject increases.
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22
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90Y-ibritumomab tiuxetan therapy in allogeneic transplantation in B-cell lymphoma with extensive marrow involvement and chronic lymphocytic leukemia: utility of pretransplantation biodistribution. Nucl Med Commun 2015; 35:1132-42. [PMID: 25076159 DOI: 10.1097/mnm.0000000000000172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Biodistribution data to date using In-ibritumomab tiuxetan have been initially obtained in patients with less than 25% lymphomatous bone marrow involvement and adequate hematopoietic synthetic function. In this article we present the results of an analysis of the biodistribution data obtained from a cohort of patients with extensive bone marrow involvement, baseline cytopenias, and chronic lymphocytic leukemia (CLL). MATERIALS AND METHODS Thirty-nine patients with a diagnosis of B-cell lymphoma or CLL expressing the CD20 antigen, who had failed at least one prior regimen, and had evidence of persistent disease were included in this analysis; however, only 38 of them completed the treatment. Semiquantitative analysis of the biodistribution was performed using regions of interest over the liver, lungs, kidneys, spleen, and sacrum. The observed interpatient variability including higher liver uptake in four patients is discussed. RESULTS No severe solid organ toxicity was observed at the maximum administered activity of 1184 MBq (32 mCi) Y-ibritumomab tiuxetan. After accounting for differences in marrow involvement, patients with CLL exhibit comparable biodistributions to those with B-NHL. We found that the estimated sacral marrow uptake on 48 h images in patients with bone marrow involvement may be an indicator of bone marrow involvement. There was no correlation between tumor visualization and response to treatment. CONCLUSION These data suggest that the imaging step is not critical when the administered activity is below 1184 MBq (32 mCi). However, our analysis confirms that the semiquantitative imaging data can be used to identify patients at risk for liver toxicity when higher doses of Y-ibritumomab tiuxetan are used. Patients with CLL can have excellent targeting of disease by In-ibritumomab tiuxetan, indicating potential efficacy in this patient population.
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23
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Chong HS, Sun X, Chen Y, Sin I, Kang CS, Lewis MR, Liu D, Ruthengael VC, Zhong Y, Wu N, Song HA. Synthesis and comparative biological evaluation of bifunctional ligands for radiotherapy applications of (90)Y and (177)Lu. Bioorg Med Chem 2014; 23:1169-78. [PMID: 25648683 DOI: 10.1016/j.bmc.2014.12.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/09/2014] [Accepted: 12/16/2014] [Indexed: 11/19/2022]
Abstract
Zevalin® is an antibody-drug conjugate radiolabeled with a cytotoxic radioisotope ((90)Y) that was approved for radioimmunotherapy (RIT) of B-cell non-Hodgkin's lymphoma. A bifunctional ligand that displays favorable complexation kinetics and in vivo stability is required for effective RIT. New bifunctional ligands 3p-C-DE4TA and 3p-C-NE3TA for potential use in RIT were efficiently prepared by the synthetic route based on regiospecific ring opening of aziridinium ions with prealkylated triaza- or tetraaza-backboned macrocycles. The new bifunctional ligands 3p-C-DE4TA and 3p-C-NE3TA along with the known bimodal ligands 3p-C-NETA and 3p-C-DEPA were comparatively evaluated for potential use in targeted radiotherapy using β-emitting radionuclides (90)Y and (177)Lu. The bifunctional ligands were evaluated for radiolabeling kinetics with (90)Y and (177)Lu, and the corresponding (90)Y or (177)Lu-radiolabeled complexes were studied for in vitro stability in human serum and in vivo biodistribution in mice. The results of the comparative complexation kinetic and stability studies indicate that size of macrocyclic cavity, ligand denticity, and bimodality of donor groups have a substantial impact on complexation of the bifunctional ligands with the radiolanthanides. The new promising bifunctional chelates in the DE4TA and NE3TA series were rapid in binding (90)Y and (177)Lu, and the corresponding (90)Y- and (177)Lu-radiolabeled complexes remained inert in human serum or in mice. The in vitro and in vivo data show that 3p-C-DE4TA and 3p-C-NE3TA are promising bifunctional ligands for targeted radiotherapy applications of (90)Y and (177)Lu.
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Affiliation(s)
- Hyun-Soon Chong
- Chemistry Division, Department of Biological and Chemical Sciences, Illinois Institute of Technology, 3101 S. Dearborn St, LS 182, Chicago, IL 60616, United States.
