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Hernandez MC, Yazaki P, Mortimer JE, Yamauchi D, Poku E, Park J, Frankel P, Kim J, Colcher DM, Wong J, Fong Y, Shively J, Woo Y. Pilot study of HER2 targeted 64 Cu-DOTA-tagged PET imaging in gastric cancer patients. Nucl Med Commun 2023; 44:1151-1155. [PMID: 37901917 PMCID: PMC10872802 DOI: 10.1097/mnm.0000000000001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Human epidermal growth factor receptor 2 (HER2) is an important biomarker for targeted gastric cancer (GC) immunotherapy. However, heterogeneous HER2 overexpression in GC, loss of HER2 expression during therapy, and inability to non-invasively identify HER2 overexpressing tumors impede effective targeting therapies. Improved HER2-specific functional imaging can address these challenges. Trastuzumab is a HER2-directed mAb to treat HER2 overexpressing cancers. The 64 Cu-DOTA-trastuzumab radiotracer is used to detect HER2+ metastatic breast cancer. We aimed to develop 64 Cu-DOTA-trastuzumab PET-CT to detect and characterize tumor uptake in HER2+ or - GC patients. METHODS We conducted a single-arm phase II pilot study exploring the feasibility of 64 Cu-DOTA-trastuzumab for PET imaging of HER2 overexpressing GC compared to HER2 non-expressing tumors. Eight patients with biopsy-confirmed gastric adenocarcinoma were included. Immunohistochemistry was used to evaluate primary tumor biopsies for HER2 overexpression. Patients were injected with 45 mg of cold trastuzumab followed by 5 mg of 64 Cu-DOTA-trastuzumab. PET-CT scans were performed 24-48 h post radiotracer injection and compared to standard staging CT scans. RESULTS We observed limited toxicity following 64 Cu-DOTA-trastuzumab injections. While there was uptake of the radiotracer in portions of HER2+ lesions, there was no statistically significant distinction between tumor and background by standardized uptake value analysis. CONCLUSION Despite the potential of 64 Cu-DOTA-trastuzumab PET imaging of HER2+ metastatic breast cancer, a 5 mg dose of this radiotracer injected 24-48 h before imaging was insufficient to identify HER2+ GC. These results inform future GC imaging studies to optimize biomarker-targeted therapies based on dosage and timing for more clinically relevant imaging.
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Affiliation(s)
- Matthew C. Hernandez
- Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Paul Yazaki
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope Medical Center, Duarte, CA
| | - Joanne E. Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | | | - Erasmus Poku
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jinha Park
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Paul Frankel
- Department of Biostatistics, Beckman Research Institute, Duarte, CA
| | - Joseph Kim
- Division of Surgical Oncology, Department of Surgery, UK Healthcare, University of Kentucky, Lexington, KY
| | - David M. Colcher
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - Jeffrey Wong
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - John Shively
- Department of Immunology, Beckman Research Institute, City of Hope, Duarte, CA
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
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Wong JYC, Monzr AM, Sahebi F, Dandapani SV, Yamauchi DM, Salhotra A, Adhikarla V, Ali H, Poku E, Yang D, Han C, Liu A, Mokhtari S, Wu A, Yazaki P, Shively JE, Hui SK, Smith E, Stein A. First-in-Human Phase I Trial Combining Biologically Guided Radioimmunotherapy (RIT) Using a 90Y-Anti-CD25 Monoclonal Antibody (Mab) with CT-guided Total Marrow and Lymphoid Irradiation (TMLI) in Relapsed and Refractory (R/R) Acute Leukemia. Int J Radiat Oncol Biol Phys 2023; 117:S162. [PMID: 37784406 DOI: 10.1016/j.ijrobp.2023.06.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients with R/R acute leukemia after allogeneic hematopoietic cell transplant (alloHCT) have a dismal prognosis with 3-year survival rates of < 20%. To improve outcomes, innovative targeted forms of organ sparing radiotherapy, such as tumor-specific RIT and TMLI, are needed to dose escalate with acceptable toxicities, especially in patients ≥ age 60 years who cannot tolerate total body irradiation (TBI) / myeloablative regimens and who have a poor prognosis. CD25 is an ideal RIT target given its expression in acute leukemias, association with poor prognosis, and expression by leukemia stem cells. In this phase I trial (NCT05139004) we hypothesized that combining dose escalated 90Y-anti-CD25 RIT with fixed dose TMLI 12 Gy, fludarabine (flu), and melphalan (mel) in patients with R/R disease is safe and associated with acceptable toxicities. MATERIALS/METHODS The primary objective of this trial is to determine the maximum tolerated dose and recommended phase 2 dose of 90Y-anti-CD25 Mab (Day -15) with 12 Gy TMLI (1.5 Gy twice a day, days -8 to -5), flu (30 mg/m2/d days -5 to -2), and mel (100 mg/m2, day -2) in patients ≥ 60 years old or with a HCT-comorbidity index ≥ 2 and with R/R AML, ALL or myelodysplastic syndrome (MDS) scheduled to undergo alloHCT from a matched donor. TMLI mean organ dose constraints for kidney, lung and liver were 4 Gy. Planned dose levels of 90Y-anti-CD25 were 0.3, 0.4, and 0.5 mCi/kg. 111In-anti-CD25 (5 mCi) was co-infused followed by serial nuclear scans to assess dosimetry and biodistribution. RESULTS To date 5 patients (ages 31-74) with R/R AML have been treated. Marrow and circulating blasts ranged from 10-36% and 9-44%, respectively. For the 3 patients at 0.3 mCi/kg, follow-up ranged from 89-191+ days. 90Y/111In-anti-CD25 nuclear scans demonstrated persistent uptake in bone out to 144 hours, which was associated with a decline in circulating blasts. After combined RIT and TMLI, mean doses (Gy) to lungs ranged from 5.7-6.5, to kidneys from 7.5-8.2 and to liver from 7.2-11.6. No dose-limiting toxicities (DLT) were observed. All 3 patients achieved CR on day +30 bone marrow biopsies and 2 remained in CR on day +90 biopsies. Two patients have recently been treated at the 0.4 mCi/kg dose level. The results of patients treated at the higher dose levels will be provided. CONCLUSION Dose escalation by adding 90Y-anti-CD25 RIT at 0.3 mCi/kg to 12 Gy TMLI was safe, including in older patients, with no dose-limiting toxicities, mean critical organ doses lower than conventional myeloablative TBI, and encouraging response rates. The toxicity profile and dose estimates at 0.3 mCi/kg predict that the planned higher dose levels will also be feasible with acceptable toxicities. RIT and TMLI are complementary and when combined address the limitations of each modality. Combining these targeted therapies may be a superior strategy to intensify dose to leukemia compared to dose escalation of either modality alone.
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Affiliation(s)
- J Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - A M Monzr
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - F Sahebi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - S V Dandapani
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - D M Yamauchi
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - A Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - V Adhikarla
- Division of Mathematical Oncology, City of Hope National Medical Center, Duarte, CA
| | - H Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | | | - D Yang
- Department of Biostatistics, City of Hope National Medical Center, Duarte, CA
| | - C Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - A Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | | | - A Wu
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, CA
| | - P Yazaki
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, CA
| | - J E Shively
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, CA
| | - S K Hui
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - E Smith
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - A Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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Lwin TM, Minnix M, Li L, Sherman A, Hong T, Wong JYC, Olafsen T, Poku E, Bouvet M, Fong Y, Shively JE, Yazaki PJ. Multimodality PET and Near-Infrared Fluorescence Intraoperative Imaging of CEA-Positive Colorectal Cancer. Mol Imaging Biol 2023:10.1007/s11307-023-01831-8. [PMID: 37341873 DOI: 10.1007/s11307-023-01831-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Molecular imaging is a major diagnostic component for cancer management, enabling detection, staging of disease, targeting therapy, and monitoring the therapeutic response. The coordination of multimodality imaging techniques further enhances tumor localization. The development of a single agent for real-time non-invasive targeted positron emission tomography (PET) imaging and fluorescence guided surgery (FGS) will provide the next generation tool in the surgical management of cancer. PROCEDURES The humanized anti-CEA M5A-IR800 "sidewinder" (M5A-IR800-SW) antibody-dye conjugate was designed with a NIR 800 nm dye incorporated into a PEGylated linker and conjugated with the metal chelate p-SCN-Bn-deferoxamine (DFO) for zirconium-89 PET imaging (89Zr, half-life 78.4 h). The dual-labeled 89Zr-DFO-M5A-SW-IR800 was evaluated for near infrared (NIR) fluorescence imaging, PET/MRI imaging, terminal tissue biodistribution, and blood clearance in a human colorectal cancer LS174T xenograft mouse model. RESULTS The 89Zr-DFO-M5A-SW-IR800 NIR fluorescence imaging showed high tumor targeting with normal liver uptake. Serial PET/MRI imaging was performed at 24 h, 48 h, and 72 h and showed tumor localization visible at 24 h that persisted throughout the experiment. However, the PET scans showed higher activity for the liver than the tumor, compared to the NIR fluorescence imaging. This difference is an important finding as it quantifies the expected difference due to the sensitivity and depth of penetration between the 2 modalities. CONCLUSIONS This study demonstrates the potential of a pegylated anti-CEA M5A-IR800-Sidewinder for NIR fluorescence/PET/MR multimodality imaging for intraoperative fluorescence guided surgery.
