Radiolabeled Monoclonal Antibody Against Colony-Stimulating Factor 1 Receptor Specifically Distributes to the Spleen and Liver in Immunocompetent Mice

Macrophages can promote tumor development. Preclinically, targeting macrophages by colony-stimulating factor 1 (CSF1)/CSF1 receptor (CSF1R) monoclonal antibodies (mAbs) enhances conventional therapeutics in combination treatments. The physiological distribution and tumor uptake of CSF1R mAbs are unknown. Therefore, we radiolabeled a murine CSF1R mAb and preclinically visualized its biodistribution by PET. CSF1R mAb was conjugated to N-succinyl-desferrioxamine (N-suc-DFO) and subsequently radiolabeled with zirconium-89 (89Zr). Optimal protein antibody dose was first determined in non-tumor-bearing mice to assess physiological distribution. Next, biodistribution of optimal protein dose and 89Zr-labeled isotype control was compared with PET and ex vivo biodistribution after 24 and 72 h in mammary tumor-bearing mice. Tissue autoradiography and immunohistochemistry determined radioactivity distribution and tissue macrophage presence, respectively. [89Zr]Zr-DFO-N-suc-CSF1R-mAb optimal protein dose was 10 mg/kg, with blood pool levels of 10 ± 2% injected dose per gram tissue (ID/g) and spleen and liver uptake of 17 ± 4 and 11 ± 4%ID/g at 72 h. In contrast, 0.4 mg/kg of [89Zr]Zr-DFO-N-suc-CSF1R mAb was eliminated from circulation within 24 h; spleen and liver uptake was 126 ± 44% and 34 ± 7%ID/g, respectively. Tumor-bearing mice showed higher uptake of [89Zr]Zr-DFO-N-suc-CSF1R-mAb in the liver, lymphoid tissues, duodenum, and ileum, but not in the tumor than did 89Zr-labeled control at 72 h. Immunohistochemistry and autoradiography showed that 89Zr was localized to macrophages within lymphoid tissues. Following [89Zr]Zr-DFO-N-suc-CSF1R-mAb administration, tumor macrophages were almost absent, whereas isotype-group tumors contained over 500 cells/mm2. We hypothesize that intratumoral macrophage depletion by [89Zr]Zr-DFO-N-suc-CSF1R-mAb precluded tumor uptake higher than 89Zr-labeled control. Translation of molecular imaging of macrophage-targeting therapeutics to humans may support macrophage-directed therapeutic development.

Abstract LB037: 89ZED88082A PET imaging to visualize CD8+ T cells in patients with cancer treated with immune checkpoint inhibitor

T cell enhancing immune checkpoint inhibitors (ICI) are effective across several tumor types in a subset of patients. Insights into systemic localization of cytotoxic CD8+ T cells might support early treatment decisions. To address this, we performed a PET imaging study with a zirconium-89 (89Zr) labeled one-armed CD8-specific antibody 89ZED88082A to assess tracer performance, safety, and pharmacokinetics (PK) before and during treatment. Here we report preliminary data on uptake in tumor lesions before ICI. Methods: Patients with locally advanced or metastatic solid tumors that may benefit from ICI are eligible. In part A (imaging before treatment) and part B (imaging before and during treatment), 37 MBq (1 mCi) 89ZED88082A is administered with unlabeled one-armed antibody CED88004S to vary total protein dose. PET images are acquired at up to 4 time points: 1 h, and days (d) 2, 4, 7 post-injection followed by a tumor biopsy for CD8 immunohistochemistry and autoradiography (NCT04029181). Subsequently, patients receive atezolizumab (NCT02478099) or standard of care nivolumab ± ipilimumab. Tumor and lymph node 89ZED88082A uptake are assessed as (geometric mean) maximum standard uptake value (SUVmax), in other organs as SUVmean. Serum 89ZED88082A/CED88004S levels are measured for PK. Tumor response is according to (i)RECIST1.1. Results: For pretreatment imaging results, 32 patients (9 part A, 23 part B) were evaluable; 3 received 4 mg total tracer protein dose, 29 received 10 mg. No tracer infusion-related reactions occurred. Here we show results on d2 PET imaging with 10 mg protein dose, which was considered optimal based on superior 89Zr blood pool activity, clinical feasibility and serum antibody PK with a half-life of 28.6 h. 89ZED88082A uptake was observed within 1 h in spleen, and strong d2 imaging signal was seen across lymphoid organs including spleen (\bar{x}$ SUVmean 47.2), lymph nodes (SUVmax 4.2), bone marrow (\bar{x}$ SUVmean 5.0), small bowel and Waldeyer's ring. 89ZED88082A tumor uptake was seen at all main metastatic organ sites (overall lesion SUVmax 5.5, range 0.6-30.9) and varied across patients (\bar{x}$ per patient SUVmax 5.4, IQR 3.8-7.4). Higher tumor uptake showed a trend with better response (p=0.059) and longer PFS (p=0.033). Tumor uptake was higher in patients with mismatch-repair deficient (dMMR) than MMR proficient tumors (SUVmax 9.3 vs 4.9, p<0.001). Tumors with immune desert vs CD8+ cell stromal/inflamed profile had a \bar{x}$ SUVmax of 4.7 vs 8.3 (p=0.042). In tumor biopsies, autoradiography signal and CD8 staining were linearly associated (p<0.001). Conclusion: 89ZED88082A PET imaging is safe and shows high uptake in normal lymphoid organs. Uptake in tumor lesions is heterogeneous within and between patients. Tumor uptake is higher pretreatment in dMMR tumors and correlated with patient outcome. 89ZED88082A uptake on PET and by autoradiography reflects CD8 expression in tumor biopsies.

Citation Format: Laura Kist de Ruijter, Pim P. van de Donk, Jahlisa S. Hooiveld-Noeken, Danique Giesen, Alexander Ungewickell, Bernard M. Fine, Simon P. Williams, Sandra M. Sanabria Bohorquez, Mahesh Yadav, Hartmut Koeppen, Jing Jing, Sebastian Guelman, Mark T. Lin, Michael J. Mamounas, Jeffrey Eastham, Patrick K. Kimes, Andor W. Glaudemans, Adrienne H. Brouwers, Marjolijn N. Lub-de Hooge, Jourik A. Gietema, Carolina P. Schröder, Wim Timens, Mathilde Jalving, Sjoerd Elias, Sjoukje F. Oosting, Derk J. de Groot, Elisabeth G. de Vries. 89ZED88082A PET imaging to visualize CD8+ T cells in patients with cancer treated with immune checkpoint inhibitor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB037.