| | - Xiang Sun
- Chemistry Division, Department of Biological and Chemical Sciences, Illinois Institute of Technology, 3101 S. Dearborn St, LS 182, Chicago, IL 60616, United States
| | - Yunwei Chen
- Chemistry Division, Department of Biological and Chemical Sciences, Illinois Institute of Technology, 3101 S. Dearborn St, LS 182, Chicago, IL 60616, United States
| | - Inseok Sin
- Chemistry Division, Department of Biological and Chemical Sciences, Illinois Institute of Technology, 3101 S. Dearborn St, LS 182, Chicago, IL 60616, United States
| | - Chi Soo Kang
- Chemistry Division, Department of Biological and Chemical Sciences, Illinois Institute of Technology, 3101 S. Dearborn St, LS 182, Chicago, IL 60616, United States
| | - Michael R Lewis
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States; Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States
| | - Dijie Liu
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States
| | - Varyanna C Ruthengael
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States
| | - Yongliang Zhong
- Chemistry Division, Department of Biological and Chemical Sciences, Illinois Institute of Technology, 3101 S. Dearborn St, LS 182, Chicago, IL 60616, United States
| | - Ningjie Wu
- Chemistry Division, Department of Biological and Chemical Sciences, Illinois Institute of Technology, 3101 S. Dearborn St, LS 182, Chicago, IL 60616, United States
| | - Hyun A Song
- Chemistry Division, Department of Biological and Chemical Sciences, Illinois Institute of Technology, 3101 S. Dearborn St, LS 182, Chicago, IL 60616, United States
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The status of radioimmunotherapy in CD20+ non-Hodgkin's lymphoma. Target Oncol 2014; 10:15-26. [PMID: 24870968 DOI: 10.1007/s11523-014-0324-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/19/2014] [Indexed: 01/30/2023]
Abstract
Rituximab, the CD20-directed antibody, has become a standard component of treatment regimens for patients with B cell non-Hodgkin's lymphoma (NHL). The use of rituximab has resulted in greatly improved response and survival rates with less toxicity relative to standard chemotherapeutic regimes. However, relapse and recurrence is common, particularly in indolent varieties which remain incurable, requiring alternate therapeutic options. The subsequent coupling of β-emitting isotopes such as (131)I and (90)Y to anti-CD20 monoclonal antibodies (mAbs), including rituximab, has been steadily growing over the last decade and demonstrates even greater therapeutic efficacy with more durable responses. (177)Lutetium-labelled rituximab offers a number of convenient advantages over (131)I and (90)Y anti-CD20 mAbs for treatment of NHL, and a number of alpha-emitting isotopes lie at the frontier of consolidation therapy for residual, micrometastatic disease.
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Felice B, Prabhakaran MP, Rodríguez AP, Ramakrishna S. Drug delivery vehicles on a nano-engineering perspective. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 41:178-95. [PMID: 24907751 DOI: 10.1016/j.msec.2014.04.049] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/04/2014] [Accepted: 04/18/2014] [Indexed: 12/21/2022]
Abstract
Nanoengineered drug delivery systems (nDDS) have been successfully used as clinical tools for not only modulation of pharmacological drug release profile but also specific targeting of diseased tissues. Until now, encapsulation of anti-cancer molecules such as paclitaxel, vincristin and doxorubicin has been the main target of nDDS, whereby liposomes and polymer-drug conjugates remained as the most popular group of nDDS used for this purpose. The success reached by these nanocarriers can be imitated by careful selection and optimization of the different factors that affect drug release profile (i.e. type of biomaterial, size, system architecture, and biodegradability mechanisms) along with the selection of an appropriate manufacture technique that does not compromise the desired release profile, while it also offers possibilities to scale up for future industrialization. This review focuses from an engineering perspective on the different parameters that should be considered before and during the design of new nDDS, and the different manufacturing techniques available, in such a way to ensure success in clinical application.
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Affiliation(s)
- Betiana Felice
- Laboratorio de Medios e Interfases, Departamento de Bioingeniería, Universidad Nacional de Tucumán, Av. Kirchner 1800, Tucumán, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917, Buenos Aires, Argentina.; START - Thrust 3, Create Research Wing, #03-08, 1 Create Way, National University of Singapore, Singapore 138602
| | - Molamma P Prabhakaran
- START - Thrust 3, Create Research Wing, #03-08, 1 Create Way, National University of Singapore, Singapore 138602.
| | - Andrea P Rodríguez
- Laboratorio de Medios e Interfases, Departamento de Bioingeniería, Universidad Nacional de Tucumán, Av. Kirchner 1800, Tucumán, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917, Buenos Aires, Argentina
| | - Seeram Ramakrishna
- START - Thrust 3, Create Research Wing, #03-08, 1 Create Way, National University of Singapore, Singapore 138602; Department of Mechanical Engineering, National University of Singapore, Singapore
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Schoffelen R, Woliner-van der Weg W, Visser EP, Goldenberg DM, Sharkey RM, McBride WJ, Chang CH, Rossi EA, van der Graaf WTA, Oyen WJG, Boerman OC. Predictive patient-specific dosimetry and individualized dosing of pretargeted radioimmunotherapy in patients with advanced colorectal cancer. Eur J Nucl Med Mol Imaging 2014; 41:1593-602. [PMID: 24643780 DOI: 10.1007/s00259-014-2742-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Pretargeted radioimmunotherapy (PRIT) with bispecific antibodies (bsMAb) and a radiolabeled peptide reduces the radiation dose to normal tissues. Here we report the accuracy of an (111)In-labeled pretherapy test dose for personalized dosing of (177)Lu-labeled IMP288 following pretargeting with the anti-CEA × anti-hapten bsMAb, TF2, in patients with metastatic colorectal cancer (CRC). METHODS In 20 patients bone marrow absorbed doses (BMD) and doses to the kidneys were predicted based on blood samples and scintigrams acquired after (111)In-IMP288 injection for individualized dosing of PRIT with (177)Lu-IMP288. Different dose schedules were studied, varying the interval between the bsMAb and peptide administration (5 days vs. 1 day), increasing the bsMAb dose (75 mg vs. 150 mg), and lowering the peptide dose (100 μg vs. 25 μg). RESULTS TF2 and (111)In/(177)Lu-IMP288 clearance was highly variable. A strong correlation was observed between peptide residence times and individual TF2 blood concentrations at the time of peptide injection (Spearman's ρ = 0.94, P < 0.0001). PRIT with 7.4 GBq (177)Lu-IMP288 resulted in low radiation doses to normal tissues (BMD <0.5 Gy, kidney dose <3 Gy). Predicted (177)Lu-IMP288 BMD were in good agreement with the actual measured doses (mean ± SD difference -0.0026 ± 0.028 mGy/MBq). Hematological toxicity was mild in most patients, with only two (10 %) having grade 3-4 thrombocytopenia. A correlation was found between platelet toxicity and BMD (Spearman's ρ = 0.58, P = 0.008). No nonhematological toxicity was observed. CONCLUSION These results show that individual high activity doses in PRIT in patients with CEA-expressing CRC could be safely administered by predicting the radiation dose to red marrow and kidneys, based on dosimetric analysis of a test dose of TF2 and (111)In-IMP288.