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Affiliation(s)
- Thinzar M Lwin
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Megan Minnix
- Department of Immunology & Theranostics, Beckman Research Institute, City of Hope, 1500 Duarte Road, Duarte, CA, 91010, USA
| | - Lin Li
- Department of Immunology & Theranostics, Beckman Research Institute, City of Hope, 1500 Duarte Road, Duarte, CA, 91010, USA
| | - Anakim Sherman
- Department of Immunology & Theranostics, Beckman Research Institute, City of Hope, 1500 Duarte Road, Duarte, CA, 91010, USA
| | - Teresa Hong
- Department of Immunology & Theranostics, Beckman Research Institute, City of Hope, 1500 Duarte Road, Duarte, CA, 91010, USA
| | - Jeffery Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Tove Olafsen
- Small Animal Imaging Core, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
| | - Erasmus Poku
- Radiopharmacy, Beckman Research Institute, City of Hope, CA, 91010, Duarte, USA
| | - Michael Bouvet
- Department of Surgery, University of California, San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, La Jolla, CA, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - John E Shively
- Department of Immunology & Theranostics, Beckman Research Institute, City of Hope, 1500 Duarte Road, Duarte, CA, 91010, USA
| | - Paul J Yazaki
- Department of Immunology & Theranostics, Beckman Research Institute, City of Hope, 1500 Duarte Road, Duarte, CA, 91010, USA.
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Awuah D, Minnix M, Caserta E, Tandoh T, Adhikarla V, Poku E, Rockne R, Pichiorri F, Shively JE, Wang X. Sequential CAR T cell and targeted alpha immunotherapy in disseminated multiple myeloma. Cancer Immunol Immunother 2023:10.1007/s00262-023-03461-z. [PMID: 37209218 PMCID: PMC10361855 DOI: 10.1007/s00262-023-03461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023]
Abstract
Multiple myeloma (MM) is still an incurable disorder despite improved antibody and cellular therapies against different MM antigens. Single targeted antigens have so far been ineffective against MM with most patients relapsing after initial response. Hence, sequential immunotherapies directed at different targets are expected to perform better than monotherapy alone. Here, we optimized and established in preclinical studies the therapeutic rationale of using targeted alpha therapy (TAT) directed against CD38 antigen (225Ac-DOTA-daratumumab) with CAR T cell therapy directed at CS1 antigen in a systemic MM model. The sequential therapies compared CAR T therapy followed by TAT to TAT followed by CAR T therapy. CAR T cell monotherapy increased median survival from 49 days (d) in untreated controls to 71d with a modest improvement to 89d for 3.7 kBq of TAT given 14d later. When CAR T was followed by 7.4 kBq of TAT 29d later, sequential therapy increased median survival from 47d in untreated controls to 106d, compared to 68d for CAR T monotherapy. When CAR T therapy was followed by untargeted alpha immunotherapy using 7.4 kBq of 225Ac-DOTA-trastuzumab (anti-HER2) antibody 29d later, there was only a slight improvement in response over CAR T monotherapy demonstrating the role of tumor targeting. TAT (7.4 kBq) followed by CAR T therapy was also effective when CAR T therapy was delayed for 21d vs 14d or 28d post TAT, highlighting the importance of timing sequential therapies. Sequential targeted therapies using CS1 CAR T or 225Ac-DOTA-CD38 TAT in either order shows promise over monotherapies alone.
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Affiliation(s)
- Dennis Awuah
- Department of Hematology, City of Hope Medical Center, Beckman Research Institute, Duarte, CA, 91010, USA
| | - Megan Minnix
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
| | - Enrico Caserta
- Department of Hematologic Malignancies Research Institute, City of Hope Medical Center, Duarte, CA, 91010, USA
| | - Theophilus Tandoh
- Department of Hematologic Malignancies Research Institute, City of Hope Medical Center, Duarte, CA, 91010, USA
| | - Vikram Adhikarla
- Division of Mathematical Oncology and Computational Systems Biology, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
| | - Erasmus Poku
- City of Hope Medical Center, Duarte, CA, 91010, USA
| | - Russell Rockne
- Division of Mathematical Oncology and Computational Systems Biology, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
| | - Flavia Pichiorri
- Department of Hematologic Malignancies Research Institute, City of Hope Medical Center, Duarte, CA, 91010, USA.
| | - John E Shively
- Department of Immunology and Theranostics, Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA.
| | - Xiuli Wang
- Department of Hematology, City of Hope Medical Center, Beckman Research Institute, Duarte, CA, 91010, USA.
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Minnix M, Kujawski M, Poku E, Yazaki PJ, Wong JY, Shively JE. Improved Tumor Responses with Sequential Targeted α-Particles Followed by Interleukin 2 Immunocytokine Therapies in Treatment of CEA-Positive Breast and Colon Tumors in CEA Transgenic Mice. J Nucl Med 2022; 63:1859-1864. [PMID: 35772959 PMCID: PMC9730924 DOI: 10.2967/jnumed.122.264126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/25/2022] [Indexed: 01/11/2023] Open
Abstract
Targeted α-therapy (TAT) delivers high-linear-transfer-energy α-particles to tumors with the potential to generate tumor immune responses that may be augmented by antigen-targeted immunotherapy. Methods: This concept was evaluated in immunocompetent carcinoembryonic antigen (CEA) transgenic mice bearing CEA-positive mammary or colon tumors. Tumors were targeted with humanized anti-CEA antibody M5A labeled with 225Ac for its 10-d half-life and emission of 4 α-particles, as well as being targeted with the immunocytokine M5A-interleukin 2. Results: A dose response (3.7, 7.4, and 11.1 kBq) to TAT only, for orthotopic CEA-positive mammary tumors, was observed, with a tumor growth delay of 30 d and an increase in median survival from 20 to 36 d at the highest dose. Immunocytokine (4 times daily) monotherapy gave a tumor growth delay of 20 d that was not improved by addition of 7.4 kBq of TAT 5 d after the start of immunocytokine. However, TAT (7.4 kBq) followed by immunocytokine 10 d later led to a tumor growth delay of 38 d, with an increase in median survival to 45 d. Similar results were seen for TAT followed by immunocytokine at 5 versus 10 d. When a similar study was performed with subcutaneously implanted CEA-positive MC38 colon tumors, TAT (7.4 kBq) monotherapy gave an increase in median survival from 29 to 42 d. The addition of immunocytokine 10 d after 7.4 kBq of TAT increased median survival to 57 d. Immunophenotyping showed increased tumor-infiltrating interferon-γ-positive, CD8-positive T cells and an increased ratio of these cells to Foxp3-positive, CD4-positive regulatory T cells with sequential therapy. Immunohistochemistry confirmed there was an increase in tumor-infiltrating CD8-positive T cells in the sequential therapy group, strongly suggesting that immunocytokine augmented TAT can lead to an immune response that improves tumor therapy. Conclusion: Low-dose (7.4 kBq) TAT followed by a 4-dose immunocytokine regimen 5 or 10 d later gave superior tumor reductions and survival curves compared with either monotherapy in breast and colon cancer tumor models. Reversing the order of therapy to immunocytokine followed by TAT 5 d later was equivalent to either monotherapy in the breast cancer model.