Mesothelin/CD3 half-life extended bispecific T-cell engager molecule shows specific tumor uptake and distributes to mesothelin and CD3 expressing tissues

BiTE ® (bispecific T-cell engager) molecules exert antitumor activity by binding one arm to CD3 on cytotoxic T-cells and the other arm to a tumor-associated antigen. We generated a fully mouse cross-reactive mesothelin (MSLN)-targeted BiTE molecule that is genetically fused to a Fc-domain for half-life extension, and evaluated biodistribution and tumor targeting of a zirconium-89 (89Zr)-labeled MSLN HLE BiTE molecule in 4T1 breast cancer bearing syngeneic mice with positron emission tomography (PET). Biodistribution of 50 µg 89Zr-MLSN HLE BiTE was studied over time by PET imaging in BALB/c mice and revealed uptake in tumor and lymphoid tissues with an elimination half-life of 63.4 hours. Compared to a non-targeting 89Zr-control HLE BiTE, the 89Zr-MLSN HLE BiTE showed a 2-fold higher tumor uptake and higher uptake in lymphoid tissues. Uptake in the tumor colocalized with mesothelin expression, while uptake in the spleen colocalized with CD3 expression. Evaluation of the effect of protein doses on the biodistribution and tumor targeting of 89Zr-MSLN HLE BiTE revealed for all dose groups that uptake in the spleen was faster than in the tumor (day 1 vs day 5). The lowest dose of 10 µg 89Zr-MSLN HLE BiTE had higher spleen uptake and faster blood clearance compared to higher doses of 50 µg and 200 µg. 89Zr-MSLN HLE BiTE tumor uptake was similar at all doses. Conclusion: The MSLN HLE BiTE showed specific tumor uptake and both arms contributed to the biodistribution profile. These findings support the potential for clinical translation of HLE BiTE molecules.

Abstract 2769: PET imaging shows dose-dependent pharmacokinetics of a 89Zr-labeled mesothelin/CD3 half-life extended bispecific T-cell engager molecule in a syngeneic mouse model

BiTE® (bispecific T cell engager) immune therapy consists of two connected single-chain variable fragments, one targeting T-cells via CD3, and one targeting the tumor via a tumor-associated antigen. Given their short half-life, these molecules are administered by continuous intravenous (iv) infusion to ensure tumor accumulation. To extend plasma half-life, they are conjugated to an Fc domain, resulting in a molecule with an extended pharmacokinetic profile. To evaluate their biodistribution in a syngeneic mouse model, a molecule targeting murine mesothelin and murine CD3 (muMSLN HLE BiTE®), and a non-targeting control HLE BiTE® molecule were radiolabeled with the positron emission tomography (PET) isotope zirconium-89 (89Zr).

METHODS: The control and muMSLN HLE BiTE® were labeled with 89Zr. Immunocompetent BALB/c mice were engrafted in the lower mammary fat pad with mesothelin-positive murine mammary carcinoma cell line 4T1. PET imaging was performed at 1, 3, 5, 7 and 9 days after 50 µg 89Zr-muMSLN HLE BiTE® was administered by iv infusion (n = 8). Next, biodistribution of 10 µg (n = 6), 50 µg (n = 6) and 200 µg 89Zr-muMSLN HLE BiTE® (n = 5) and 50 µg 89Zr-control HLE BiTE® (n = 6) was compared via PET imaging on day 1, 3 and 5. PET-scans were quantified by mean standardized uptake value (SUVmean). Tracer injections were 4 MBq. To compare uptake in multiple groups, an analysis of variance followed by a post-hoc Tukey's multiple comparison test was performed. Values are expressed as mean ± standard deviation.

RESULTS: PET imaging following 50 µg 89Zr-muMSLN HLE BiTE® dosed iv revealed a blood elimination half-life of 63.4 hours. Uptake in tumor, spleen, thymus and liver were visible from 3 days post injection (pi). On day 5, tumor uptake was highest (SUVmean = 1.50 ± 0.2) with a tumor to blood ratio of 1.9 ± 0.3 and a spleen to blood of 1.7 ± 0.2. Heart SUVmean 5 days pi revealed that 10 μg 89Zr-muMSLN HLE cleared faster from the blood (0.5 ± 0.1) than the 50 μg (0.8 ± 0.1, P < 0.01) and the 200 μg dose group (0.8 ± 0.1, P < 0.01). Tumor SUVmean was higher in 50 µg (1.5 ± 0.2) than the 10 µg dose group (1.2 ± 0.1, P < 0.01), but similar to the 200 μg dose group (1.3 ± 0.1, P = 0.28). Spleen uptake 5 days pi was dose-dependent (SUVmean: 10 µg = 1.6 ± 0.2; 50 µg = 1.3 ± 0.1; 200 µg = 0.8 ± 0.1, P < 0.01). Spleen and tumor SUVmean 5 days pi of 50 µg 89Zr-muMSLN HLE BiTE® were higher than 50 µg 89Zr-control HLE BiTE® (spleen = 0.5 ± 0.1, P < 0.01; tumor = 0.8 ± 0.1, P < 0.01), while blood SUVmean of 50 µg 89Zr-control HLE BiTE® was similar (0.6 ± 0.1, P = 0.12).

CONCLUSION: PET imaging with a 89Zr-labeled muMSLN HLE BiTE® in a tumor-bearing syngeneic mouse model revealed a long blood half-life, specific uptake in tumor and spleen, and dose-dependent pharmacokinetics. Taken together, the HLE BiTE® molecule demonstrates an extended pharmacokinetic profile over previously evaluated small, canonical, BiTE® molecules.

Citation Format: Frans V. Suurs, Grit Lorenczewski, Julie M. Bailis, Sabine Stienen, Matthias Friedrich, Elisabeth G.E. de Vries, Derk Jan A. de Groot, Marjolijn N. Lub-de Hooge. PET imaging shows dose-dependent pharmacokinetics of a 89Zr-labeled mesothelin/CD3 half-life extended bispecific T-cell engager molecule in a syngeneic mouse model [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2769.

Abstract 1134: PET-imaging of 89Zr-labeled bispecific T-cell engagers in syngeneic tumor bearing mice

BACKGROUND Bispecific T-cell engagers (BiTE®) harness the immune system against cancer. BiTE® antibody constructs are small proteins of ~53 kDa existing of two connected single-chain variable fragments. MuS110, a BiTE® with affinity for murine CD3 (KD= 2.9 nM) and murine EpCAM (KD= 21 nM), was radiolabeled with positron emission tomography (PET) isotope zirconium-89 (89Zr) to study its pharmacokinetics and involvement of the immune system in an immunocompetent mouse model bearing a syngeneic tumor.