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Affiliation(s)
- Rafke Schoffelen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Pasternack JB, Howell RW. RadNuc: a graphical user interface to deliver dose rate patterns encountered in nuclear medicine with a 137Cs irradiator. Nucl Med Biol 2013; 40:304-11. [PMID: 23265668 PMCID: PMC3840905 DOI: 10.1016/j.nucmedbio.2012.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED The temporal variations in absorbed dose rates to organs and tissues in the body are very large in diagnostic and therapeutic nuclear medicine. The response of biological endpoints of relevance to radiation safety and therapeutic efficacy is generally modulated by dose rate. Therefore, it is important to understand how the complex dose rate patterns encountered in nuclear medicine impact relevant biological responses. Accordingly, a graphical user interface (GUI) was created to control a cesium-137 irradiator to deliver such dose rate patterns. METHODS Visual Basic 6.0 was used to create a user-friendly GUI to control the dose rate by varying the thickness of a mercury attenuator. The GUI facilitates the delivery of a number of dose rate patterns including constant, exponential increase or decrease, and multi-component exponential. Extensive visual feedback is provided by the GUI during both the planning and delivery stages. RESULTS The GUI controlled irradiator can achieve a maximum dose rate of 40 cGy/h and a minimum dose rate of 0.01 cGy/h. Addition of machined lead blocks can be used to further reduce the minimum dose rate to 0.0001 cGy/h. Measured dose rate patterns differed from programmed dose rate patterns in total dose by 3.2% to 8.4%. CONCLUSION The GUI controlled irradiator is able to accurately create dose rate patterns encountered in nuclear medicine and other related fields. This makes it an invaluable tool for studying the effects of chronic constant and variable low dose rates on biological tissues in the contexts of both radiation protection and clinical administration of internal radionuclides.
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Affiliation(s)
- Jordan B Pasternack
- Division of Radiation Research, Department of Radiology, New Jersey Medical School Cancer Center, University of Medicine & Dentistry of New Jersey, Newark, New Jersey 07103, USA.
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Loke KSH, Padhy AK, Ng DCE, Goh ASW, Divgi C. Dosimetric considerations in radioimmunotherapy and systemic radionuclide therapies: a review. World J Nucl Med 2012; 10:122-38. [PMID: 22144871 PMCID: PMC3227338 DOI: 10.4103/1450-1147.89780] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Radiopharmaceutical therapy, once touted as the “magic bullet” in radiation oncology, is increasingly being used in the treatment of a variety of malignancies; albeit in later disease stages. With ever-increasing public and medical awareness of radiation effects, radiation dosimetry is becoming more important. Dosimetry allows administration of the maximum tolerated radiation dose to the tumor/organ to be treated but limiting radiation to critical organs. Traditional tumor dosimetry involved acquiring pretherapy planar scans and plasma estimates with a diagnostic dose of intended radiopharmaceuticals. New advancements in single photon emission computed tomography and positron emission tomography systems allow semi-quantitative measurements of radiation dosimetry thus allowing treatments tailored to each individual patient.
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Affiliation(s)
- Kelvin S H Loke
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
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Evaluation of new bi-functional terpolymeric nanoparticles for simultaneous in vivo optical imaging and chemotherapy of breast cancer. Drug Deliv Transl Res 2012; 2:437-53. [DOI: 10.1007/s13346-012-0103-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kang CS, Sun X, Jia F, Song HA, Chen Y, Lewis M, Chong HS. Synthesis and preclinical evaluation of bifunctional ligands for improved chelation chemistry of 90Y and 177Lu for targeted radioimmunotherapy. Bioconjug Chem 2012; 23:1775-82. [PMID: 22881720 DOI: 10.1021/bc200696b] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a practical and high-yield synthesis of a bimodal bifunctional ligand 3p-C-NETA-NCS containing the isothiocyanate group for conjugation to a tumor targeting antibody. 3p-C-NETA-NCS was conjugated to a tumor-targeting antibody, trastuzumab, and the corresponding 3p-C-NETA-trastuzumab conjugate was evaluated and compared to trastuzumab conjugates of the known bifunctional ligands C-DOTA, C-DTPA, and 3p-C-DEPA for radiolabeling kinetics with (90)Y and (177)Lu. 3p-C-NETA-trastuzumab conjugate exhibited extremely rapid complexation kinetics with (90)Y and (177)Lu. (90)Y-3p-C-NETA-trastuzumab and (177)Lu-3p-C-NETA-trastuzumab conjugates were stable in human serum for 2 weeks. A pilot biodistribution study was conducted to evaluate in vivo stability and tumor targeting of (177)Lu-radiolabeled trastuzumab conjugate using nude mice bearing ZR-75-1 human breast cancer. (177)Lu-3p-C-NETA-trastuzumab conjugate displayed low radioactivity level at blood (1.6%), low organ uptake (<2.2%), and high tumor-to-blood ratio (6.4) at 120 h. 3p-C-NETA possesses favorable in vitro and in vivo profiles and is an excellent bifunctional chelator that can be used for targeted RIT applications using (90)Y and (177)Lu and has the potential to replace DOTA and DTPA analogues in current clinical use.
