The status of radioimmunotherapy in CD20+ non-Hodgkin's lymphoma

Chlorambucil Conjugation Enhances the Potency of Rituximab: Synthesis and Evaluation of the Novel [177Lu]Lu-Labeled Rituximab-Chlorambucil Conjugate toward Therapy of Non-Hodgkin's Lymphoma

In this study, a novel antibody-drug conjugate (ADC) consisting of Rituximab and Chlorambucil (Rituximab-CMB) was synthesized. The average number of drug molecules attached per Rituximab molecule was determined using MALDI-TOF mass spectrometry, revealing a range of 4-6 drug molecules per antibody. To further improve the therapeutic potential of the ADC, it was radiolabeled with the therapeutic radionuclide 177Lu via a DOTA chelator, achieving a final radiochemical purity of over 95%. In vitro assays demonstrated that the Rituximab-CMB conjugate had greater cytotoxicity compared to that of both unconjugated Rituximab and Chlorambucil alone. Moreover, [177Lu]Lu-labeled-Rituximab-CMB (15.67 MBq/mg) exhibited higher radiotoxicity (37.08 ± 1.40% cell death) compared to [177Lu]Lu-labeled-Rituximab (83.99 MBq/mg) (25.25 ± 0.8% cell death) when administered at similar radioactivity doses. Ex vivo experiments indicated that coinjecting cold Rituximab with the radiolabeled formulations significantly improved tumor accumulation and reduced nontarget organ uptake. SPECT-CT imaging results supported these findings, further confirming the enhanced tumor-targeting and biodistribution of the radiolabeled ADC.

Synthesis, Characterization, and Therapeutic Efficacy of 177Lu-DMSA@SPIONs in Nanobrachytherapy of Solid Tumors

As an alternative to classical brachytherapy, intratumoral injection of radionuclide-labeled nanoparticles (nanobrachytherapy, NBT) has been investigated as a superior delivery method over an intravenous route for radionuclide therapy of solid tumors. We created superparamagnetic iron oxide nanoparticles (SPIONs) coated with meso-1,2-dimercaptosuccinic acid (DMSA) and radiolabeled with Lutetium-177 (¹⁷⁷Lu), generating ¹⁷⁷Lu-DMSA@SPIONs as a potential antitumor agent for nanobrachytherapy. Efficient radiolabeling of DMSA@SPIONS by ¹⁷⁷Lu resulted in a stable bond with minimal leakage in vitro. After an intratumoral injection to mouse colorectal CT-26 or breast 4T1 subcutaneous tumors, the nanoparticles remained well localized at the injection site for weeks, with limited leakage. The dose of 3.70 MBq/100 µg/50 µL of ¹⁷⁷Lu-DMSA@SPIONs applied intratumorally resulted in a high therapeutic efficacy, without signs of general toxicity. A decreased dose of 1.85 MBq/100 µg/50 µL still retained therapeutic efficacy, while an increased dose of 9.25 MBq/100 µg/50 µL did not significantly benefit the therapy. Histopathology analysis revealed that the ¹⁷⁷Lu-DMSA@SPIONs act within a limited range around the injection site, which explains the good therapeutic efficacy achieved by a single administration of a relatively low dose without the need for increased or repeated dosing. Overall, ¹⁷⁷Lu-DMSA@SPIONs are safe and potent agents suitable for intra-tumoral administration for localized tumor radionuclide therapy.

Targeted Alpha Therapy (TAT) with Single-Domain Antibodies (Nanobodies)

The persistent threat of cancer necessitates the development of improved and more efficient therapeutic strategies that limit damage to healthy tissues. Targeted alpha therapy (TαT), a novel form of radioimmuno-therapy (RIT), utilizes a targeting vehicle, commonly antibodies, to deliver high-energy, but short-range, alpha-emitting particles specifically to cancer cells, thereby reducing toxicity to surrounding normal tissues. Although full-length antibodies are often employed as targeting vehicles for TαT, their high molecular weight and the presence of an Fc-region lead to a long blood half-life, increased bone marrow toxicity, and accumulation in other tissues such as the kidney, liver, and spleen. The discovery of single-domain antibodies (sdAbs), or nanobodies, naturally occurring in camelids and sharks, has introduced a novel antigen-specific vehicle for molecular imaging and TαT. Given that nanobodies are the smallest naturally occurring antigen-binding fragments, they exhibit shorter relative blood half-lives, enhanced tumor uptake, and equivalent or superior binding affinity and specificity. Nanobody technology could provide a viable solution for the off-target toxicity observed with full-length antibody-based TαT. Notably, the pharmacokinetic properties of nanobodies align better with the decay characteristics of many short-lived α-emitting radionuclides. This review aims to encapsulate recent advancements in the use of nanobodies as a vehicle for TαT.