METHODS MuS110 and two control BiTE® antibody constructs (hyS110 and AMG110) were radiolabeled with 89Zr. HyS110 has affinity for murine CD3 and human EpCAM, AMG110 for human CD3 and human EpCAM. The human and murine variants of EpCAM and CD3 are not cross-reactive. Either immunocompetent BALB/c or immunodeficient nude BALB/c mice were all orthotopically engrafted in the lower mammary fat pad with EpCAM-positive murine breast cancer cell line 4T1. PET-imaging was performed at 0.5, 3, 6, 24, 48 and 72 h after intravenous (iv) administration of 10 µg 89Zr-muS110. Distribution of 10 µg 89Zr-muS110, 89Zr-hyS110 and 89Zr-AMG110 was assessed 24 h after administration in BALB/c and nude BALB/c mice with PET-imaging and ex-vivo biodistribution. In addition, a group of BALB/c mice received 10 µg muS110 iv daily for 5 days followed by 10 µg 89Zr-muS110 or 10 µg 89Zr-AMG110 and PET-imaging 24 h after tracer administration. Values are expressed as median (interquartile range).

RESULTS PET-imaging revealed fast renal clearance of 89Zr-muS110 in the BALB/c mice resulting in a blood half-life of 0.93 h (one-phase decay). Tumor- and spleen-to-blood ratios increased to 3.7 (3.0 to 4.5) and 9.3 (7.5 to 11.1) after 72 h. Ex-vivo biodistribution 24 h after tracer administration showed 89Zr-muS110 and 89Zr-hyS110 accumulation in the spleen with 8.2 % injected dose per gram (ID/g) and 8.7 %ID/g, in comparison to 89Zr-AMG110 (2.3 %ID/g; vs 89Zr-muS110 P<0.05, vs 89Zr-hyS110 P<0.05). In mesenteric lymph nodes (mesLNs), 89Zr-muS110 and 89Zr-hyS110 resulted in a higher uptake (3.5 and 6.4 %ID/g) than 89Zr-AMG110 (2.0 %ID/g; vs 89Zr-muS110 P<0.05, vs 89Zr-hyS110 P<0.05). Tumor uptake did not differ for 89Zr-muS110 and 89Zr-AMG110 (2.6 vs 2.2 %ID/g, P>0.05). In nude BALB/c mice spleen and mesLN uptake of 89Zr-muS110 was lower than in BALB/c mice (spleen: 3.4 vs 8.2 %ID/g, P<0.05; mesLNs: 1.7 vs 3.5, P<0.05). In addition, in nude BALB/c mice, tumor uptake was the same for 89Zr-muS110 and 89Zr-AMG110 (1.5 vs 1.7 %ID/g, P>0.05). 89Zr-muS110 uptake was lower in spleen and mesLNs following 5 days of 10 µg muS110 iv compared to control mice

(spleen: 4.2 vs 8.2 %ID/g, P<0.01; mesLNs: 1.9 vs 3.5, P<0.01), likely representing target saturation.

CONCLUSION Distribution of BiTE® 89Zr-muS110 is predominantly mediated by the affinity for CD3, resulting in uptake in lymphoid tissues.

Citation Format: Frans V. Suurs, Derk J. de Groot, Urszula M. Domanska, Grit Lorenczewski, Sabine Stienen, Matthias Friedrich, Elisabeth G. de Vries, Marjolijn N. Lub-de Hooge. PET-imaging of 89Zr-labeled bispecific T-cell engagers in syngeneic tumor bearing mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1134.

Comparative biodistribution analysis across four different 89Zr-monoclonal antibody tracers-The first step towards an imaging warehouse

Rationale: Knowledge on monoclonal antibody biodistribution in healthy tissues in humans can support clinical drug development. Molecular imaging with positron emission tomography (PET) can yield information in this setting. However, recent imaging studies have analyzed the behavior of single antibodies only, neglecting comparison across different antibodies. Methods: We compared the distribution of four ⁸⁹Zr-labeled antibodies in healthy tissue in a retrospective analysis based on the recently published harmonization protocol for ⁸⁹Zr-tracers and our delineation protocol. Results: The biodistribution patterns of ⁸⁹Zr-lumretuzumab, ⁸⁹Zr-MMOT0530A, ⁸⁹Zr-bevacizumab and ⁸⁹Zr-trastuzumab on day 4 after tracer injection were largely similar. The highest tracer concentration was seen in healthy liver, spleen, kidney and intestines. About one-third of the injected tracer dose was found in the circulation, up to 15% in the liver and only 4% in the spleen and kidney. Lower tracer concentration was seen in bone marrow, lung, compact bone, muscle, fat and the brain. Despite low tracer accumulation per gram of tissue, large-volume tissues, especially fat, can influence overall distribution: On average, 5-7% of the injected tracer dose accumulated in fat, with a peak of 19% in a patient with morbid obesity. Conclusion: The similar biodistribution of the four antibodies is probably based on their similar molecular structure, binding characteristics and similar metabolic pathways. These data provide a basis for a prospectively growing, online accessible warehouse of molecular imaging data, which enables researchers to increase and exchange knowledge on whole body drug distribution and potentially supports drug development decisions.

Abstract 3035: 89Zr-labeled anti-PD-L1 Probody therapeutic CX-072 biodistribution in mice bearing human xenograft or murine syngeneic tumors

BACKGROUND Immune checkpoint inhibiting antibodies have antitumor activity across several tumor types, but are not effective in all patients and can elicit side effects. CX-072, a fully human Probody™ therapeutic currently in a phase 1/2 clinical trial, is reactive to the murine and human programmed cell death-ligand 1 (PD-L1) immune checkpoint. Probody therapeutics are engineered antibodies with target-binding region blocking masking peptides, which can be preferentially cleaved by tumor-associated proteases, yielding fully active antibodies. CX-072 may thus preserve anti-tumor efficacy, while limiting side effects. We radiolabeled CX-072 with the positron emission tomography (PET) isotope zirconium-89 (89Zr) to reveal its tumor targeting properties and whole body distribution using non-invasive PET imaging.