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Affiliation(s)
- Chi Soo Kang
- Chemistry Division, Biological and Chemical Sciences Department, Illinois Institute of Technology, Chicago, Illinois 60616, USA
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Stillebroer AB, Zegers CM, Boerman OC, Oosterwijk E, Mulders PF, O'Donoghue JA, Visser EP, Oyen WJ. Dosimetric Analysis of 177Lu-cG250 Radioimmunotherapy in Renal Cell Carcinoma Patients: Correlation with Myelotoxicity and Pretherapeutic Absorbed Dose Predictions Based on 111In-cG250 Imaging. J Nucl Med 2011; 53:82-9. [DOI: 10.2967/jnumed.111.094896] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Eberlein U, Bröer JH, Vandevoorde C, Santos P, Bardiès M, Bacher K, Nosske D, Lassmann M. Biokinetics and dosimetry of commonly used radiopharmaceuticals in diagnostic nuclear medicine - a review. Eur J Nucl Med Mol Imaging 2011; 38:2269-81. [PMID: 21877166 PMCID: PMC3218267 DOI: 10.1007/s00259-011-1904-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 08/02/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The impact on patients' health of radiopharmaceuticals in nuclear medicine diagnostics has not until now been evaluated systematically in a European context. Therefore, as part of the EU-funded Project PEDDOSE.NET ( www.peddose.net ), we review and summarize the current knowledge on biokinetics and dosimetry of commonly used diagnostic radiopharmaceuticals. METHODS A detailed literature search on published biokinetic and dosimetric data was performed mostly via PubMed ( www.ncbi.nlm.nih.gov/pubmed ). In principle the criteria for inclusion of data followed the EANM Dosimetry Committee guidance document on good clinical reporting. RESULTS Data on dosimetry and biokinetics can be difficult to find, are scattered in various journals and, especially in paediatric nuclear medicine, are very scarce. The data collection and calculation methods vary with respect to the time-points, bladder voiding, dose assessment after the last data point and the way the effective dose was calculated. In many studies the number of subjects included for obtaining biokinetic and dosimetry data was fewer than ten, and some of the biokinetic data were acquired more than 20 years ago. CONCLUSION It would be of interest to generate new data on biokinetics and dosimetry in diagnostic nuclear medicine using state-of-the-art equipment and more uniform dosimetry protocols. For easier public access to dosimetry data for diagnostic radiopharmaceuticals, a database containing these data should be created and maintained.
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Affiliation(s)
- Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.
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Czuczman MS, Vose JM, Witzig TE, Zinzani PL, Buckstein R, Polikoff J, Li J, Pietronigro D, Ervin-Haynes A, Reeder CB. The differential effect of lenalidomide monotherapy in patients with relapsed or refractory transformed non-Hodgkin lymphoma of distinct histological origin. Br J Haematol 2011; 154:477-81. [DOI: 10.1111/j.1365-2141.2011.08781.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Outcomes of patients with non-Hodgkin's lymphoma treated with Bexxar with or without external-beam radiotherapy. Int J Radiat Oncol Biol Phys 2011; 82:1122-7. [PMID: 21570217 DOI: 10.1016/j.ijrobp.2010.09.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/22/2010] [Accepted: 09/24/2010] [Indexed: 01/19/2023]
Abstract
PURPOSE To compare the efficacy and toxicity of external-beam radiotherapy (EBRT) to sites of bulky lymphadenopathy in patients with chemotherapy-refractory low-grade non-Hodgkin's lymphoma (NHL) immediately before receiving Bexxar (tositumomab and (131)I) vs. in patients receiving Bexxar alone for nonbulky disease. METHODS AND MATERIALS Nineteen patients with chemotherapy-refractory NHL were treated with Bexxar at our institution (University of Florida, Gainesville, FL) from 2005 to 2008. Seventeen patients had Grade 1-2 follicular lymphoma. Ten patients received a median of 20 Gy in 10 fractions to the areas of clinical involvement, immediately followed by Bexxar (EBRT + Bexxar); 9 patients received Bexxar alone. The median tumor sizes before EBRT + Bexxar and Bexxar alone were 4.8 cm and 3.3 cm, respectively. All 5 patients with a tumor diameter >5 cm were treated with EBRT + Bexxar. A univariate analysis of prognostic factors for progression-free survival (PFS) was performed. RESULTS The median follow-up was 2.3 years for all patients and 3.1 years for 12 patients alive at last follow-up. Of all patients, 79% had a partial or complete response; 4 of the 8 responders in the EBRT + Bexxar group achieved a durable response of over 2 years, including 3 of the 5 with tumors >5 cm. Three of 9 patients treated with Bexxar alone achieved a durable response over 2 years. Actuarial estimates of 3-year overall survival and PFS for EBRT + Bexxar and Bexxar alone were 69% and 38% and 62% and 33%, respectively. The median time to recurrence after EBRT + Bexxar and Bexxar alone was 9 months. Having fewer than 4 involved lymph-node regions was associated with superior PFS at 3 years (63% vs. 18%). There was no Grade 4 or 5 complications. CONCLUSIONS Adding EBRT immediately before Bexxar produced PFS equivalent to that with Bexxar alone, despite bulkier disease. Hematologic toxicity was not worsened. EBRT combined with Bexxar adds a safe and effective therapeutic treatment for managing recurrent low-grade follicular NHL.