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Affiliation(s)
- Megan Minnix
- Department of Immunology and Theranostics, Riggs Institute of Diabetes and Metabolic Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Maciej Kujawski
- Department of Immunology and Theranostics, Riggs Institute of Diabetes and Metabolic Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Erasmus Poku
- Radiopharmacy, Beckman Research Institute of the City of Hope, Duarte, California; and
| | - Paul J. Yazaki
- Department of Immunology and Theranostics, Riggs Institute of Diabetes and Metabolic Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Jeffrey Y. Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - John E. Shively
- Department of Immunology and Theranostics, Riggs Institute of Diabetes and Metabolic Research, Beckman Research Institute of the City of Hope, Duarte, California
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Filippov A, Bonjoc KJC, Chea J, Bowles N, Poku E, Chaudhry A. Role of theranostics in thoracic oncology. J Thorac Dis 2020; 12:5140-5146. [PMID: 33145091 PMCID: PMC7578517 DOI: 10.21037/jtd-2019-pitd-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Theranostics is a re-emerging field of medicine that aims to create targeted agents that can be used for diagnostic and/or therapeutic indications. In the past, theranostics has been used to treat neoplasms, such as thyroid cancer and neuroblastomas. More recently, theranostics has seen a resurgence with advent of new therapeutic antibodies and small molecules which can be transformed into Theranostic agents through radioconjugating with a radioactive isotope. Positron emitting radioisotopes can be used for diagnostic purposes while alpha- and beta-emitting radioisotopes can be used for therapy. The technique of radiolabeling an existing therapeutic agent (small molecule or antibody) leverages the existing qualities of that drug, and potentiates therapeutic effect by conjugating it with a cytotoxic-energy bearing radioisotope (e.g., 131-iodine, 177-lutetium). Theranostics have been used for a few decades now, starting with 131-iodine for therapy of autoimmune thyroiditis (Graves’ disease, Hashimoto’s thyroiditis) as well as for thyroid cancer. Additionally, 131-iodine-meta-iodobenzylguanidine (131-I-MIBG) initially had been used for gastroenteropancreatic neuroendocrine (carcinoid) tumors. However, recently clinical trials have start enrolling patients to evaluate efficacy of 131-I-MIBG in patients with small cell carcinoma of the lung. In the era of precision medicine and personalized targeted therapeutics, Theranostics can play a key pivotal in improving diagnostic and therapeutic specificity by increasing potency of these targeted small molecules and antibodies with radioisotopes. In this review, we will review various clinically relevant Theranostics agent and their utility in thoracic disorders, notably within oncology.
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Affiliation(s)
- Aleksandr Filippov
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kimberley-Jane C Bonjoc
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Junie Chea
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Nicole Bowles
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Erasmus Poku
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Ammar Chaudhry
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
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Minnix M, Adhikarla V, Caserta E, Poku E, Rockne R, Shively JE, Pichiorri F. Comparison of CD38-Targeted α- Versus β-Radionuclide Therapy of Disseminated Multiple Myeloma in an Animal Model. J Nucl Med 2020; 62:795-801. [PMID: 33127621 DOI: 10.2967/jnumed.120.251983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023] Open
Abstract
Targeted therapies for multiple myeloma (MM) include the anti-CD38 antibody daratumumab, which, in addition to its inherent cytotoxicity, can be radiolabeled with tracers for imaging and with β- and α-emitter radionuclides for radioimmunotherapy. Methods: We have compared the potential therapeutic efficacy of β- versus α-emitter radioimmunotherapy using radiolabeled DOTA-daratumumab in a preclinical model of disseminated multiple myeloma. Multiple dose levels were investigated to find the dose with the highest efficacy and lowest toxicity. Results: In a dose–response study with the β-emitter 177Lu-DOTA-daratumumab, the lowest tested dose, 1.85 MBq, extended survival from 37 to 47 d but did not delay tumor growth. Doses of 3.7 and 7.4 MBq extended survival to 55 and 58 d, respectively, causing a small equivalent delay in tumor growth, followed by regrowth. The higher dose, 11.1 MBq, eradicated the tumor but had no effect on survival compared with untreated controls, because of whole-body toxicity. In contrast, the α-emitter 225Ac-DOTA-daratumumab had a dose-dependent effect, in which 0.925, 1.85, and 3.7 kBq increased survival, compared with untreated controls (35 d), to 47, 52, and 73 d, respectively, with a significant delay in tumor growth for all 3 doses. Higher doses of 11.1 and 22.2 kBq resulted in equivalent survival to 82 d but with significant whole-body toxicity. Parallel studies with untargeted 225Ac-DOTA-trastuzumab conferred no improvement over untreated controls and resulted in whole-body toxicity. Conclusion: We conclude, and mathematic modeling confirms, that maximal biologic doses were achieved by targeted α-therapy and demonstrated 225Ac to be superior to 177Lu in delaying tumor growth and decreasing whole-body toxicity.
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Affiliation(s)
- Megan Minnix
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California.,Irell and Manella Graduate School of Biological Sciences, Beckman Research Institute, City of Hope, Duarte, California
| | - Vikram Adhikarla
- Department of Computational and Quantitative Medicine, Division of Mathematical Oncology, Beckman Research Institute, City of Hope, Duarte, California
| | - Enrico Caserta
- Briskin Myeloma Center and Department of Hematologic Malignancies Research Institute, City of Hope, Duarte, California; and
| | | | - Russell Rockne
- Department of Computational and Quantitative Medicine, Division of Mathematical Oncology, Beckman Research Institute, City of Hope, Duarte, California
| | - John E Shively
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California
| | - Flavia Pichiorri
- Briskin Myeloma Center and Department of Hematologic Malignancies Research Institute, City of Hope, Duarte, California; and
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Li D, Minnix M, Allen R, Bading J, Chea J, Wong P, Bowles N, Poku E, Shively JE. Preclinical PET Imaging of NTSR-1-Positive Tumors with 64Cu- and 68Ga-DOTA-Neurotensin Analogs and Therapy with an 225Ac-DOTA-Neurotensin Analog. Cancer Biother Radiopharm 2020; 36:651-661. [PMID: 32822229 DOI: 10.1089/cbr.2020.3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: The aim of the study was to perform PET imaging and radiotherapy with a novel neurotensin derivative for neurotensin receptor 1 (NTSR-1)-positive tumors in an animal model. Materials and Methods: A di-DOTA analog of NT(6-13) with three unnatural amino acids was synthesized and radiolabeled with either 64Cu or 68Ga and tested for serum stability and tumor imaging in mice bearing NTSR-1-positive PC3, and HT29 xenografts. A dose-response therapy study was performed with 18.5, 37, and 74 kBq of 225Ac-di-DOTA-α,ɛ-Lys-NT(6-13). Results: 68Ga-di-DOTA-α,ɛ-Lys-NT(6-13) was >99% stable in serum for 48 h, had an IC50 of 5 nM using 125I labeled NT(8-13) for binding to HT-29 cells, and high uptake in tumor models expressing NTSR-1. 68Ga-di-DOTA-α,ɛ-Lys-NT(6-13) had an average %ID/g (n = 4) at 2 h of 4.0 for tumor, 0.5 for blood, 12.0 for kidney, and <1 for other tissues, resulting in a favorable T/B of 8. Mean survivals of tumor-bearing mice treated with 18.5 or 37 kBq of 225Ac-di-DOTA-α,ɛ-Lys-NT(6-13) were 81 and 93 d, respectively, versus 53 d for controls. Whole-body toxicity was seen for the 74 kBq dose. Conclusions: Based on the results of the animal model, di-DOTA-α,ɛ-Lys-NT(6-13) is a useful imaging agent for NTSR-1-positive tumors when radiolabeled with 68Ga, and when radiolabeled with 225Ac, a potent therapeutic agent.
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Affiliation(s)
- Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Megan Minnix
- Deparment of Molecular Imaging and Therapy, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Rebecca Allen
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - James Bading
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Junie Chea
- Radiopharmacy, Beckman Research Institute of the City of Hope, Duarte, California, USA
| | - Patty Wong
- Deparment of Molecular Imaging and Therapy, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Nicole Bowles
- Radiopharmacy, Beckman Research Institute of the City of Hope, Duarte, California, USA
| | - Erasmus Poku
- Radiopharmacy, Beckman Research Institute of the City of Hope, Duarte, California, USA
| | - John E Shively
- Deparment of Molecular Imaging and Therapy, Beckman Research Institute of City of Hope, Duarte, California, USA
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Minnix M, Li L, Yazaki PJ, Miller AD, Chea J, Poku E, Liu A, Wong JYC, Rockne RC, Colcher D, Shively JE. TAG-72-Targeted α-Radionuclide Therapy of Ovarian Cancer Using 225Ac-Labeled DOTAylated-huCC49 Antibody. J Nucl Med 2020; 62:55-61. [PMID: 32620701 DOI: 10.2967/jnumed.120.243394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022] Open
Abstract
Radioimmunotherapy, an approach using radiolabeled antibodies, has had minimal success in the clinic with several β-emitting radionuclides for the treatment of ovarian cancer. Alternatively, radioimmunotherapy with α-emitters offers the advantage of depositing much higher energy over shorter distances but was thought to be inappropriate for the treatment of solid tumors, for which antibody penetration is limited to a few cell diameters around the vascular system. However, the deposition of high-energy α-emitters to tumor markers adjacent to a typical leaky tumor vascular system may have large antitumor effects at the tumor vascular level, and their reduced penetration in normal tissue would be expected to lower off-target toxicity. Methods: To evaluate this concept, DOTAylated-huCC49 was labeled with the α-emitter 225Ac to target tumor-associated glycoprotein 72-positive xenografts in a murine model of ovarian cancer. Results: 225Ac-labeled DOTAylated-huCC49 radioimmunotherapy significantly reduced tumor growth in a dose-dependent manner (1.85, 3.7, and 7.4 kBq), with the 7.4-kBq dose extending survival by more than 3-fold compared with the untreated control. Additionally, a multitreatment regime (1.85 kBq followed by 5 weekly doses of 0.70 kBq for a total of 5.4 kBq) extended survival almost 3-fold compared with the untreated control group, without significant off-target toxicity. Conclusion: These results establish the potential for antibody-targeted α-radionuclide therapy for ovarian cancer, which may be generalized to α-radioimmunotherapy in other solid tumors.