METHODS CX-072 and a non-specific Probody therapeutic control (PbCtrl) were radiolabeled with 89Zr. For in vivo studies, PD-L1 expressing MDA-MB-231 human breast cancer cells were subcutaneously (sc) engrafted in Balb/c nude mice. To assess tracer protein dose dependency of the tumor uptake, mice received 10 μg 89Zr-CX-072 or 89Zr-PbCtrl (~5 MBq) supplemented with 0, 40 or 240 µg of unlabeled CX-072 or PbCtrl. To evaluate 89Zr-CX-072 biodistribution in an immune-competent setting, C57BL6 mice were implanted sc with low PD-L1 expressing MC38 syngeneic murine colon adenocarcinoma cells. All mice underwent serial in vivo PET imaging 1, 3 and 6 days post injection (pi), quantified by mean standardized uptake value (SUVmean) and followed by ex vivo biodistribution. Activated Probody species in tissues were detected by Western capillary electrophoresis.

RESULTS PET imaging revealed increasing 89Zr-CX-072 tumor accumulation between 1-6 days pi, with the highest SUVmean of 1.5 (± 0.2) observed for 10 µg at 6 days pi. Ex vivo biodistribution analysis showed 8.7 % injected dose per gram (%ID/g) tumor uptake for 10 µg 89Zr-CX-072 versus 3.8 %ID/g for 10 µg 89Zr-PbCtrl (P<0.01) in MDA-MB-231 xenografted mice. In the syngeneic MC38 model biodistribution analysis showed modest tumor uptake for 10 μg 89Zr-CX-072 and 89Zr-PbCtrl (6.5 vs 5.5 %ID/g, P=0.24; tumor-to-blood ratio of 0.61 vs 0.45, P<0.05). 89Zr-CX-072 uptake in lymphoid tissues (spleen, lymph nodes) was similar to 89Zr-PbCtrl. Activated Probody species were predominantly detected in tumor with lesser amounts present in lymphoid tissues.

CONCLUSION 89Zr-CX-072 accumulates more in PD-L1-expressing tumor tissues than in lymphoid tissues. A sub-study of an ongoing clinical study (PROCLAIM-CX-072) is designed to validate study drug distribution in patients using a good manufacturing practice (GMP) quality 89Zr-CX-072 tracer.

Citation Format: Danique Giesen, Linda N. Broer, Marjolijn N. Lub-de Hooge, Irina Popova, Bruce Howng, Olga Vasiljeva, Elisabeth G. de Vries, Martin Pool. 89Zr-labeled anti-PD-L1 Probody therapeutic CX-072 biodistribution in mice bearing human xenograft or murine syngeneic tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3035.

Abstract 3028: PET imaging with the bispecific 89Zr-antibody ERY974 targeting CD3 and glypican 3 in tumor-bearing mouse models

BACKGROUND: ERY974, a modified monoclonal IgG4 bispecific antibody directed against human CD3 on T cells and glypican 3 (GPC3) on tumor cell, is currently in phase I clinical trial. The oncofetal protein GPC3 is overexpressed in several tumor types. Radiolabeling ERY974 with positron emission tomography (PET) isotope zirconium-89 (89Zr) enables non-invasive molecular imaging of tumor targeting and whole-body distribution. We aimed to evaluate 89Zr-ERY974 tumor targeting and effect of T cells on tumor uptake in mouse models, including a humanized mouse model.

METHODS: ERY974 and two control molecules namely bispecific CD3xkeyhole limpet hemocyanin (KLH) and KLHxKLH antibodies were radiolabeled with 89Zr. Studies were performed in immunodeficient NOD/Shi-SCID/IL-2Rgnull (NOG) as well as human CD34+ hematopoietic stem cell engrafted NOG mice (huNOG), all subcutaneously inoculated with GPC3 overexpressing human hepatocellular carcinoma HepG2 cells. Mice received 10 µg 89Zr-ERY974, 89Zr-CD3xKLH or 89Zr-KLHxKLH intravenously, with subsequent µPET scanning at 24, 72, 120 and 168 h followed by ex vivo biodistribution. Organs of interest were quantified on µPET scans as mean standardized uptake value (SUVmean) and with ex vivo biodistribution as % injected dose/gram of tissue (%ID/g). Tumor, spleen and lymph nodes were analyzed with autoradiography and immunohistochemical CD3 staining.

RESULTS: µPET imaging revealed increased tumor-to-blood ratio (TBR) of 89Zr-ERY974 in NOG over time with maximal TBR of 2.2±0.3 at 168 h post tracer injection (pi). At 168 h, tumor uptake was specific as 89Zr-CD3xKLH and 89Zr-KLHxKLH showed a TBR of only 0.6±0.2 and 0.8±0.3, respectively. In huNOG mice human CD3+ T cells were present in tumor, spleen and lymph nodes. In huNOG mice tumor uptake of 89Zr-ERY974 was higher than in NOG mice as measured on µPET scans (SUVmean at 168 h pi 6.9±2.6 vs 2.9±0.2; P<0.01) and with ex vivo biodistribution (60.9±26.2 %ID/g vs 16.7±2.3 %ID/g; P<0.001), whereas 89Zr-CD3xKLH tumor uptake in both mouse models was lower (P<0.05) but were similar in these mouse models. Autoradiography 168 h following 89Zr-ERY974 administration to huNOG mice showed 89Zr in extensive T cell infiltrate areas in the tumors of huNOG mice, whereas T cell infiltrate was lower in tumors of 89Zr-CD3xKLH and 89Zr-KLHxKLH injected huNOG mice. Spleens of huNOG mice showed CD3+ specific uptake as 89Zr-ERY974 and 89Zr-CD3xKLH uptake were higher than 89Zr-KLHxKLH uptake(P<0.05), whereas spleen uptake in NOG mice of the 3 tracers was similar. Moreover, in huNOG CD3+ mesenteric lymph nodes 89Zr-ERY974 uptake was higher than 89Zr-KLHxKLH uptake (P<0.05)

CONCLUSION: 89Zr-ERY974 demonstrates specific tumor uptake in NOG and huNOG mice, while in huNOG mice tumor uptake colocalized with T cell rich infiltrate and also uptake in in spleen and lymph nodes was observed.

Citation Format: Stijn J. Waaijer, Danique Giesen, Takahiro Ishiguro, Yuji Sano, Norihisa Ohishi, Athos Gianella-Borradori, Carolien P. Schröder, Elisabeth G. de Vries, Marjolijn N. Lub-de Hooge. PET imaging with the bispecific 89Zr-antibody ERY974 targeting CD3 and glypican 3 in tumor-bearing mouse models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3028.