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⁹⁰Y-Ibritumomab tiuxetan, fludarabine, and TBI-based nonmyeloablative allogeneic transplantation conditioning for patients with persistent high-risk B-cell lymphoma. Blood 2011; 118:1132-9. [PMID: 21508413 DOI: 10.1182/blood-2010-12-324392] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nonmyeloablative allogeneic transplantation (NMAT) infrequently cures active chemoresistant, bulky, or aggressive B-cell lymphoma (B-cell non-Hodgkin lymphoma [B-NHL]). We hypothesized that ⁹⁰Y-ibritumomab tiuxetan-based NMAT would facilitate early cytoreduction in such patients promoting improved long-term disease control by the allogeneic graft. Forty high-risk B-NHL patients with persistent disease received 0.4 mCi/kg (maximum, 32 mCi/kg) ⁹⁰Y-ibritumomab tiuxetan, fludarabine, and 2 Gy total body irradiation and matched-related (15) or unrelated (25) transplantation. Baseline features included: median age, 58 years (range, 29-69 years); median prior regimens, 6 (range, 3-12); chemosensitive disease, 6 (15%); bulk > 5 cm, 17 (range, 5.2-18.6 cm, 43%); diffuse large B-cell lymphoma, 14 (35%); and comorbidity score > zero, 34 (85%). Early responses were observed in 24 (60%, 14 complete remission/complete remission unconfirmed, 10 partial response) patients, including 17 of 29 (59%) with chemotherapy-resistant disease and 10 (59%) with bulk > 5 cm. The estimated 30-month survival, progression-free survival, and nonrelapse mortality were 54.1%, 31.1%, and 15.9%, respectively. Early response, baseline platelet counts over 25 000/μL, indolent histology, and related donors were associated with improved survival. The addition of ⁹⁰Y-ibritumomab tiuxetan to NMAT is safe and yields early responses and prolonged disease control in some of the highest-risk B-NHL patients. This trial was registered at www.clinicaltrials.gov as #NCT00119392.
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Lammers T, Kiessling F, Hennink WE, Storm G. Nanotheranostics and image-guided drug delivery: current concepts and future directions. Mol Pharm 2010; 7:1899-912. [PMID: 20822168 DOI: 10.1021/mp100228v] [Citation(s) in RCA: 310] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nanomedicine formulations aim to improve the biodistribution and the target site accumulation of systemically applied (chemo-) therapeutics. Various different passively and actively targeted nanomedicines have been evaluated over the years, based e.g. on liposomes, polymers, micelles and antibodies, and a significant amount of (pre-) clinical evidence has been obtained showing that these 5-200 nm sized carrier materials are able to improve the therapeutic index of low-molecular-weight drugs. Besides for therapeutic purposes, however, nanomedicine formulations have also been more and more used for imaging applications, as well as, in recent years, for theranostic approaches, i.e. for systems and strategies in which disease diagnosis and therapy are combined. Potential applications of theranostic nanomedicine formulations range from the noninvasive assessment of the biodistribution and the target site accumulation of low-molecular-weight drugs, and the visualization of drug distribution and drug release at the target site, to the optimization of strategies relying on triggered drug release, and the prediction and real-time monitoring of therapeutic responses. Nanotheranostic systems are consequently considered to be highly suitable systems for (pre-) clinical implementation, not only because they might assist in better understanding various important aspects of the drug delivery process, and in developing better drug delivery systems, but also because they might contribute to realizing the potential of "personalized medicine", and to developing more effective and less toxic treatment regimens for individual patients.
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Affiliation(s)
- Twan Lammers
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands.
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Danhier F, Feron O, Préat V. To exploit the tumor microenvironment: Passive and active tumor targeting of nanocarriers for anti-cancer drug delivery. J Control Release 2010; 148:135-46. [PMID: 20797419 DOI: 10.1016/j.jconrel.2010.08.027] [Citation(s) in RCA: 1723] [Impact Index Per Article: 123.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 08/10/2010] [Indexed: 12/12/2022]
Abstract
Because of the particular characteristics of the tumor microenvironment and tumor angiogenesis, it is possible to design drug delivery systems that specifically target anti-cancer drugs to tumors. Most of the conventional chemotherapeutic agents have poor pharmacokinetics profiles and are distributed non-specifically in the body leading to systemic toxicity associated with serious side effects. Therefore, the development of drug delivery systems able to target the tumor site is becoming a real challenge that is currently addressed. Nanomedicine can reach tumor passively through the leaky vasculature surrounding the tumors by the Enhanced Permeability and Retention effect whereas ligands grafted at the surface of nanocarriers allow active targeting by binding to the receptors overexpressed by cancer cells or angiogenic endothelial cells. This review is divided into two parts: the first one describes the tumor microenvironment and the second one focuses on the exploitation and the understanding of these characteristics to design new drug delivery systems targeting the tumor. Delivery of conventional chemotherapeutic anti-cancer drugs is mainly discussed.