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Affiliation(s)
- Megan Minnix
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California.,Irell and Manella Graduate School of Biological Sciences, Beckman Research Institute, City of Hope, Duarte, California
| | - Lin Li
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California
| | - Paul J Yazaki
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California
| | - Aaron D Miller
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California
| | - Junie Chea
- Radiopharmacy, City of Hope Medical Center, Duarte, California
| | - Erasmus Poku
- Radiopharmacy, City of Hope Medical Center, Duarte, California
| | - An Liu
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California; and
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California; and
| | - Russell C Rockne
- Division of Mathematical Oncology, Beckman Research Institute, City of Hope, Duarte, California
| | - David Colcher
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California
| | - John E Shively
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California
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10
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Minnix M, Li L, Yazaki P, Chea J, Poku E, Colcher D, Shively JE. Improved targeting of an anti-TAG-72 antibody drug conjugate for the treatment of ovarian cancer. Cancer Med 2020; 9:4756-4767. [PMID: 32368864 PMCID: PMC7333846 DOI: 10.1002/cam4.3078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/18/2020] [Accepted: 01/29/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Ovarian cancer has only a 17% 5-year survival rate in patients diagnosed with late stage disease. Tumor-associated glycoprotein-72 (TAG72), expressed in 88% of all stages of ovarian cancer, is an excellent candidate for antibody-targeted therapy, as it is not expressed in normal human adult tissues, except in the secretory endometrium. METHODS Using the clinically relevant anti-TAG72 murine monoclonal antibody CC49, we evaluated antibody drug conjugates (ADCs) incorporating the highly potent, synthetic antimitotic agent monomethylauristatin E (MMAE). MMAE was conjugated to CC49 via reduced disulfides in the hinge region, using three different types of linker chemistry, vinylsulfone (VS-MMAE), bromoacetamido (Br-MMAE), and maleimido (mal-MMAE). RESULTS The drug antibody ratios (DARs) of the three ADCs were 2.3 for VS-MMAE, 10 for Br-MMAE, and 9.5 for mal-MMAE. All three ADCs exhibited excellent tumor to blood ratios on PET imaging, but the absolute uptake of CC49-mal-MMAE (3.3%ID/g) was low compared to CC49-Br-MMAE (6.43%ID/g), at 142 hours. Blood clearance at 43 hours was 38% for intact CC49, about 24% for both CC49-VS-MMAE and CC49-Br-MMAE, and 7% for CC49-mal-MMAE. CC49-VS-MMAE was not further studied due to its low DAR, while CC49-mal-MMAE was ineffective in the OVCAR3 xenograft likely due to its rapid blood clearance. In contrast, CC49-Br-MMAE treated mice exhibited an average of a 15.6 day tumor growth delay and a 40% increase in survival vs controls with four doses of 7.5 or 15 mg/kg of CC49-Br-MMAE. CONCLUSION We conclude that CC49-Br-MMAE with a high DAR and stable linker performs well in a difficult to treat solid tumor model.
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Affiliation(s)
- Megan Minnix
- Department of Molecular Imaging and TherapyBeckman Research InstituteCity of HopeDuarteCAUSA
- Irell and Manella Graduate School of Biological SciencesBeckman Research InstituteCity of HopeDuarteCAUSA
| | - Lin Li
- Department of Molecular Imaging and TherapyBeckman Research InstituteCity of HopeDuarteCAUSA
| | - Paul Yazaki
- Department of Molecular Imaging and TherapyBeckman Research InstituteCity of HopeDuarteCAUSA
| | - Junie Chea
- RadiopharmacyCity of Hope Medical CenterDuarteCAUSA
| | - Erasmus Poku
- RadiopharmacyCity of Hope Medical CenterDuarteCAUSA
| | - David Colcher
- Department of Molecular Imaging and TherapyBeckman Research InstituteCity of HopeDuarteCAUSA
| | - John E. Shively
- Department of Molecular Imaging and TherapyBeckman Research InstituteCity of HopeDuarteCAUSA
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11
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Wong P, Li L, Chea J, Hu W, Poku E, Ebner T, Bowles N, Wong JYC, Yazaki PJ, Sligar S, Shively JE. Antibody Targeted PET Imaging of 64Cu-DOTA-Anti-CEA PEGylated Lipid Nanodiscs in CEA Positive Tumors. Bioconjug Chem 2020; 31:743-753. [DOI: 10.1021/acs.bioconjchem.9b00854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Patty Wong
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California 91010, United States
| | - Lin Li
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California 91010, United States
| | - Junie Chea
- Radiopharmacy, City of Hope Medical Center, Duarte, California 91010, United States
| | - Weidong Hu
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California 91010, United States
| | - Erasmus Poku
- Radiopharmacy, City of Hope Medical Center, Duarte, California 91010, United States
| | - Todd Ebner
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California 91010, United States
| | - Nicole Bowles
- Radiopharmacy, City of Hope Medical Center, Duarte, California 91010, United States
| | - Jeffrey Y. C. Wong
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, California 91010, United States
| | - Paul J. Yazaki
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California 91010, United States
| | - Stephen Sligar
- Department of Molecular and Cellular Biology, University of Illinois, Urbana, Illinois 61801, United States
| | - John E. Shively
- Department of Molecular Imaging and Therapy, Beckman Research Institute, City of Hope, Duarte, California 91010, United States
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12
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Yazaki PJ, Lwin TM, Minnix M, Li L, Sherman A, Molnar J, Miller A, Frankel P, Chea J, Poku E, Bowles N, Hoffman RM, Shively JE, Bouvet M. Improved antibody-guided surgery with a near-infrared dye on a pegylated linker for CEA-positive tumors. J Biomed Opt 2019; 24:1-9. [PMID: 31254333 PMCID: PMC6978469 DOI: 10.1117/1.jbo.24.6.066012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/04/2019] [Indexed: 05/09/2023]
Abstract
Real-time intraoperative image-guided cancer surgery promises to improve oncologic outcomes. Tumor-specific antibodies conjugated with near-infrared (NIR) fluorophores have demonstrated the potential to enhance visualization of solid tumor margins and metastatic disease; however, multiple challenges remain, including improvement in probe development for clinical utility. We have developed an NIR-IR800 dye on a PEGylated linker (sidewinder) conjugated to the humanized anti-carcinoembryonic antigen (CEA) antibody (M5A) with extended in vivo serum and tumor persistence. The anti-CEA M5A-sidewinder has a high dye-to-antibody ratio (average of 7 per antibody) that allows, in an orthotopic implanted human pancreatic cancer mouse model increased tumor fluorescence, higher tumor-to-background ratio and extends the surgical scheduling window compared to current antibody dye conjugates. These preclinical results demonstrate the potential of this probe for fluorescence-guided surgery of CEA-positive gastrointestinal cancers.
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Affiliation(s)
- Paul J. Yazaki
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
- Address all correspondence to Paul J. Yazaki, E-mail:
| | - Thinzar M. Lwin
- University of California San Diego, Department of Surgery, La Jolla, California, United States
| | - Megan Minnix
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Lin Li
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Anakim Sherman
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Justin Molnar
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Aaron Miller
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Paul Frankel
- Beckman Research Institute, Department of Computational and Quantitative Medicine, City of Hope, Duarte, California, United States
| | - Junie Chea
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Erasmus Poku
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Nicole Bowles
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Robert M. Hoffman
- University of California San Diego, Department of Surgery, La Jolla, California, United States
- AntiCancer, Inc., San Diego, California, United States
- VA San Diego Healthcare System, San Diego, California, United States
| | - John E. Shively
- Beckman Research Institute, Diabetes Metabolism Research Institute, Department of Molecular Imaging and Therapy, City of Hope, Duarte, California, United States
| | - Michael Bouvet
- University of California San Diego, Department of Surgery, La Jolla, California, United States
- VA San Diego Healthcare System, San Diego, California, United States
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13
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Wong P, Li L, Chea J, Delgado MK, Poku E, Szpikowska B, Bowles N, Minnix M, Colcher D, Wong JYC, Shively JE, Yazaki PJ. Synthesis, Positron Emission Tomography Imaging, and Therapy of Diabody Targeted Drug Lipid Nanoparticles in a Prostate Cancer Murine Model. Cancer Biother Radiopharm 2018; 32:247-257. [PMID: 28910151 DOI: 10.1089/cbr.2017.2253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The blood clearance of chemotherapeutic drugs such as doxorubicin (Dox) can be extended by incorporation into lipid nanoparticles (LNPs) and further improved by tumor targeting with antibody fragments. We used positron emission tomography (PET) imaging in a murine prostate cancer model to evaluate tumor targeting of LNPs incorporating Dox and antiprostate-specific membrane antigen (PSMA) diabodies. Dox-LNPs were generated by mixing or covalent attachment to water soluble distearoylphosphatidyl ethanolamine-polyethylene glycol (DSPE-PEG)2000. Cu-64 PET imaging was performed with DOTA-conjugated Dox, PEG-LNP, or an anti-PSMA site-specific cysteine-diabody. Since the mixture Dox+PEG-LNP was unstable in serum, further studies utilized Dox covalently bound to LNP ± covalently bound DOTA-cys-diabody (cys-DB)-LNP. Blood clearance of covalent Dox-PEG-LNP was slower than Dox alone or Dox+PEG-LNP. PET imaging of 64Cu-DOTA-Dox-PEG-LNP reached a maximum of 10% ID/g in tumors compared with 3% ID/g of 64Cu-DOTA-Dox, due to the prolonged blood clearance. Mixing 64Cu-DOTA-cys-DB-PEG-LNP with covalent Dox-PEG-LNP gave LNPs containing both drug and tumor targeting cys-DB. The mixed LNPs exhibited increased tumor uptake (15% ID/g) versus untargeted 64Cu-DOTA-Dox-PEG-LNPs (10% ID/g) demonstrating feasibility of the approach. Based on these results, a therapy study with mixed LNPs containing cys-DB-LNP and either Dox-LNP or the antitubulin drug auristatin-LNP showed significant reduction of tumor growth with the auristatin-diabody-LNP mixture, but not the Dox-diabody-LNP mixture.