Harnessing Integrative Omics to Facilitate Molecular Imaging of the Human Epidermal Growth Factor Receptor Family for Precision Medicine

Cancer is a growing problem worldwide. The cause of death in cancer patients is often due to treatment-resistant metastatic disease. Many molecularly targeted anticancer drugs have been developed against 'oncogenic driver' pathways. However, these treatments are usually only effective in properly selected patients. Resistance to molecularly targeted drugs through selective pressure on acquired mutations or molecular rewiring can hinder their effectiveness. This review summarizes how molecular imaging techniques can potentially facilitate the optimal implementation of targeted agents. Using the human epidermal growth factor receptor (HER) family as a model in (pre)clinical studies, we illustrate how molecular imaging may be employed to characterize whole body target expression as well as monitor drug effectiveness and the emergence of tumor resistance. We further discuss how an integrative omics discovery platform could guide the selection of 'effect sensors' - new molecular imaging targets - which are dynamic markers that indicate treatment effectiveness or resistance.

Abstract 4208: Development of 18F-IL2: a PET radiotracer for imaging activated T-cells

Introduction: Activation of T-cells is accompanied by a strong up-regulation of interleukin-2 (IL2) receptor (CD25). Therefore PET imaging of IL2 receptors might be a suitable imaging biomarker for T-cell activation. 18F-IL2 PET could detect CD25-positive T-cells and the migration of these T-cells to distant sites of inflammation in SCID mice subcutaneously injected with human peripheral blood mononuclear cells1 and NOD mice with insulitis. Also a strong correlation was found between the accumulation of 18F-IL2 and the number of injected activated T-cells in immune-competent rats.2 In tumor bearing mice, 18F-IL2 PET could detect treatment-induced accumulation of activated T-cells in the tumor following local radiotherapy and/or vaccination.

Cancer immunotherapy is increasingly obtaining a place in clinical practice. However not all patients benefit. A biomarker for upfront or early response prediction for these immunotherapies might support patient selection before and during therapy. Potentially 18F-IL2 PET might serve this purpose. Therefore we aimed to accommodate the production of 18F-IL2 for use in clinical imaging studies.

Material and methods: In order to produce a GMP-compliant tracer the production is being implemented on the Eckert & Ziegler PharmTracer synthesis module. In this synthesis module, disposable cassettes, reactors and vials are used to avoid cross-contamination between productions. First the prosthetic group N-succinimidyl 4-fluorobenzoate (18F-SFB) is produced in 3 steps from cyclotron-produced 18F-fluoride. Subsequently, 18F-SFB is conjugated to human recombinant IL2 (Proleukin®). Various methods for synthesis and purification of 18F-SFB have been evaluated. Also purification of 18F-IL2 has been optimized. Quality control has been performed using ultra performance liquid chromatography (UPLC) and Thin Layer Chromatography (TLC).

Results: 18F-SFB was successfully synthesized with the Eckert & Ziegler PharmTracer synthesis module with decay-corrected radiochemical yields comparable to literature (range 28-64%). Major challenges have been encountered, most importantly regarding the purification of the 18F-SFB and 18F-IL2, stability of the IL2 and specific activity. The activated ester 18F-SFB was purified by high performance liquid chromatography (HPLC) to remove any impurities that could interfere with the conjugation. 18F-IL2 has been purified using PD-10 columns with PBS containing 0.05% SDS as mobile phase.

Conclusions: Several challenges for the GMP-compliant production of 18F-IL2 have been overcome. In the near future this tracer will be used in preclinical and clinical studies to non-invasively image activated T-cells before and during cancer immunotherapy. This can provide insight in the effects of cancer immunotherapy on the immune response.

References:

1. Di Gialleonardo V, et al. J Nucl Med.2012;53(5):679-86.

2. Di Gialleonardo V, et al. Eur J Nucl Med Mol Imaging.2012;39(10):1551-60.

Citation Format: Elly L. van der Veen, Petra Maarsingh, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Geke A.P. Hospers, Erik F.J. de Vries, Elisabeth G.E. de Vries. Development of 18F-IL2: a PET radiotracer for imaging activated T-cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4208.

Abstract LB-B11: Assessment of HER3 status during lapatinib treatment in HER3-positive breast cancer using 89Zr-anti-HER3 mAb

Treatment of human epidermal growth factor receptor 2 (HER2)-driven breast cancer with the HER-targeting tyrosine kinase inhibitor lapatinib can lead to a rapid compensatory increase in expression, signaling activity and relocalization of HER3 to the plasma membrane, which may attenuate the response to lapatinib. This might imply a potential role for a more dynamic assessment of HER3 tumor status using molecular imaging techniques, such as positron emission tomography (PET), instead of immunohistochemical HER3 staining on tumor biopsies. Here, we explored the feasibility of a dynamic assessment of HER3 status during lapatinib treatment in human breast cancer xenografts using zirconium-89 labeled anti-human HER3 monoclonal antibody (mAb) as a potential tracer for animal PET imaging.

The anti-human HER3 mouse mAb MAB3481 was used for all experiments. The effect of lapatinib treatment on HER3 expression and HER3 mAb internalization in human breast cancer cell lines SKBR3 and BT474 was determined using flow cytometry. Biodistribution was performed using 89Zr-anti-HER3 mAb in mice bearing BT474 or SKBR3 tumors. Mice received daily vehicle or a lapatinib dose of 25, 50 or 100 mg/kg orally. A tracer dose of 89Zr-anti-HER3 mAb combined with the aspecific tracer 111In-IgG was injected 3 days after treatment. Ex vivo organ distribution assessment of 89Zr-anti-HER3 mAb was performed 6 days after tracer injection. Ex vivo tumor analysis using western blotting, ELISA and immunohistochemistry were performed to measure HER3 levels.

In vitro, lapatinib treatment resulted in a ∼2-fold increase in membranous HER3 expression and HER3 internalization in SKBR3 and BT474 tumor cells. 89Zr-anti-HER3 mAb tumor uptake was significantly higher compared to 111In-IgG uptake in BT474 (P < 0.01), demonstrating HER3 specific tumor uptake. SKBR3 xenografts did not show HER3 specific uptake, which was likely caused by the poor viability of the tumors. HER3 upregulation was observed in BT474 xenografts after lapatinib treatment for 9 days. The enhanced HER3 expression was related to a 76 ± 9% increase in 89Zr-anti-HER3 mAb tumor uptake at 25 mg/kg and 92 ± 27% at 50 mg/kg lapatinib. Lapatinib at the highest concentration (100 mg/kg) strongly inhibited tumor growth and did not increase tumor uptake of the tracer.