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Affiliation(s)
- Fabienne Danhier
- Université Catholique de Louvain, Louvain Drug Research Institute, Unit of Pharmaceutics, UCL-FARG 7320, Avenue E. Mounier, B-1200, Brussels, Belgium
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Bouchat V, Nuttens VE, Michiels C, Masereel B, Feron O, Gallez B, Vander Borght T, Lucas S. Radioimmunotherapy with radioactive nanoparticles: biological doses and treatment efficiency for vascularized tumors with or without a central hypoxic area. Med Phys 2010; 37:1826-39. [PMID: 20443505 DOI: 10.1118/1.3368599] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Radioactive atoms attached to monoclonal antibodies are used in radioimmunotherapy to treat cancer while limiting radiation to healthy tissues. One limitation of this method is that only one radioactive atom is linked to each antibody and the deposited dose is often insufficient to eradicate solid and radioresistant tumors. In a previous study, simulations with the Monte Carlo N-Particle eXtended code showed that physical doses up to 50 Gy can be delivered inside tumors by replacing the single radionuclide by a radioactive nanoparticle of 5 nm diameter containing hundreds of radioactive atoms. However, tumoral and normal tissues are not equally sensitive to radiation, and previous works did not take account the biological effects such as cellular repair processes or the presence of less radiosensitive cells such as hypoxic cells. METHODS The idea is to adapt the linear-quadratic expression to the tumor model and to determine biological effective doses (BEDs) delivered through and around a tumor. This BED is then incorporated into a Poisson formula to determine the shell control probability (SCP) which predicts the cell cluster-killing efficiency at different distances "r" from the center of the tumor. BED and SCP models are used to analyze the advantages of injecting radioactive nanoparticles instead of a single radionuclide per vector in radioimmunotherapy. RESULTS Calculations of BED and SCP for different distances r from the center of a solid tumor, using the non-small-cell lung cancer as an example, were investigated for 90Y2O3 nanoparticles. With a total activity of about 3.5 and 20 MBq for tumor radii of 0.5 and 1.0 cm, respectively, results show that a very high BED is deposited in the well oxygenated part of the spherical carcinoma. CONCLUSIONS For either small or large solid tumors, BED and SCP calculations highlight the important benefit in replacing the single beta-emitter 90Y attached to each antibody by a 90Y2O3 nanoparticle.
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Affiliation(s)
- V Bouchat
- Research Center in Physics of Matter and Radiation, Laboratoire d'Analyses par Réactions Nucléaires, University of Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium.
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Vitolo U, Barosi G, Fanti S, Gianni AM, Martelli M, Petrini M, Zinzani PL, Tura S. Consensus conference on the use of 90-yttrium-ibritumomab tiuxetan therapy in clinical practice. A project of the Italian society of hematology. Am J Hematol 2010; 85:147-55. [PMID: 20095035 DOI: 10.1002/ajh.21602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Umberto Vitolo
- Department of Oncology and Hematology, Hematology 2, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy.
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A theoretical dose-escalation study based on biological effective dose in radioimmunotherapy with (90)Y-ibritumomab tiuxetan (Zevalin). Eur J Nucl Med Mol Imaging 2010; 37:862-73. [PMID: 20069297 DOI: 10.1007/s00259-009-1333-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 11/10/2009] [Indexed: 12/25/2022]
Abstract
AIM To investigate the variation in biological effective dose (BED) produced by the uncertainty in absorbed dose and radiobiological parameters in Zevalin radioimmunotherapy. METHODS Eight patients scheduled for treatment with standard administration of (90)Y-ibritumomab tiuxetan (Zevalin) were studied. Patient-specific pretherapy dosimetry was performed by injection of (111)In-ibritumomab tiuxetan. Absorbed doses and BEDs were calculated for critical organs (COs) and tumours, assuming a 30% dose uncertainty and varying the radiobiological parameters in a reasonable range. In an activity-escalation study, BEDs for the COs were compared with the BED limits of external beam radiotherapy (EBRT) and BEDs for the tumour with the EBRT dose prescriptions. RESULTS At standard activities, the absorbed doses per unit activity for the COs were in agreement with those in the literature. Absorbed doses to lesions were rather variable, ranging from 1.47 to 16.7 Gy/GBq. Median tumour absorbed dose to lesions in the range 80-110 g was 9.6 Gy/GBq (range 9.2-16.7 Gy/GBq), yielding a mean BED of about 12 Gy for administration of 15 MBq/kg. For the administration of the myeloablative activity of 45 MBq/kg, risk of liver toxicity in one patient would have been foreseen by the model. Considering also the dose uncertainty, the potential risk of liver toxicity in one more patient, lung toxicity in one patient, and kidney toxicity in one patient would have been suggested. The absorbed dose uncertainty was found to be the main source of uncertainty in the BED. As for radiobiological parameters, at myeloablative activities, the increase in the repair half-time for sublethally damaged tissue (T(mu)) from 0.5 h to 5 h induced more consistent increases in mean BED/BED(limit) than alpha/beta variation from 2 Gy to 5 Gy: at 53 MBq/kg, 38% for the liver, and 34% for the lungs and kidneys (about threefold higher than that obtained for the increase alpha/beta). CONCLUSION At standard activities, absorbed doses to lesions appear to be effective, even though lower than prescribed by EBRT. At myeloablative dosages, the uncertainty associated with the absorbed doses and radiobiological parameters considerably affect BED evaluation and may account for possible "second-organ" toxicities.