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Affiliation(s)
- Patty Wong
- 1 Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Lin Li
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - Junie Chea
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - Melissa K Delgado
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - Erasmus Poku
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - Barbara Szpikowska
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - Nicole Bowles
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - Megan Minnix
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - David Colcher
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - Jeffrey Y C Wong
- 1 Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - John E Shively
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
| | - Paul J Yazaki
- 2 Department of Molecular Immunology, Beckman Research Institute , City of Hope, Duarte, California
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14
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Weist MR, Starr R, Aguilar B, Chea J, Miles JK, Poku E, Gerdts E, Yang X, Priceman SJ, Forman SJ, Colcher D, Brown CE, Shively JE. PET of Adoptively Transferred Chimeric Antigen Receptor T Cells with 89Zr-Oxine. J Nucl Med 2018; 59:1531-1537. [PMID: 29728514 DOI: 10.2967/jnumed.117.206714] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/17/2018] [Indexed: 12/21/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cell therapy is a promising clinical approach for reducing tumor progression and prolonging patient survival. However, improvements in both the safety and the potency of CAR T cell therapy demand quantitative imaging techniques to determine the distribution of cells after adoptive transfer. The purpose of this study was to optimize 89Zr-oxine labeling of CAR T cells and evaluate PET as a platform for imaging adoptively transferred CAR T cells. Methods: CAR T cells were labeled with 0-1.4 MBq of 89Zr-oxine per 106 cells and assessed for radioactivity retention, viability, and functionality. In vivo trafficking of 89Zr-oxine-labeled CAR T cells was evaluated in 2 murine xenograft tumor models: glioblastoma brain tumors with intracranially delivered IL13Rα2-targeted CAR T cells, and subcutaneous prostate tumors with intravenously delivered prostate stem cell antigen (PSCA)-targeted CAR T cells. Results: CAR T cells were efficiently labeled (75%) and retained more than 60% of the 89Zr over 6 d. In vitro cytokine production, migration, and tumor cytotoxicity, as well as in vivo antitumor activity, were not significantly reduced when labeled with 70 kBq/106 cells. IL13Rα2-CAR T cells delivered intraventricularly were detectable by PET for at least 6 d throughout the central nervous system and within intracranial tumors. When intravenously administered, PSCA-CAR T cells also showed tumor tropism, with a 9-fold greater tumor-to-muscle ratio than for CAR-negative T cells. Conclusion: 89Zr-oxine can be used for labeling and imaging CAR T cells while maintaining cell viability and function. On the basis of these studies, we conclude that 89Zr-oxine is a clinically translatable platform for real-time assessment of cell therapies.
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Affiliation(s)
- Michael R Weist
- Department of Molecular Immunology, Beckman Research Institute, City of Hope Medical Center, Duarte, California.,Irell and Manella Graduate School of Biological Sciences, City of Hope Medical Center, Duarte, California; and
| | - Renate Starr
- Department of Hematology, City of Hope Medical Center, Duarte, California
| | - Brenda Aguilar
- Department of Hematology, City of Hope Medical Center, Duarte, California
| | - Junie Chea
- Department of Molecular Immunology, Beckman Research Institute, City of Hope Medical Center, Duarte, California
| | - Joshua K Miles
- Department of Molecular Immunology, Beckman Research Institute, City of Hope Medical Center, Duarte, California
| | - Erasmus Poku
- Department of Molecular Immunology, Beckman Research Institute, City of Hope Medical Center, Duarte, California
| | - Ethan Gerdts
- Department of Hematology, City of Hope Medical Center, Duarte, California
| | - Xin Yang
- Department of Hematology, City of Hope Medical Center, Duarte, California
| | - Saul J Priceman
- Department of Hematology, City of Hope Medical Center, Duarte, California
| | - Stephen J Forman
- Department of Hematology, City of Hope Medical Center, Duarte, California
| | - David Colcher
- Department of Molecular Immunology, Beckman Research Institute, City of Hope Medical Center, Duarte, California
| | - Christine E Brown
- Department of Hematology, City of Hope Medical Center, Duarte, California
| | - John E Shively
- Department of Molecular Immunology, Beckman Research Institute, City of Hope Medical Center, Duarte, California
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15
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Phillips P, Poku E, Essat M, Woods H, Goka E, Kaltenthaler E. Systematic Review of Carotid Artery Procedures and the Volume-Outcome Relationship in Europe. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Aber A, Poku E, Phillips P, Essat M, Buckley Woods H, Palfreyman S. Systematic Review of Patient-Reported Outcome Measures in Patients With Varicose Veins. J Vasc Surg Venous Lymphat Disord 2018. [DOI: 10.1016/j.jvsv.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Poku E, Aber A, Phillips P, Essat M, Buckley Woods H, Palfreyman S, Kaltenthaler E, Jones G, Michaels J. Systematic review assessing the measurement properties of patient-reported outcomes for venous leg ulcers. BJS Open 2017; 1:138-147. [PMID: 29951616 PMCID: PMC5989950 DOI: 10.1002/bjs5.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/14/2017] [Indexed: 12/21/2022] Open
Abstract
Background A variety of instruments have been used to assess outcomes for patients with venous leg ulcers. This study sought to identify, evaluate and recommend the most appropriate patient‐reported outcome measures (PROMs) for English‐speaking patients with venous leg ulcers. Methods This systematic review used a two‐stage search approach. Electronic searches of major databases including MEDLINE were completed in October 2015, and then updated in July 2016. Additional studies were identified from citation checking. Study selection, data extraction and quality assessment were undertaken independently by at least two reviewers. Evaluation and summary of measurement properties of identified PROMs were done using standard and adapted study‐relevant criteria. Results Ten studies with data for four generic PROMS and six condition‐specific measures were identified. No generic PROM showed adequate content and criterion validity; however, the EuroQoL Five Dimensions (EQ‐5D™), Nottingham Health Profile (NHP) and 12‐item Short‐Form Health Survey (SF‐12®) had good acceptability. In general, the EQ‐5D™ showed poor responsiveness in patients with venous leg ulcers. Most condition‐specific PROMs demonstrated poor criterion and construct validity. Overall, there was some evidence of internal consistency for the Venous Leg Ulcer Quality of Life (VLU‐QoL) and the Sheffield Preference‐based Venous Ulcer questionnaire (SPVU‐5D). Test–retest reliability was satisfactory for the Venous Leg Ulcer Self‐Efficacy Tool (VeLUSET). Conclusion The NHP and VLU‐QoL questionnaire seemed the most suitable PROMs for use by clinicians. However, a valid condition‐specific PROM is still required.