In conclusion, HER3-specific uptake of 89Zr-anti-HER3 mAb was shown in breast cancer xenografts. HER3 upregulation after lapatinib treatment was related to an enhanced 89Zr-anti-HER3 mAb uptake in these xenografts. These promising data warrant future dynamic assessment of HER3 status with 89Zr-anti-HER3 mAb PET imaging.

Citation Format: Arjan Kol, Martin Pool, Steven de Jong, Elisabeth GE de Vries, Marjolijn N. Lub-de Hooge, Anton GT Terwisscha van Scheltinga. Assessment of HER3 status during lapatinib treatment in HER3-positive breast cancer using 89Zr-anti-HER3 mAb. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr LB-B11.

Abstract A86: Extracellular domain shedding influences specific tumor uptake and kinetics of EGFR PET tracer 89Zr-imgatuzumab

Background

Overexpression and mutations of epidermal growth factor receptor (EGFR) are associated with tumor cell growth, differentiation, proliferation, apoptosis and cellular invasiveness. Imgatuzumab is a novel EGFR monoclonal antibody (mAb), glycoengineered for enhanced antibody-dependent cellular cytotoxicity. Molecular imaging using radiolabeled mAbs can potentially support decision making during (pre)clinical development and clinical practice. However, preclinical EGFR imaging studies revealed a mismatch between in vivo EGFR expression levels and tumor tracer uptake. Factors suggested causing the mismatch include differences in perfusion rates, vascularity, vascular permeability, interstitial pressure and mAb plasma half-life. Another factor that might influence tracer kinetics is shed EGFR (sEGFR) extracellular domain (ECD), which is found in sera of cancer patients with EGFR expressing tumors. We radiolabeled imgatuzumab with zirconium-89 (89Zr) and determined the influence of sEGFR on 89Zr-imgatuzumab tracer kinetics and tumor uptake in xenograft models.

Methods

Imgatuzumab was conjugated to N-Suc-desferal and radiolabeled with 89Zr. MicroPET imaging was performed 24, 72 and 144 hours post injection of 10, 25 and 160 μg 89Zr-imgatuzumab (5 MBq). As a non-specific control, 111In-DTPA-IgG (1 MBq) was used in equal doses in the same animals. Imaging studies were performed in A431 (human epidermoid carcinoma, EGFR overexpressing) and A549 and H441 (both human non-small cell lung cancer, medium EGFR expressing) subcutaneous xenograft bearing mice. Ex vivo biodistribution analysis was performed after the last scan. sEGFR levels in liver lysates and plasma were obtained using a human EGFR ECD ELISA assay.

Results

Increasing 89Zr-imgatuzumab dose from 10 to 160 μg enhanced tumor uptake in A431 bearing mice from 8.7 ± 3.1 to 31.4 ± 11.6% ID/g. On contrary, dose escalation between 10 and 160 μg 89Zr-imgatuzumab lowered tumor uptake from 13.8 ± 5.9 to 6.7 ± 0.8% ID/g in A549 and from 27.6 ± 3.6 to 15.5 ± 3.2% ID/g in H441 bearing mice. High liver uptake of 22.0 ± 5.4% ID/g was observed in A431 tumors at 10 μg 89Zr-imgatuzumab, this was higher than A549 (7.4 ± 1.5% ID/g, p<0.0001) and H441 (8.4 ± 2.1% ID/g, p<0.001) bearing mice. Liver uptake in A431 bearing mice could be blocked with 160 μg 89Zr-imgatuzumab to 7.1 ± 1.6% ID/g. Human EGFR ECD ELISA showed presence of 790 ± 267 ng/g protein sEGFR in liver lysates and 831 ± 173 ng/ml in plasma of A431 bearing mice, while sEGFR levels in liver and plasma of A549 and H441 tumor bearing mice were comparable to non tumor bearing control mice.

Conclusion

89Zr-imgatuzumab effectively accumulates in EGFR expressing tumors. A431 tumors extensively shedded EGFR, which highly influenced 89Zr-imgatuzumab kinetics in A431 bearing mice. These results support the use of shed antigen measurements and subsequent tracer dose adjustment in future EGFR imaging studies.

Citation Format: Martin Pool, Arjan Kol, Marjolijn N. Lub-de Hooge, Christian A. Gerdes, Steven de Jong, Elisabeth G.E. de Vries, Anton G.T. Terwisscha van Scheltinga. Extracellular domain shedding influences specific tumor uptake and kinetics of EGFR PET tracer 89Zr-imgatuzumab. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr A86.

Antibody Positron Emission Tomography Imaging in Anticancer Drug Development

More than 50 monoclonal antibodies (mAbs), including several antibody–drug conjugates, are in advanced clinical development, forming an important part of the many molecularly targeted anticancer therapeutics currently in development. Drug development is a relatively slow and expensive process, limiting the number of drugs that can be brought into late-stage trials. Development decisions could benefit from quantitative biomarkers, enabling visualization of the tissue distribution of (potentially modified) therapeutic mAbs to confirm effective whole-body target expression, engagement, and modulation and to evaluate heterogeneity across lesions and patients. Such biomarkers may be realized with positron emission tomography imaging of radioactively labeled antibodies, a process called immunoPET. This approach could potentially increase the power and value of early trials by improving patient selection, optimizing dose and schedule, and rationalizing observed drug responses. In this review, we summarize the available literature and the status of clinical trials regarding the potential of immunoPET during early anticancer drug development.