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Papi S, Martano L, Garaboldi L, Rossi A, Cremonesi M, Grana CM, Paolucci D, Sansovini M, Paganelli G, Chinol M. Radiolabeling optimization and reduced staff radiation exposure for high-dose 90Y-ibritumomab tiuxetan (HD-Zevalin). Nucl Med Biol 2010; 37:85-93. [DOI: 10.1016/j.nucmedbio.2009.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 08/27/2009] [Accepted: 08/28/2009] [Indexed: 12/01/2022]
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Imaging in targeted delivery of therapy to cancer. Target Oncol 2009; 4:201-17. [PMID: 19838639 DOI: 10.1007/s11523-009-0119-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 09/08/2009] [Indexed: 12/15/2022]
Abstract
We review the current status of imaging as applied to targeted therapy with particular focus on antibody-based therapeutics. Antibodies have high tumor specificity and can be engineered to optimize delivery to, and retention within, the tumor. Whole antibodies can activate natural immune effector mechanisms and can be conjugated to beta- and alpha-emitting radionuclides, toxins, enzymes, and nanoparticles for enhanced therapeutic effect. Imaging is central to the development of these agents and is used for patient selection, performing dosimetry and assessment of response. gamma- and positron-emitting radionuclides may be used to image the distribution of antibody-targeted therapeutics While some radionuclides such as iodine-131 emit both beta and gamma radiation and are therefore suitable for both imaging and therapy, others are more suited to imaging or therapy alone. Hence for radionuclide therapy of neuroendocrine tumors, patients can be selected for therapy on the basis of gamma-emitting indium-111-octreotide imaging and treated with beta-emitting yttrium-90-octreotate. Positron-emitting radionuclides can give greater sensitivity that gamma-emitters but only a single radionuclide can be imaged at one time and the range of radionuclides is more limited. The multiple options for antibody-based therapeutic molecules, imaging technologies and therapeutic scenarios mean that very large amounts of diverse data are being acquired. This can be most effectively shared and progress accelerated by use of common data standards for imaging, biological, and clinical data.
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Harnessing the Energy: Development of Radioimmunotherapy for Patients with Non‐Hodgkin's Lymphoma. Oncologist 2009; 14 Suppl 2:4-16. [DOI: 10.1634/theoncologist.2009-s2-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Inhibition of tumor growth by targeted toxins in mice is dramatically improved by saponinum album in a synergistic way. J Immunother 2009; 32:713-25. [PMID: 19561537 DOI: 10.1097/cji.0b013e3181ad4052] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The application of targeted toxins in cancer therapy remains a challenge due to the severe side effects as a consequence of the high systemic doses required. Here, we describe the combined application of a glycosylated triterpenoid (Spn) and epidermal growth factor receptor (EGFR)-targeted chimeric toxins (SA2E). The cytotoxicity of SA2E on murine TSA tumor cells transfected with human EGFR was enhanced 20,000-fold by low nonpermeabilizing Spn concentrations in a synergistic manner. Subcutaneous application of Spn and SA2E in BALB/c mice bearing a solid TSA cells transfected with epidermal growth factor receptor tumor resulted in 94% tumor volume reduction with a 50-fold lower chimeric toxin concentration compared with pure SA2E treatment. Side effects as monitored by observable complications, body weight, blood parameters; histologic analyses and antibody responses were only moderate and usually reversible.
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Bar J, Herbst RS, Onn A. Targeted drug delivery strategies to treat lung metastasis. Expert Opin Drug Deliv 2009; 6:1003-16. [PMID: 19663628 DOI: 10.1517/17425240903167926] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Bousis C, Emfietzoglou D, Hadjidoukas P, Nikjoo H. A Monte Carlo study of cellularS-factors for 1 keV to 1 MeV electrons. Phys Med Biol 2009; 54:5023-38. [DOI: 10.1088/0031-9155/54/16/012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tolmachev V, Carlsson J, Lundqvist H. A limiting factor for the progress of radionuclide-based cancer diagnostics and therapy--availability of suitable radionuclides. Acta Oncol 2009; 43:264-75. [PMID: 15244250 DOI: 10.1080/02841860410028943] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Advances in diagnostics and targeted radionuclide therapy of haematological and neuroendocrine tumours have raised hope for improved radionuclide therapy of other forms of disseminated tumours. New molecular target structures are characterized and this stimulates the efforts to develop new radiolabelled targeting agents. There is also improved understanding of factors of importance for choice of appropriate radionuclides. The choice is determined by physical, chemical, biological, and economic factors, such as a character of emitted radiation, physical half-life, labelling chemistry, chemical stability of the label, intracellular retention time, and fate of radiocatabolites and availability of the radionuclide. There is actually limited availability of suitable radionuclides and this is a limiting factor for further progress in the field and this is the focus in this article. The probably most promising therapeutic radionuclide, 211At, requires regional production and distribution centres with dedicated cyclotrons. Such centres are, with a few exceptions in the world, lacking today. They can be designed to also produce beta- and Augeremitters of therapeutic interest. Furthermore, emerging satellite PET scanners will in the near future demand long-lived positron emitters for diagnostics with macromolecular radiopharmaceuticals, and these can also be produced at such centres. To secure continued development and to meet the foreseen requirements for radionuclide availability from the medical community it is necessary to establish specialized cyclotron centres for radionuclide production.
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Affiliation(s)
- Vladimir Tolmachev
- Biomedical Radiation Sciences, Department of Oncology, Radiology and Clinical Immunology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
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Cheung MC, Haynes AE, Stevens A, Meyer RM, Imrie K. Yttrium 90 ibritumomab tiuxetan in lymphoma. Leuk Lymphoma 2009; 47:967-77. [PMID: 16840185 DOI: 10.1080/10428190600572582] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Radioimmunoconjugates are radioisotope-bound monoclonal antibodies that target radiation specifically to sites of lymphoma involvement. Initial studies of 90Y-ibritumomab tiuxetan in non-Hodgkin's lymphoma (NHL) have suggested benefit in patients with relapsed or refractory indolent disease. However, the routine adoption of this agent is tempered by concerns of associated toxicities and unclear long-term benefit. A comprehensive search for studies on 90Y-ibritumomab tiuxetan use in lymphoma was completed. The aims of this systematic review were to summarize and evaluate the evidence on: (1) the benefits and risks of this novel therapy; (2) predictors for response and toxicity; and (3) the role of dosimetry and imaging studies prior to treatment. A total of twenty trials investigating the use of 90Y-ibritumomab tiuxetan for the treatment of adult patients with NHL were identified. In trials of patients with relapsed or refractory indolent NHL, overall response rates ranged from 67 - 83%. In patients with follicular NHL refractory to the monoclonal antibody, rituximab, response rates remained high (74%). However, in rituximab-naïve patients with relapsed or refractory indolent or transformed NHL, the higher response rate seen with 90Y-ibritumomab tiuxetan therapy compared to rituximab monotherapy has not translated into clear improvements in time-to-progression or survival. 90Y-ibritumomab tiuxetan is an active agent in relapsed and refractory non-Hodgkin's lymphoma that should be considered in select patients.