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Affiliation(s)
- E Poku
- School of Health and Related Research University of Sheffield Sheffield UK
| | - A Aber
- School of Health and Related Research University of Sheffield Sheffield UK
| | - P Phillips
- School of Health and Related Research University of Sheffield Sheffield UK
| | - M Essat
- School of Health and Related Research University of Sheffield Sheffield UK
| | - H Buckley Woods
- School of Health and Related Research University of Sheffield Sheffield UK
| | - S Palfreyman
- Edmonton Clinic Health Academy, University of Alberta Edmonton, Alberta Canada
| | - E Kaltenthaler
- School of Health and Related Research University of Sheffield Sheffield UK
| | - G Jones
- School of Social Sciences Leeds Beckett University Leeds UK
| | - J Michaels
- School of Health and Related Research University of Sheffield Sheffield UK
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Aber A, Poku E, Phillips P, Essat M, Buckley Woods H, Palfreyman S, Kaltenthaler E, Jones G, Michaels J. Systematic review of patient-reported outcome measures in patients with varicose veins. Br J Surg 2017; 104:1424-1432. [DOI: 10.1002/bjs.10639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/20/2017] [Accepted: 06/04/2017] [Indexed: 02/04/2023]
Abstract
Abstract
Background
Varicose veins can affect quality of life. Patient-reported outcome measures (PROMs) provide a direct report from the patient about the impact of the disease without interpretation from clinicians or anyone else. The aim of this study was to examine the quality of the psychometric evidence for PROMs used in patients with varicose veins.
Methods
A systematic review was undertaken to identify studies that reported the psychometric properties of generic and disease-specific PROMs in patients with varicose veins. Literature searches were conducted in databases including MEDLINE, up to July 2016. The psychometric criteria used to assess these studies were adapted from published recommendations in accordance with US Food and Drug Administration guidance.
Results
Nine studies were included which reported on aspects of the development and/or validation of one generic (36-Item Short Form Health Survey, SF-36®) and three disease-specific (Aberdeen Varicose Vein Questionnaire, AVVQ; Varicose Veins Symptoms Questionnaire, VVSymQ®; Specific Quality-of-life and Outcome Response – Venous, SQOR-V) PROMs. The evidence from included studies provided data to support the construct validity, test–retest reliability and responsiveness of the AVVQ. However, its content validity, including weighting of the AVVQ questions, was biased and based on the opinion of clinicians, and the instrument had poor acceptability. VVSymQ® displayed good responsiveness and acceptability rates. SF-36® was considered to have satisfactory responsiveness and internal consistency.
Conclusion
There is a scarcity of psychometric evidence for PROMs used in patients with varicose veins. These data suggest that AVVQ and SF-36® are the most rigorously evaluated PROMs in patients with varicose veins.
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Affiliation(s)
- A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Phillips
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Essat
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - H Buckley Woods
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Palfreyman
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - E Kaltenthaler
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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19
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Phillips P, Poku E, Essat M, Woods HB, Goka EA, Kaltenthaler EC, Shackley P, Walters S, Michaels JA. Systematic review of carotid artery procedures and the volume-outcome relationship in Europe. Br J Surg 2017. [PMID: 28632941 DOI: 10.1002/bjs.10593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospitals that conduct more procedures on the carotid arteries may achieve better outcomes. In the context of ongoing reconfiguration of UK vascular services, this systematic review was conducted to evaluate the relationship between the volume of carotid procedures and outcomes, including mortality and stroke. METHODS Searches of electronic databases identified studies that reported the effect of hospital or clinician volume on outcomes. Reference and citation searches were also performed. Inclusion was restricted to European populations on the basis that the model of healthcare delivery is similar across Europe, but differs from that in the USA and elsewhere. Analyses of hospital and clinician volume, and carotid endarterectomy (CEA) and carotid artery stenting (CAS) were conducted separately. RESULTS Eleven eligible studies were identified (233 411 participants), five from the UK, two from Sweden, one each from Germany, Finland and Italy, and a combined German, Austrian and Swiss population. All studies were observational. Two large studies (179 736 patients) suggested an inverse relationship between hospital volume and mortality (number needed to treat (NNT) as low as 165), and combined mortality and stroke (NNT as low as 93), following CEA. The evidence was less clear for CAS; multiple analyses in three studies did not identify convincing evidence of an association. Limited data are available on the relationship between clinician volume and outcome in CAS; in CEA, an inverse relationship was identified by two of three small studies. CONCLUSION The evidence from the largest and highest-quality studies included in this review support the centralization of CEA.
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Affiliation(s)
- P Phillips
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - E Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Essat
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - H B Woods
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E A Goka
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E C Kaltenthaler
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Shackley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J A Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Ahrens BJ, Li L, Ciminera AK, Chea J, Poku E, Bading JR, Weist MR, Miller MM, Colcher DM, Shively JE. Diagnostic PET Imaging of Mammary Microcalcifications Using 64Cu-DOTA-Alendronate in a Rat Model of Breast Cancer. J Nucl Med 2017; 58:1373-1379. [PMID: 28450564 DOI: 10.2967/jnumed.117.190850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022] Open
Abstract
The development of improved breast cancer screening methods is hindered by a lack of cancer-specific imaging agents and effective small-animal models to test them. The purpose of this study was to evaluate 64Cu-DOTA-alendronate as a mammary microcalcification-targeting PET imaging agent, using an ideal rat model. Our long-term goal is to develop 64Cu-DOTA-alendronate for the detection and noninvasive differentiation of malignant versus benign breast tumors with PET. Methods: DOTA-alendronate was synthesized, radiolabeled with 64Cu, and administered to normal or tumor-bearing aged, female, retired breeder Sprague-Dawley rats for PET imaging. Mammary tissues were subsequently labeled and imaged with light, confocal, and electron microscopy to verify microcalcification targeting specificity of DOTA-alendronate and elucidate the histologic and ultrastructural characteristics of the microcalcifications in different mammary tumor types. Tumor uptake, biodistribution, and dosimetry studies were performed to evaluate the efficacy and safety of 64Cu-DOTA-alendronate. Results:64Cu-DOTA-alendronate was radiolabeled with a 98% yield. PET imaging using aged, female, retired breeder rats showed specific binding of 64Cu-DOTA-alendronate in mammary glands and mammary tumors. The highest uptake of 64Cu-DOTA-alendronate was in malignant tumors and the lowest uptake in benign tumors and normal mammary tissue. Confocal analysis with carboxyfluorescein-alendronate confirmed the microcalcification binding specificity of alendronate derivatives. Biodistribution studies revealed tissue alendronate concentrations peaking within the first hour, then decreasing over the next 48 h. Our dosimetric analysis demonstrated a 64Cu effective dose within the acceptable range for clinical PET imaging agents and the potential for translation into human patients. Conclusion:64Cu-DOTA-alendronate is a promising PET imaging agent for the sensitive and specific detection of mammary tumors as well as the differentiation of malignant versus benign tumors based on absolute labeling uptake.
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Affiliation(s)
- Bradley J Ahrens
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California.,Division of Comparative Medicine, Beckman Research Institute of the City of Hope, Duarte, California.,Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, California
| | - Lin Li
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - Alexandra K Ciminera
- Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, California.,Department of Molecular Medicine, Beckman Research Institute of the City of Hope, Duarte, California
| | - Junie Chea
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - Erasmus Poku
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - James R Bading
- Department of Medical Oncology, City of Hope, Duarte, California; and
| | - Michael R Weist
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California.,Irell and Manella Graduate School of Biological Sciences, City of Hope, Duarte, California
| | - Marcia M Miller
- Department of Cell and Molecular Biology, Beckman Research Institute of the City of Hope, Duarte, California
| | - David M Colcher
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - John E Shively
- Deparment of Molecular Immunology, Beckman Research Institute of the City of Hope, Duarte, California
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Wong P, Li L, Chea J, Delgado MK, Crow D, Poku E, Szpikowska B, Bowles N, Channappa D, Colcher D, Wong JYC, Shively JE, Yazaki PJ. PET imaging of 64Cu-DOTA-scFv-anti-PSMA lipid nanoparticles (LNPs): Enhanced tumor targeting over anti-PSMA scFv or untargeted LNPs. Nucl Med Biol 2017; 47:62-68. [PMID: 28126683 DOI: 10.1016/j.nucmedbio.2017.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/24/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Single chain (scFv) antibodies are ideal targeting ligands due to their modular structure, high antigen specificity and affinity. These monovalent ligands display rapid tumor targeting but have limitations due to their fast urinary clearance. METHODS An anti-prostate membrane antigen (PSMA) scFv with a site-specific cysteine was expressed and evaluated in a prostate cancer xenograft model by Cu-64 PET imaging. To enhance tumor accumulation, the scFv-cys was conjugated to the co-polymer DSPE-PEG-maleimide that spontaneously assembled into a homogeneous multivalent lipid nanoparticle (LNP). RESULTS The targeted LNP exhibited a 2-fold increase in tumor uptake compared to the scFv alone using two different thiol ester chemistries. The anti-PSMA scFv-LNP exhibited a 1.6 fold increase in tumor targeting over the untargeted LNP. CONCLUSIONS The targeted anti-PSMA scFv-LNP showed enhanced tumor accumulation over the scFv alone or the untargeted DOTA-micelle providing evidence for the development of this system for drug delivery. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE Anti-tumor scFv antibody fragments have not achieved their therapeutic potential due to their fast blood clearance. Conjugation to an LNP enables multivalency to the tumor antigen as well as increased molecular size for chemotherapy drug delivery.