89zr-GC1008 PET imaging and GC1008 treatment of recurrent glioma patients

2050

Background: Transforming growth factor-β (TGF-β) signaling is involved in glioma development. GC1008 is a monoclonal antibody that has demonstrated significant neutralization of all mammalian isoforms of TGF-β in preclinical models (Lonning, Curr Pharm Biotechnol 2011). The aim of this study was to investigate whether GC1008 uptake in brain tumors can be visualized using the 89Zirkonium (Zr)-GC1008 PET scan and to assess treatment outcome in patients with recurrent glioma treated with GC1008 (NCT01472731). Methods: Patients with WHO II-IV glioma who presented with recurrent disease were eligible. After iv administration of 37 MBq (5 mg) 89Zr-GC1008, 89Zr-GC1008 PET scans were performed on day 2 and day 4 post injection. Thereafter, patients were treated with 5 mg/kg GC1008 iv every 3 weeks. MRI scans were made for response evaluation after 3 courses or as clinically indicated. Results: Twelve patients with 1st-8th recurrent disease were included (10 glioblastoma, 1 anaplastic oligodendroglioma, 1 anaplastic astrocytoma), all underwent an 89Zr-GC1008 PET scan on day 4, 4 patients also underwent a PET scan on day 2 after tracer injection. Median SUVmax on day 4 was in tumor lesions 4.6 (range 1.5-13.9) and median SUVmean in normal brain tissue 0.3 (range 0.2-0.5). In 3 out of 4 patients who underwent a day 2 and day 4 whole body scan uptake decreased in most normal organs but not in tumor lesions, supporting tumor specific 89Zr-GC1008 uptake. No major toxicity of GC1008 treatment was observed, but all patients showed clinical and/or radiological progressive disease after 1-3 cycles. Median progression free survival was 61 days (range 25-80) and median overall survival 106 days (range 37-287+). Conclusions: 89Zr-GC1008 showed excellent uptake by recurrent gliomas. Clinical benefit of GC1008 treatment was not observed in this limited study population. Clinical trial information: 01472731.

Abstract 2659: Imaging human pancreatic tumor xenografts with 89Zr-labeled anti-mesothelin antibody

Background: Mesothelin (MSLN) is a tumor differentiation antigen that is highly expressed by cells of many epithelial tumors, with limited expression in normal human tissues. Our understanding of therapeutic antibodies targeting MSLN might benefit from immunoPET imaging of antibody uptake. We developed and preclinically validated an 89Zr labeled anti-MSLN antibody (“89Zr-AMA”) for this noninvasive imaging of tumor and normal organ uptake.

Methods: 89Zr was attached to an anti-MSLN humanized IgG1 monoclonal antibody derivatized with the bifunctional chelator reagent N-succinyldesferrioxamine-B-tetrafluorphenol. The 89Zr-AMA was characterized in terms of conjugation ratio, aggregation, radiochemical purity, stability, and immunoreactivity. Two human MSLN-expressing pancreatic tumor cell lines, HPAC and CAPAN-2, were used for xenograft studies in mice. Tumor uptake and organ distribution of 89Zr-AMA were studied in the HPAC line at three protein doses (10, 25 and 100 μg) labeled with 1 MBq 89Zr and results were compared with nonspecific 111In-IgG. After dose-finding, CAPAN-2 and HPAC tumor xenograft-bearing mice were scanned with μPET at 1, 3, and 6 days after tracer injection of the optimal AMA dose labeled with 5 MBq 89Zr, followed by ex vivo biodistribution at day 6. Tracer uptake was quantified and expressed as mean standardized uptake values (SUVmean).

Results: 89Zr-AMA formed with high specific activity (> 500 MBq/mg), high yield (> 90% without further purification), and high purity (> 95% determined by SE-HPLC analysis). In vitro validation of 89Zr-AMA showed a fully preserved immunoreactivity with a long (> 1 week) stability in 0.9% NaCl. Biodistribution analyses of the dose-finding groups revealed a dose-dependent 89Zr-AMA tumor uptake, with the highest fractional tumor uptake in the 10 μg dose group, 14.2 %ID/g on day 6. Tumor uptake of the non-specific control antibody, 111In-IgG, was lower than that of the 89Zr-AMA (P < 0.05, paired t test). Day 6 89Zr-AMA biodistribution data from the animals that underwent μPET showed ex vivo tumor uptake of 12.0 %ID/g in HPAC and 11.8 %ID/g in CAPAN-2 tumors and 4.6 and 4.4 %ID/g in blood. Uptake of the nonspecific control 111In-IgG was 5.7 %ID/g for HPAC and 3.6 %ID/g for CAPAN-2 tumors, and 10.0 and 7.5 %ID/g for their respective blood pools. MicroPET imaging was consistent with the biodistribution data. 89Zr-AMA showed a progressive increase in tumor uptake over time, whereas the activity in the blood pool decreased; in liver, spleen and kidney it remained stable.

Conclusion: 89Zr-AMA tumor uptake is antigen-specific in MSLN-expressing tumors. This tracer can be translated to the clinic for serial non-invasive PET imaging.

Citation Format: Eva J. ter Weele, Marjolijn N. Lub-de Hooge, Daniel Maslyar, Anton G.T. Terwisscha van Scheltinga, Jos G.W. Kosterink, Elisabeth G.E. de Vries, Simon P. Williams. Imaging human pancreatic tumor xenografts with 89Zr-labeled anti-mesothelin antibody. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2659. doi:10.1158/1538-7445.AM2013-2659

Abstract 2664: Next generation PET imaging agents: The development of radiolabeled c-Met specific Anticalin 89Zr-PRS-110 with diagnostic and therapeutic drug monitoring applications

The oncogene c-Met is a clinically validated target having been shown to be involved in tumorigenesis. Imaging agents capable of quantifying c-Met expression in human tumors would be a valuable tool for aiding diagnosis, drug scheduling and monitoring the response to targeted therapies. Anticalins are a novel class of biopharmaceuticals based on the human lipocalin scaffold with many properties which make them desirable imaging agents including their smaller size and ease of manufacturing when compared to antibodies. PRS-110 is a c-Met specific anticalin which is being developed as a therapeutic and imaging modality. The aim of this study was to evaluate the utility of the c-Met anticalin as a positron emission tomography (PET) imaging agent and analyze its biodistribution in human tumor bearing mice.

Methods: A zirconium-89 (89Zr) labeled version of PRS-110 was generated and biodistribution studies were performed 96 h after single dose injection of the tracer (10 to 500 μg) into Balb/c mice bearing subcutaneous c-Met expressing human H441 non-small cell lung cancer tumors. PET imaging was executed at 6, 24, 48 and 96 h after injection of 50 μg 89Zr-PRS-110 to mice bearing H441 (c-Met ++), primary glioblastoma U87-MG (c-Met +) or ovarian cancer A2780 (c-Met -) xenografts. After the final scan, biodistribution analysis was performed. The excised tumors were analyzed for c-Met expression by immunohistochemistry and fluorescent PRS-110-800CW distribution by fluorescence microscopy.

Results: Biodistribution analyses showed a PRS-110 dose-dependent 89Zr-PRS-110 H441-tumor uptake, with the highest tumor uptake at 10 μg PRS-110 resulting in 7.5 %ID/g at 96 h after tracer injection. MicroPET imaging revealed specific tumor uptake of 89Zr-PRS-110 in the c-Met expressing H441 and U87 tumors while imaging of the c-Met negative A2780 tumor model showed background level similar to a non-specific anticalin control. Biodistribution data supported the microPET findings, showing ex vivo tumor uptake of 89Zr-PRS-110 of 5.9, 1.8 and 1.7 %ID/g in H441, U87 and A2780 xenografts respectively, which correlated with c-Met expression levels. Tumor : blood ratios of 89Zr-PRS-110 compared to 89Zr-Tlc-PEG confirmed these finding. Ex vivo fluorescence revealed intracellular presence of PRS-110 96 h after tracer injection.