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Affiliation(s)
- Matthew C Cheung
- Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada
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Chiesa C, Botta F, Coliva A, Maccauro M, Devizzi L, Guidetti A, Carlo-Stella C, Seregni E, Gianni MA, Bombardieri E. Absorbed dose and biologically effective dose in patients with high-risk non-Hodgkin's lymphoma treated with high-activity myeloablative 90Y-ibritumomab tiuxetan (Zevalin). Eur J Nucl Med Mol Imaging 2009; 36:1745-57. [PMID: 19455328 DOI: 10.1007/s00259-009-1141-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 04/02/2009] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to carry out two different dose estimation approaches in patients with non-Hodgkin's lymphoma (NHL) treated with a myeloablative amount of (90)Y-labelled ibritumomab tiuxetan (Zevalin(R)) in an open-label dose escalation study. METHODS Twenty-seven patients with relapsed/refractory or de novo high-risk NHL receiving one myeloablative dose of (90)Y-ibritumomab tiuxetan followed by tandem stem cell reinfusion were evaluated for dose estimate. The injected activity was 30 MBq/kg in 12 patients and 45 MBq/kg in 15 patients. Dose estimation was performed 1 week prior to (90)Y-ibritumomab tiuxetan by injection of (111)In-ibritumomab tiuxetan (median activity: 200 MBq). The absorbed dose (D) and the biologically effective dose (BED) were calculated. RESULTS The absorbed doses per unit activity (Gy/GBq) were [median (range)]: heart wall 4.6 (2.5-9.7), kidneys 5.1 (2.8-10.5), liver 6.1 (3.9-10.4), lungs 2.9 (1.5-6.8), red marrow 1.0 (0.5-1.7), spleen 7.0 (1.5-14.4) and testes 4.9 (2.9-16.7). The absorbed dose (Gy) for the 15 patients treated with 45 MBq/kg were: heart wall 17.0 (8.7-25.4), kidneys 17.1 (7.9-22.4), liver 20.8 (15.4-28.3), lungs 8.1 (5.4-11.4), red marrow 3.1 (2.0-4.0), spleen 26.2 (17.0-35.6) and testes 17.3 (9.0-28.4). At the highest activities the acute haematological toxicity was mild or moderate and of very short duration, and it was independent of the red marrow absorbed dose. No secondary malignancy or treatment-related myelodysplastic syndrome was observed. No non-haematological toxicity (liver, kidney, lung) was observed during a follow-up period of 24-48 months. CONCLUSION The use of 45 MBq/kg of (90)Y-ibritumomab tiuxetan in association with stem cell autografting resulted in patients being free of toxicity in non-haematological organs. These clinical findings were in complete agreement with our dose estimations, considering both organ doses and BED values.
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Affiliation(s)
- C Chiesa
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy.
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de Jong GM, Hendriks T, Eek A, Oyen WJG, Heskamp S, Bleichrodt RP, Boerman OC. Radioimmunotherapy improves survival of rats with microscopic liver metastases of colorectal origin. Ann Surg Oncol 2009; 16:2065-73. [PMID: 19430843 PMCID: PMC2695874 DOI: 10.1245/s10434-009-0477-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 03/25/2009] [Accepted: 03/25/2009] [Indexed: 01/22/2023]
Abstract
Background Half of the patients with colorectal cancer develop liver metastases during the course of their disease. The aim of the present study was to assess the efficacy of radioimmunotherapy (RIT) with a radiolabeled monoclonal antibody (mAb) to treat experimental colorectal liver metastases. Methods Male Wag/Rij rats underwent a minilaparotomy with intraportal injection of 1 × 106 CC531 tumor cells. The biodistribution of 111In-labeled MG1, 1 day after intravenous administration, was determined in vivo and compared with that of an isotype-matched control antibody (UPC-10). The maximal tolerated dose (MTD) of 177Lu-labeled MG1 was determined and the therapeutic efficacy of 177Lu-MG1 at MTD was compared with that of 177Lu-UPC-10 and saline only. RIT was administered either at the day of tumor inoculation or 14 days after tumor inoculation. Primary endpoint was survival. Results 111In-MG1 preferentially accumulated in CC531 liver tumors (9.2 ± 3.7%ID/g), whereas 111In-UPC-10 did not (0.8 ± 0.1%ID/g). The MTD of 177Lu-MG1 was 400 MBq/kg body weight. Both the administration of 177Lu-MG1 and 177Lu-UPC-10 had no side-effects except a transient decrease in body weight. The survival curves of the group that received 177Lu-UPC-10 and the group that received saline only did not differ (P = 0.407). Administration of 177Lu-MG1 RIT immediately after surgery improved survival significantly compared with administration of 177Lu-UPC-10 (P = 0.009) whereas delayed treatment did not (P = 0.940). Conclusion This study provides proof of principle that RIT can be an effective treatment modality for microscopic liver metastases, whereas RIT is not effective in larger tumors.
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Affiliation(s)
- Gabie M de Jong
- Department of Surgery, Division of Abdominal and Oncological Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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