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Affiliation(s)
- Patty Wong
- Department of Radiation Oncology, City of Hope Medical Center, City of Hope, Duarte, CA, 91010-3000, USA
| | - Lin Li
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Junie Chea
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Melissa K Delgado
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Desiree Crow
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Erasmus Poku
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Barbara Szpikowska
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Nicole Bowles
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Divya Channappa
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - David Colcher
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope Medical Center, City of Hope, Duarte, CA, 91010-3000, USA
| | - John E Shively
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA
| | - Paul J Yazaki
- Department of Molecular Immunology, Beckman Research Institute, City of Hope, Duarte, CA, 91010-3000, USA.
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Phillips P, Poku E, Essat M, Woods H, Goka E, Kaltenthaler E, Walters S, Shackley P, Michaels J. Procedure Volume and the Association with Short-term Mortality Following Abdominal Aortic Aneurysm Repair in European Populations: A Systematic Review. Eur J Vasc Endovasc Surg 2017; 53:77-88. [DOI: 10.1016/j.ejvs.2016.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/10/2016] [Indexed: 01/03/2023]
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23
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Duncan R, Essat M, Jones G, Booth A, Buckley Woods H, Poku E, Kaltenthaler E, Keetharuth AD, Palfreyman S, Michaels J. Systematic review and qualitative evidence synthesis of patient-reported outcome measures for abdominal aortic aneurysm. Br J Surg 2016; 104:317-327. [PMID: 27935014 DOI: 10.1002/bjs.10407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/29/2016] [Accepted: 09/20/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim was to identify and evaluate existing patient-reported outcome measures (PROMs) for use in patients with an abdominal aortic aneurysm (AAA) to inform the selection for use in surgical practice. METHODS Two reviews were conducted: a systematic review to identify valid, reliable and acceptable PROMs for patients with an AAA, and a qualitative evidence synthesis to assess the relevance to patients of the identified PROM items. PROM studies were evaluated for their psychometric properties using established assessment criteria, and for their methodological quality using the COSMIN checklist. Qualitative studies were synthesized using framework analysis, and concepts identified were then triangulated using a protocol with the item concepts of the identified PROMs. RESULTS Four PROMs from three studies were identified in the first review: Short Form 36, Australian Vascular Quality of Life Index, Aneurysm Dependent Quality of Life (AneurysmDQoL) and Aneurysm Symptoms Rating Questionnaire (AneurysmSRQ). None of the identified PROMs had undergone a rigorous psychometric evaluation within the AAA population. Four studies were included in the qualitative synthesis, from which 28 concepts important to patients with an AAA were identified. The AneurysmDQoL and AneurysmSRQ together provided the most comprehensive assessment of these concepts. Fear of rupture, control, ability to forget about the condition and size of aneurysm were all concepts identified in the qualitative studies but not covered by items in the identified PROMs. CONCLUSION Further research is needed to develop PROMs for AAA that are reliable, valid and acceptable to patients.
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Affiliation(s)
- R Duncan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Essat
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Jones
- School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - H Buckley Woods
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Kaltenthaler
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Palfreyman
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Simpson E, Stevenson M, Scope A, Poku E, Minton J, Evans P. Echocardiography in newly diagnosed atrial fibrillation patients: a systematic review and economic evaluation. Health Technol Assess 2014; 17:1-263, v-vi. [PMID: 23985296 DOI: 10.3310/hta17360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the clinical effectiveness and cost-effectiveness of transthoracic echocardiography (TTE) in all patients who are newly diagnosed with atrial fibrillation (AF). DESIGN Narrative synthesis reviews were conducted on the prognostic and diagnostic accuracy of TTE for, and prevalence of, pathologies in patients with AF. Databases were searched from inception. MEDLINE searches were conducted from March to August 2010, and reference lists of articles checked. There were 44 diagnostic accuracy studies, five prognostic studies, and 16 prevalence studies accepted into the review. Given the complexity of the many pathologies identified by TTE, the variety of potential changes to clinical management, and paucity of data, the model focused on changes to oral anticoagulation (OAC). The mathematical model assessed the cost-effectiveness of TTE for patients with AF who were not routinely given OAC, assuming, if left atrial abnormality was detected, that the higher risk of stroke warranted OAC; this meant that patients with a CHADS2 (cardiac failure, hypertension, age, diabetes, stroke doubled) score of 0 [dabigatran etexilate (Pradaxa, Boehringer Ingelheim)/rivaroxaban (Xarelto, Bayer Schering)] or 0/1 (warfarin) were included. A simplified approach evaluated the additional quality-adjusted life-years (QALYs) required in order for TTE to be perceived as cost-effective at a threshold of £20,000 per QALY. SETTING Transthoracic echocardiography is usually performed in cardiology clinics but may be used in primary or non-specialist secondary care. PARTICIPANTS Patients with newly diagnosed AF. INTERVENTION Transthoracic echocardiography. MAIN OUTCOME MEASURES Prognosis, diagnostic sensitivity or specificity of TTE, prevalence of pathologies in patients with AF, cost-effectiveness and QALYs. RESULTS Prognostic studies indicated that TTE-diagnosed left ventricular dysfunction, increased left atrial diameter and valvular abnormality were significantly associated with an increased risk of stroke, mortality or thromboembolism. There was a high prevalence (around 25-30%) of ischaemic heart disease, valvular heart disease and heart failure in patients with AF. Diagnostic accuracy of TTE was high, with most pathologies having specificity of ≥ 0.8 and sensitivity of ≥ 0.6. The mathematical model predicted that when the CHADS2 tool is used the addition of TTE in identifying patients with left atrial abnormality appears to be cost-effective for informing some OAC decisions. In the simplified approach a threshold of 0.0033 was required for a TTE to be cost-effective. CONCLUSIONS When CHADS2 was used, the addition of TTE in identifying patients with left atrial abnormality was cost-effective for informing some OAC decisions. A simple analysis indicates that the number of QALYs required for TTE to be cost-effective is small, and that if benefits beyond those associated with a reduction in stroke are believed probable then TTE is likely to be cost-effective in all scenarios. Our findings suggest that further research would be useful, following up newly diagnosed patients with AF who have undergone TTE, to study treatments given as a result of TTE diagnoses and subsequent cardiovascular events. This could identify additional benefits of routine testing, beyond stroke prevention. Studies assessing the proportion of people with a CHADS2 score of 0 or 1 that have left atrial abnormality would provide better estimates of the cost-effectiveness of TTE, and allow more accurate estimates of the sensitivity and specificity of TTE for identifying left atrial abnormality in AF to be obtained. STUDY REGISTRATION PROSPERO CRD42011001354. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- El Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
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25
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Mortimer JE, Bading JR, Colcher DM, Conti PS, Frankel PH, Carroll MI, Tong S, Poku E, Miles JK, Shively JE, Raubitschek AA. Functional imaging of human epidermal growth factor receptor 2-positive metastatic breast cancer using (64)Cu-DOTA-trastuzumab PET. J Nucl Med 2013; 55:23-9. [PMID: 24337604 DOI: 10.2967/jnumed.113.122630] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
UNLABELLED Women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are candidates for treatment with the anti-HER2 antibody trastuzumab. Assessment of HER2 status in recurrent disease is usually made by core needle biopsy of a single lesion, which may not represent the larger tumor mass or other sites of disease. Our long-range goal is to develop PET of radiolabeled trastuzumab for systemically assessing tumor HER2 expression and identifying appropriate use of anti-HER2 therapies. The purpose of this study was to evaluate PET/CT of (64)Cu-DOTA-trastuzumab for detecting and measuring tumor uptake of trastuzumab in patients with HER2-positive metastatic breast cancer. METHODS Eight women with biopsy-confirmed HER2-positive metastatic breast cancer and no anti-HER2 therapy for 4 mo or longer underwent complete staging, including (18)F-FDG PET/CT. For 6 of the 8 patients, (64)Cu-DOTA-trastuzumab injection (364-512 MBq, 5 mg of trastuzumab) was preceded by trastuzumab infusion (45 mg). PET/CT (PET scan duration 1 h) was performed 21-25 (day 1) and 47-49 (day 2) h after (64)Cu-DOTA-trastuzumab injection. Scan fields of view were chosen on the basis of (18)F-FDG PET/CT. Tumor detection sensitivity and uptake analyses were limited to lesions identifiable on CT; lesions visualized relative to adjacent tissue on PET were considered PET-positive. Radiolabel uptake in prominent lesions was measured as maximum single-voxel standardized uptake value (SUVmax). RESULTS Liver uptake of (64)Cu was reduced approximately 75% with the 45-mg trastuzumab predose, without significant effect on tumor uptake. The study included 89 CT-positive lesions. Detection sensitivity was 77%, 89%, and 93% for day 1, day 2, and (18)F-FDG, respectively. On average, tumor uptake was similar for (64)Cu-DOTA-trastuzumab and (18)F-FDG (SUVmax and range, 8.1 and 3.0-22.5 for day 1 [n = 48]; 8.9 and 0.9-28.9 for day 2 [n = 38]; 9.7 and 3.3-25.4 for (18)F-FDG [n = 56]), but same-lesion SUVmax was not correlated between the 2 radiotracers. No toxicities were observed, and estimated radiation dose from (64)Cu-DOTA-trastuzumab was similar to (18)F-FDG. CONCLUSION (64)Cu-DOTA-trastuzumab visualizes HER2-positive metastatic breast cancer with high sensitivity and is effective in surveying disseminated disease. A 45-mg trastuzumab predose provides a (64)Cu-DOTA-trastuzumab biodistribution favorable for tumor imaging. (64)Cu-DOTA-trastuzumab PET/CT warrants further evaluation for assessing tumor HER2 expression and individualizing treatments that include trastuzumab.
