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Anderson PM, Subbiah V, Trucco MM. Current and future targeted alpha particle therapies for osteosarcoma: Radium-223, actinium-225, and thorium-227. Front Med (Lausanne) 2022; 9:1030094. [PMID: 36457575 PMCID: PMC9705365 DOI: 10.3389/fmed.2022.1030094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/07/2022] [Indexed: 07/30/2023] Open
Abstract
Osteosarcoma is a high-grade sarcoma characterized by osteoid formation, nearly universal expression of IGF1R and with a subset expressing HER-2. These qualities provide opportunities for the use of the alpha particle-emitting isotopes to provide targeted radiation therapy via alpha particles precisely to bone-forming tumors in addition to IFG1R or Her-2 expressing metastases. This review will detail experience using the alpha emitter radium-223 (223Ra, tradename Xofigo), that targets bone formation, in osteosarcoma, specifically related to patient selection, use of gemcitabine for radio-sensitization, and using denosumab to increasing the osteoblastic phenotype of these cancers. A case of an inoperable left upper lobe vertebral-paraspinal-mediastinal osteoblastic lesion treated successfully with 223Ra combined with gemcitabine is described. Because not all areas of osteosarcoma lesions are osteoblastic, but nearly all osteosarcoma cells overexpress IGF1R, and some subsets expressing Her-2, the anti-IGF1R antibody FPI-1434 linked to actinium-225 (225Ac) or the Her-2 antibody linked to thorium-227 (227Th) may become other means to provide targeted alpha particle therapy against osteosarcoma (NCT03746431 and NCT04147819).
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Affiliation(s)
- Peter M. Anderson
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s Hospital, Pediatric Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Vivek Subbiah
- Investigational Cancer Therapeutics, Cancer Medicine, Clinical Center for Targeted Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Matteo M. Trucco
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s Hospital, Pediatric Institute, Cleveland Clinic, Cleveland, OH, United States
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Valduga SG, Forte GC, Paganin RP, Abreu DG, Medeiros TM, Irion K, Hochhegger B, Mattiello R. Whole-body magnetic resonance imaging for the diagnosis of metastasis in children and adolescents: a systematic review and meta-analysis. Radiol Bras 2021; 54:329-335. [PMID: 34602669 PMCID: PMC8475173 DOI: 10.1590/0100-3984.2020.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/15/2021] [Indexed: 11/21/2022] Open
Abstract
Whole-body magnetic resonance imaging (WB-MRI) is a noninvasive imaging method that can be used to diagnose and stage tumors, as well as to assess therapeutic responses in oncology. The objective of this meta-analysis was to evaluate the accuracy of WB-MRI for the diagnosis of metastases in pediatric patients. The following electronic databases were searched: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. All of the selected studies included children and adolescents with histopathological confirmation of a primary tumor. Collectively, the studies included 118 patients ranging in age from 7 months to 19 years. The pooled sensitivity and specificity of WB-MRI were, respectively, 0.964 (95% CI: 0.944-0.978; I2 = 0%) and 0.902 (95% CI: 0.882-0.919; I2 = 98.4%), with an area under the curve (AUC) of 0.991. We found that WB-MRI had good accuracy for the diagnosis of metastases in pediatric patients and could therefore provide an alternative to complete the staging of tumors in such patients, being a safer option because it does not involve the use of ionizing radiation.
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Affiliation(s)
| | - Gabriele Carra Forte
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | | | - Diego Gomez Abreu
- Universidad Industrial de Santander (UIS), Bucaramanga, Santander, Colombia
| | | | - Klaus Irion
- Thoracic Imaging DIIRM, Manchester University and Manchester University NHS Foundation Trust Department of Radiology, Manchester, UK
| | - Bruno Hochhegger
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Rita Mattiello
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Phelps TE, Roy J, Green MV, Seidel J, Baidoo KE, Adler S, Edmondson EF, Butcher D, Matta JL, Ton AT, Wong K, Huang S, Ren L, LeBlanc AK, Choyke PL, Jagoda EM. Sodium Fluoride-18 and Radium-223 Dichloride Uptake Colocalize in Osteoblastic Mouse Xenograft Tumors. Cancer Biother Radiopharm 2021; 36:133-142. [PMID: 33646017 DOI: 10.1089/cbr.2020.4068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Patients with osteoblastic bone metastases are candidates for radium-223 (223RaCl2) therapy and may undergo sodium fluoride-18 (18F-NaF) positron emission tomography-computed tomography imaging to identify bone lesions. 18F-NaF has been shown to predict 223RaCl2 uptake, but intratumor distributions of these two agents remain unclear. In this study, the authors evaluate the spatial distribution and relative uptakes of 18F-NaF and 223RaCl2 in Hu09-H3 human osteosarcoma mouse xenograft tumors at macroscopic and microscopic levels to better quantify their correlation. Materials and Methods: 18F-NaF and 223RaCl2 were co-injected into Hu09-H3 xenograft tumor severe combined immunodeficient mice. Tumor content was determined from in vivo biodistributions and visualized by PET, single photon emission computed tomography, and CT imaging. Intratumor distributions were visualized by quantitative autoradiography of tumor tissue sections and compared to histology of the same or adjacent sections. Results: 18F and 223Ra accumulated in proportional amounts in whole Hu09-H3 tumors (r2 = 0.82) and in microcalcified regions within these tumors (r2 = 0.87). Intratumor distributions of 18F and 223Ra were spatially congruent in these microcalcified regions. Conclusions: 18F-NaF and 223RaCl2 uptake are strongly correlated in heterogeneously distributed microcalcified regions of Hu09-H3 xenograft tumors, and thus, tumor accumulation of 18F is predictive of 223Ra accumulation. Hu09-H3 xenograft tumors appear to possess certain histopathological features found in patients with metastatic bone disease and may be useful in clarifying the relationship between administered 223Ra dose and therapeutic effect.