Conclusion: 89Zr-PRS-110 specifically accumulates in c-Met expressing tumors. PET imaging with this tracer provides real-time non-invasive information about PRS-110 distribution and tumor accumulation. This makes 89Zr-PRS-110, which is ready for clinical evaluation, of interest for the clinical development of PRS-110.

Citation Format: Anton G.T. Terwisscha van Scheltinga, Elisabeth G.E. de Vries, Marlon Hinner, Remy B. Verheijen, Andrea Allesdorfer, Laurent Audoly, Wouter B. Nagengast, Carolien P. Schröder, Martin Hülsmeyer, Jos G.W. Kosterink, Marjolijn N. Lub-de Hooge, Shane A. Olwill. Next generation PET imaging agents: The development of radiolabeled c-Met specific Anticalin 89Zr-PRS-110 with diagnostic and therapeutic drug monitoring applications. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2664. doi:10.1158/1538-7445.AM2013-2664

89 Zr-bevacizumab PET imaging in metastatic renal cell carcinoma patients before and during antiangiogenic treatment

10581

Background: Renal cell cancer (RCC) is characterized by high VEGF production leading to excessive angiogenesis. To visualize VEGF, we performed serial 89Zr-bevacizumab-PET scans before and during antiangiogenic treatment in RCC patients. Methods: Metastatic (m) RCC patients who received sunitinib (50 mg once daily, 4 out of 6 weeks) or bevacizumab (10 mg/kg every 2 weeks) plus interferon (IFN 3-9 MU 3x/week), underwent 89Zr-bevacizumab-PET scans at baseline and after 2 and 6 weeks, and CT scans at baseline and every 3 months. Tracer uptake in tumor lesions was quantified with maximum Standardized Uptake Value (SUVmax). Relationship between baseline and Δ SUVmax and time to progression (TTP) was analyzed. Wilcoxon test was used to compare scans, Kaplan-Meier method for survival analysis. Results: 22 out of 26 patients were evaluable, 11 per treatment. On 89Zr-bevacizumab-PET, 131 out of 231 lesions ≥ 10 mm (detection limit) were visible and 125 quantifiable. Mean SUVmax at baseline was 10.1 (SD 8.4; range 2.3 - 46.9). During bevacizumab/IFN treatment, SUVmax consistently decreased (mean decrease 47.0% 95% CI 39.1-54.9, P<0.0001) at 2 weeks with a further decrease of 9.7% (95% CI 0.86-18.5, P=0.016) at 6 weeks. After 2 weeks sunitinib, there was only a modest decrease in mean  SUVmax  (14.6%, 95% CI 1.57-27.63, P=0.0064) with a wide range (-80.4% to +269.9%) and an overshoot of 84.4% (95% CI 47.8-120.9, P=0.0001) after 2 drug free weeks. TTP was longer in (n=15) patients with baseline SUVmax > 11.1 (highest normal tissue uptake) in the 3 most intense lesions than in those with a lower value (median 89.7 vs 22.8 weeks, HR 0.16, 95% CI 0.04 - 0.70). TTP was longer in patients (n=11) with an absolute Δ SUVmax >6.00 in the most intense lesion at 2 weeks (HR 0.25, 95% CI 0.06-0.98). Conclusions: 89Zr-bevacizumab-PET visualizes tumor lesions in mRCC patients. Different changes in tumor tracer uptake after start of bevacizumab/IFN versus sunitinib indicate that these drugs induce different angiogenic responses. High baseline SUVmax and large change in SUVmax corresponded with longer TTP, suggesting that 89Zr-bevacizumab-PET may help to identify patients who benefit the most from antiangiogenic treatment.

Abstract 2431: 89Zr-bevacizumab PET as an early biomarker for response to everolimus treatment in an ovarian cancer xenograft model

The mammalian target of rapamycin (mTOR) pathway is activated in the majority of ovarian cancers and is involved in tumor angiogenesis. Inhibitors of mTOR, like everolimus, are potentially interesting drugs as they can exert antitumor activity in part through reducing downstream vascular endothelial growth factor-A (VEGF-A) production. We investigated whether early effects of everolimus treatment could be monitored with 89Zr-bevacizumab positron emission tomography (VEGF-PET). Methods: The effect of everolimus on VEGF-A secretion was determined in three human ovarian cancer cell lines and in A2780luc+ ovarian cancer cells xenografted subcutaneously in BALB/c mice. Mice received daily everolimus (10 mg/kg intraperitoneally) for 14 days. PET scans with the tracer 89Zr-labeled bevacizumab were performed to monitor tumor VEGF-A expression before (baseline) and after treatment. Images were obtained 6 days after tracer injection. Tracer uptake was quantified and expressed as mean standardized uptake values (SUVmean). For ex vivo 89Zr-bevacizumab biodistribution and correlative tissue analyses, control animals were sacrificed after the baseline scans. Tumor VEGF-A levels were measured with ELISA in tumor lysates and mean vascular density (MVD) was determined with immunohistochemistry. Results: Everolimus treatment lowered VEGF-A levels in the supernatant of all cell lines. Everolimus lowered 89Zr-bevacizumab tumor uptake by 21.7 ± 4.0% (SUVmean 2.26 ± 0.18 versus 2.89 ± 0.20, p &lt; 0.01). Ex vivo 89Zr-bevacizumab biodistribution showed less tracer uptake in the tumors of treated compared to control animals (7.78 ± 0.84 %ID/g versus 14.02 ± 1.68 %ID/g, p &lt; 0.01), while no differences were observed for other tissues. VEGF-A protein levels in tumor lysates were lower in treated versus untreated tumors (p = 0.04), as was the MVD (p &lt; 0.01). Conclusion: 89Zr-bevacizumab PET showed reduced tumor VEGF-A levels in vivo in response to everolimus therapy, coinciding with inhibition of tumor angiogenesis. Currently there are 2 clinical trials ongoing to study the value of 89Zr-bevacizumab PET to monitor tumor VEGF-A levels as an early biomarker of response to mTOR inhibitor therapy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2431. doi:1538-7445.AM2012-2431