Comparative evaluation of radionuclide therapy using 90Y and 177Lu

OBJECTIVE

Both ⁹⁰Y and ¹⁷⁷Lu are attractive β-emitters for radionuclide therapy and have been used in clinical practice. Nevertheless, comparative evaluation between ⁹⁰Y- and ¹⁷⁷Lu-labeled molecules has not been fully conducted. Thus, in this study, the features of ⁹⁰Y and ¹⁷⁷Lu for radionuclide therapy were assessed in tumor-bearing mice.

METHODS

Two tumor cell lines with different growth rates were used. Biodistribution studies of ¹⁷⁷Lu-labeled antibodies (¹⁷⁷Lu-Abs) were conducted in each tumor-bearing mouse model. Subsequently, the therapeutic effect of ⁹⁰Y- and ¹⁷⁷Lu-Ab were assessed in tumor-bearing mice. The absorbed radiation dose for the tumor was estimated using the Monte Carlo simulation.

RESULTS

¹⁷⁷Lu-Abs demonstrated high tumor accumulation in both tumor-xerograph. In the fast-growing tumor model, ⁹⁰Y-Ab showed a better therapeutic effect than ¹⁷⁷Lu-Ab, reflecting a higher absorbed radiation dose of ⁹⁰Y-Ab than that of ¹⁷⁷Lu-Ab. In the slow-growing tumor model, both ⁹⁰Y- and ¹⁷⁷Lu-Ab showed an excellent therapeutic effect; however, ¹⁷⁷Lu-Ab had a longer efficacy period than ⁹⁰Y-Ab, which could be attributed to the longer half-life and better dose uniformity of ¹⁷⁷Lu than those of ⁹⁰Y.

CONCLUSIONS

To accomplish a maximum therapeutic effect, selecting ⁹⁰Y or ¹⁷⁷Lu, to depend on the growth rate of individual cancer, would be helpful.

Potential of three-step pretargeting radioimmunotherapy using biotinylated bevacizumab and succinylated streptavidin in triple-negative breast cancer xenograft

OBJECTIVE

Pretargeting radioimmunotherapy (PRIT) is a promising approach that can reduce long-time retention of blood radioactivity and consequently reduce hematotoxicity. Among the PRIT strategies, the combination of biotin-conjugated mAb and radiolabeled streptavidin (StAv) is a simple and convenient method because of its ease of preparation. This study performed three-step (3-step) PRIT using the sequential injection of (1) biotinylated bevacizumab (Bt-BV), (2) avidin, and (3) radiolabeled StAv for the treatment of triple-negative breast cancer (TNBC).

METHODS

Four biodistribution studies were performed using ¹¹¹In in tumor-bearing mice to optimize each step of our PRIT methods. Further, a therapeutic study was performed with optimized 3-step PRIT using ⁹⁰Y-labeled StAv.

RESULTS

Based on the biodistribution studies, the protein dose of Bt-BV and avidin was optimized to 100 μg and 10 molar equivalent of BV, respectively. Succinylation of StAv significantly decreased the kidney accumulation level (with succinylation (6.96 ± 0.91) vs without succinylation (20.60 ± 1.47) at 1 h after injection, p < 0.0001) with little effect on the tumor accumulation level. In the therapeutic study, tumor growth was significantly suppressed in treatment groups with optimized 3-step PRIT using ⁹⁰Y-labeled succinylated StAv compared to that of the no-treatment group (p < 0.05).

CONCLUSIONS

The 3-step PRIT strategy of this study achieved fast blood clearance and low kidney uptake with little effect on the tumor accumulation level, and a certain degree of therapeutic effect was consequently observed. These results indicated that the pretargeting treatment of the current study may be effective for human TNBC treatment.

Monte Carlo dosimetry of a realistic multicellular model of follicular lymphoma in a context of radioimmunotherapy

PURPOSE

Small-scale dosimetry studies generally consider an artificial environment where the tumors are spherical and the radionuclides are homogeneously biodistributed. However, tumor shapes are irregular and radiopharmaceutical biodistributions are heterogeneous, impacting the energy deposition in targeted radionuclide therapy. To bring realism, we developed a dosimetric methodology based on a three-dimensional in vitro model of follicular lymphoma incubated with rituximab, an anti-CD20 monoclonal antibody used in the treatment of non-Hodgkin lymphomas, which might be combined with a radionuclide. The effects of the realistic geometry and biodistribution on the absorbed dose were highlighted by comparison with literature data. Additionally, to illustrate the possibilities of this methodology, the effect of different radionuclides on the absorbed dose distribution delivered to the in vitro tumor were compared.