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Affiliation(s)
- Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jyoti Roy
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael V Green
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Jurgen Seidel
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Kwamena E Baidoo
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephen Adler
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Elijah F Edmondson
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Donna Butcher
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Jennifer L Matta
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Anita T Ton
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Karen Wong
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shan Huang
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ling Ren
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy K LeBlanc
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elaine M Jagoda
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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RADTHYR: an open-label, single-arm, prospective multicenter phase II trial of Radium-223 for the treatment of bone metastases from radioactive iodine refractory differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2021; 48:3238-3249. [PMID: 33619600 PMCID: PMC8426251 DOI: 10.1007/s00259-021-05229-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/01/2021] [Indexed: 01/02/2023]
Abstract
Purpose This is the first prospective trial evaluating the efficacy of alpha emitter Radium-223 in patients with bone metastases from radioactive iodine (RAI) refractory (RAIR) differentiated thyroid cancer. Methods RADTHYR is a multicenter, single-arm prospective Simon two-stage phase II trial (NCT02390934). The primary objective was to establish the efficacy of three administrations of 55 kBq/kg of Radium-223 by 18F-FDG PET/CT according to PERCIST criteria. Secondary objectives were to establish the efficacy of six administrations of Radium-223 by 18F-FDG PET/CT, 99mTc-HMDP bone scan and 18FNa PET/CT, clinical benefits, changes in serum bone markers, thyroglobulin levels, and safety. Results Ten patients were enrolled between July 2015 and December 2017 (4 M; median age 74 years). Prior to Radium-223 administration, patients received a median RAI cumulative activity of 15 GBq (7.4–35.6), external radiation therapy (n = 9), bone surgery (n = 8), cimentoplasty (n = 5), and cryoablation (n = 2). 18F-FDG PET/CT showed stable disease (SD) in 4/10 and progressive disease (PD) in 6/10 cases after three administrations and SD in 4/10, PD in 5/10 cases, and 1/10 non-evaluable (NE) case after six administrations. After six injections, 99mTc-HMDP bone scan showed SD in 9 cases and was NE in 1 case; 18FNa PET/CT showed SD in 8 cases, partial response (PR) in 1 case, and was NE in 1 case. No significant clinical benefits were reported during the study. A skeletal event occurred in 6 patients (median time without skeletal event of 12.1 months). Seventy-seven adverse events were reported during treatment (7 of grade 3–4). Three patients developed an acute myeloid, a promyelocytic, and a chronic myeloid leukemia after the last Radium-223 administration considered as drug-related. Conclusion The trial was stopped after interim analysis for lack of response of bone metastases from RAIR thyroid cancer to Radium-223. Severe hematological toxicity was observed in patients heavily pretreated with RAI and external radiation. Trial registration number NCT02390934. Registration date 18.03.2015. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05229-y.
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Brito AE, Etchebehere E. Radium-223 as an Approved Modality for Treatment of Bone Metastases. Semin Nucl Med 2020; 50:177-192. [PMID: 32172803 DOI: 10.1053/j.semnuclmed.2019.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Radium-223 dichloride (223Ra) is an α-emitter radionuclide approved for treatment of osteoblastic metastases in castrate-resistant prostate cancer (mCRPC) patients. 223Ra increases overall survival, improves bone pain, increases the median time to the first skeletal-related event, reduces the use of external beam radiation therapy for bone pain palliation, reduces the rates of spinal cord compression, and hospitalization. 223Ra therapy has minimal side effects; the most common hematological side effects are anemia, thrombocytopenia and neutropenia while the nonhematological side effects that may occur are bone pain flare, nausea, fatigue, and diarrhea. Alongside 223Ra therapy there are currently a variety of first-line therapeutic options available to treat mCRPC patients and much debate regarding the appropriate treatment algorithm for these patients and the possible combination of therapies among the ones available. In this article, we review the rationale behind 223Ra therapy as well as 223Ra mechanisms of action, biodistribution and dosimetry, optimal timing possibilities to initiate 223Ra in contrast to other treatments available, the association of 223Ra with other therapies and the means of evaluating patients in order to properly deliver to 223Ra therapy. Furthermore, we will discuss 223Ra dose administration possibilities, patient and dose preparation and the challenges of treatment response evaluation during and after 223Ra.
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Affiliation(s)
- Ana Emília Brito
- Real Nuclear, Real Hospital Português de Beneficência em Pernambuco, Recife, Brazil
| | - Elba Etchebehere
- Division of Nuclear Medicine, The University of Campinas (UNICAMP), Campinas, Brazil.
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