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Affiliation(s)
- Joanne E Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
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Yazaki PJ, Lee B, Channappa D, Cheung CW, Crow D, Chea J, Poku E, Li L, Andersen JT, Sandlie I, Orcutt KD, Wittrup KD, Shively JE, Raubitschek A, Colcher D. A series of anti-CEA/anti-DOTA bispecific antibody formats evaluated for pre-targeting: comparison of tumor uptake and blood clearance. Protein Eng Des Sel 2012; 26:187-93. [PMID: 23175797 DOI: 10.1093/protein/gzs096] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A series of anti-tumor/anti-chelate bispecific antibody formats were developed for pre-targeted radioimmunotherapy. Based on the anti-carcinoembryonic antigen humanized hT84.66-M5A monoclonal antibody and the anti-DOTA C8.2.5 scFv antibody fragment, this cognate series of bispecific antibodies were radioiodinated to determine their tumor targeting, biodistribution and pharmacokinetic properties in a mouse xenograft tumor model. The in vivo biodistribution studies showed that all the bispecific antibodies exhibited specific high tumor uptake but the tumor targeting was approximately one-half of the parental anti-CEA mAb due to faster blood clearance. Serum stability and FcRn studies showed no apparent reason for the faster blood clearance. A dual radiolabel biodistribution study revealed that the (111)In-DOTA bispecific antibody had increased liver and spleen uptake, not seen for the (125)I-version due to metabolism and release of the radioiodine from the cells. These data suggest increased clearance of the antibody fusion formats by the mononuclear phagocyte system. Importantly, a pre-targeted study showed specific tumor uptake of (177)Lu-DOTA and a tumor : blood ratio of 199 : 1. This pre-targeted radiotherapeutic and substantial reduction in the radioactive exposure to the bone marrow should enhance the therapeutic potential of RIT.
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Affiliation(s)
- Paul J Yazaki
- Department of Cancer Immunotherapeutics & Tumor Immunology, Beckman Research Institute, City of Hope, Duarte, CA 91010, USA.
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Li L, Crow D, Turatti F, Bading JR, Anderson AL, Poku E, Yazaki PJ, Carmichael J, Leong D, Wheatcroft D, Raubitschek AA, Hudson PJ, Colcher D, Shively JE. Correction to “Site-Specific Conjugation of Monodispersed DOTA-PEGn to Thiolated Diabody Reveals Effect of Increasing Peg Size on Kidney Clearance and Tumor Uptake with Improved 64-Copper PET Imaging”. Bioconjug Chem 2011. [DOI: 10.1021/bc2002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Li L, Crow D, Turatti F, Bading JR, Anderson AL, Poku E, Yazaki PJ, Carmichael J, Leong D, Wheatcroft D, Wheatcroft MP, Raubitschek AA, Hudson PJ, Colcher D, Shively JE. Site-specific conjugation of monodispersed DOTA-PEGn to a thiolated diabody reveals the effect of increasing peg size on kidney clearance and tumor uptake with improved 64-copper PET imaging. Bioconjug Chem 2011; 22:709-16. [PMID: 21395337 DOI: 10.1021/bc100464e] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Optimal PET imaging of tumors with radiolabeled engineered antibodies requires, among other parameters, matching blood clearance and tumor uptake with the half-life of the engineered antibody. Although diabodies have favorable molecular sizes (50 kDa) for rapid blood clearance (t(1/2) = 30-60 min) and are bivalent, thereby increasing tumor uptake, they exhibit substantial kidney uptake as their major route of clearance, which is especially evident when they are labeled with the PET isotope (64)Cu (t(1/2) = 12 h). To overcome this drawback, diabodies may be conjugated to PEG, a modification that increases the apparent molecular size of the diabody and reduces kidney uptake without adversely affecting tumor uptake or the tumor to blood ratio. We show here that site-specific attachment of monodispersed PEGn of increasing molecular size (n = 12, 24, and 48) can uniformly increase the apparent molecular size of the PEG-diabody conjugate, decrease kidney uptake, and increase tumor uptake, the latter due to the increased residence time of the conjugate in the blood. Since the monodispersed PEGs were preconjugated to the chelator DOTA, the conjugates were able to bind radiometals such as (111)In and (64)Cu that can be used for SPECT and PET imaging, respectively. To allow conjugation of the DOTA-PEG to the diabody, the DOTA-PEG incorporated a terminal cysteine conjugated to a vinyl sulfone moiety. In order to control the conjugation chemistry, we have engineered a surface thiolated diabody that incorporates two cysteines per monomer (four per diabody). The thiolated diabody was expressed and purified from bacterial fermentation and only needs to be reduced prior to conjugation to the DOTA-PEGn-Cys-VS. This novel imaging agent (a diabody with DOTA-PEG48-Cys-VS attached to introduced thiols) gave up to 80%ID/g of tumor uptake with a tumor to blood ratio (T/B) of 8 at 24 h when radiolabeled with (111)In and 37.9% ID/g of tumor uptake (T/B = 8) at 44 h when radiolabeled with (64)Cu in PET imaging in an animal model. Tumor uptake was significantly improved from the 50% ID/g at 24 h observed with diabodies that were pegylated on surface lysine residues. Importantly, there was no loss of immunoreactivity of the site-specific Cys-conjugated diabody to its antigen (TAG-72) compared to the parent, unconjugated diabody. We propose that thiolated diabodies conjugated to DOTAylated monodisperse PEGs have the potential for superior SPECT and PET imaging in a clinical setting.
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Affiliation(s)
- Lin Li
- Department of Immunology, Beckman Research Institute of City of Hope , Duarte, California 91010, United States
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Li L, Turatti F, Crow D, Bading JR, Anderson AL, Poku E, Yazaki PJ, Williams LE, Tamvakis D, Sanders P, Leong D, Raubitschek A, Hudson PJ, Colcher D, Shively JE. Monodispersed DOTA-PEG-conjugated anti-TAG-72 diabody has low kidney uptake and high tumor-to-blood ratios resulting in improved 64Cu PET. J Nucl Med 2010; 51:1139-46. [PMID: 20554731 DOI: 10.2967/jnumed.109.074153] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Diabodies are noncovalent dimers of single-chain antibody fragments that retain the avidity of intact IgG but have more favorable blood clearance than intact IgG. Radiometals offer a wide range of half-lives and emissions for matching imaging and therapy requirements and provide facile labeling of chelate-antibody conjugates. However, because of their high retention and metabolism in the kidney, the use of radiometal-labeled diabodies can be problematic for both imaging and therapy. METHODS Having previously shown that (111)In-DOTA-polyethylene glycol (PEG)3400-anti-carcinoembryonic antigen diabody has less than half the kidney uptake and retention of non-PEGylated diabody and that the two have similarly high tumor uptake and retention, we synthesized a similar derivative for an anti-tumor-associated glycoprotein 72 diabody. We also reduced the molecular size of the polydispersed PEG3400 to monodispersed PEG27 and PEG12 (nominal masses of 1,321 and 617, respectively). We performed biodistributions of their DOTA conjugates radiolabeled with (125)I, (111)In, or (64)Cu in tumor-bearing athymic mice. RESULTS The addition of PEG3400 to the diabody reduced kidney uptake to a level (approximately 10 percentage injected dose/g) comparable to that obtained with radiometal-labeled intact IgG. The PEG27 and PEG12 diabody conjugates also demonstrated low kidney uptake without reduction of tumor uptake or tumor-to-blood ratios. When radiolabeled with (64)Cu, the DOTA-PEG12 and -PEG27 diabody conjugates gave high-contrast PET images of colon cancer xenografts in athymic mice. CONCLUSION PEGylated diabodies may be a valuable platform for delivery of radionuclides and other agents to tumors.
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Affiliation(s)
- Lin Li
- Department of Immunology, Beckman Research Institute of City of Hope, Duarte, California 91010, USA
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