METHODS

The starting point was a model named multicellular aggregates of lymphoma cells (MALC). Three MALCs of different dimensions and their rituximab biodistribution were considered. Geometry, antibody location and concentration were extracted from selective plane illumination microscopy. Assuming antibody radiolabeling with Auger electron (¹²⁵ I and ¹¹¹ In) and β^- particle emitters (¹⁷⁷ Lu, ¹³¹ I and ⁹⁰ Y), we simulated energy deposition in MALCs using two Monte Carlo codes: Geant4-DNA with "CPA100" physics models for Auger electron emitters and Geant4 with "Livermore" physics models for β^- particle emitters.

RESULTS

MALCs had ellipsoid-like shapes with major radii, r, of ~0.25, ~0.5 and ~1.3 mm. Rituximab was concentrated in the periphery of the MALCs. The absorbed doses delivered by ¹⁷⁷ Lu, ¹³¹ I and ⁹⁰ Y in MALCs were compared with literature data for spheres with two types of homogeneous biodistributions (on the surface or throughout the volume). Compared to the MALCs, the mean absorbed doses delivered in spheres with surface biodistributions were between 18% and 38% lower, while with volume biodistribution they were between 15% and 29% higher. Regarding the radionuclides comparison, the relationship between MALC dimensions, rituximab biodistribution and energy released per decay impacted the absorbed doses. Despite releasing less energy, ¹²⁵ I delivered a greater absorbed dose per decay than ¹¹¹ In in the r ~ 0.25 mm MALC (6.78·10^-2 vs 6.26·10^-2  µGy·Bq^-1 ·s^-1 ). Similarly, the absorbed doses per decay in the r ~ 0.5 mm MALC for ¹⁷⁷ Lu (2.41·10^-2  µGy·Bq^-1 ·s^-1 ) and ¹³¹ I (2.46·10^-2  µGy·Bq^-1 ·s^-1 ) are higher than for ⁹⁰ Y (1.98·10^-2  µGy·Bq^-1 ·s^-1 ). Furthermore, radionuclides releasing more energy per decay delivered absorbed dose more uniformly through the MALCs. Finally, when considering the radiopharmaceutical effective half-life, due to the biological half-life of rituximab being best matched by the physical half-life of ¹⁷⁷ Lu and ¹³¹ I compared to ⁹⁰ Y, the first two radionuclides delivered higher absorbed doses.

CONCLUSION

In the simulated configurations, β^- emitters delivered higher and more uniform absorbed dose than Auger electron emitters. When considering radiopharmaceutical half-lives, ¹⁷⁷ Lu and ¹³¹ I delivered absorbed doses higher than ⁹⁰ Y. In view of real irradiation of MALCs, such a work may be useful to select suited radionuclides and to help explain the biological effects.

Comparative In Vitro Cytotoxicity Studies of 177Lu-CHX-A″-DTPA-Trastuzumab and 177Lu-CHX-A″-DTPA-F(ab')2-Trastuzumab in HER2-Positive Cancer Cell Lines

Background: Human epidermal growth factor receptor 2 (HER2) is found to be amplified in ∼15%-20% of breast cancers. In this study, the authors report the synthesis and comparative in vitro therapeutic efficacy of ¹⁷⁷Lu-CHX-A″-DTPA-trastuzumab and ¹⁷⁷Lu-CHX-A″-DTPA-F(ab')₂-trastuzumab to determine their potential as theranostic agents for patients with breast cancer. Materials and Methods: Bivalent F(ab')₂-trastuzumab was produced by enzymatic digestion of trastuzumab, conjugated with p-SCN-Bn-CHX-A″-DTPA and subsequently radiolabeled with ¹⁷⁷Lu. Cell viability, membrane toxicity assays, and apoptosis analysis were carried out with ¹⁷⁷Lu-CHX-A″-DTPA-trastuzumab and ¹⁷⁷Lu-CHX-A″-DTPA-F(ab')₂-trastuzumab in HER2-positive ovarian (SK-OV-3) and breast cancer (SK-BR-3 and MDA-MB-453) cells. Results: In vitro cell binding studies showed ∼20%-25% binding of ¹⁷⁷Lu-CHX-A″-DTPA-trastuzumab and ¹⁷⁷Lu-CHX-A″-DTPA-F(ab')₂-trastuzumab to SK-OV-3, SK-BR-3, and MDA-MB-453 cells. The cells exhibited similar degree of membrane integrity and cellular toxicity when treated with same amount (activity) of ¹⁷⁷Lu-CHX-A″-DTPA-F(ab')₂-trastuzumab and ¹⁷⁷Lu-CHX-A″-DTPA-trastuzumab, and the toxicity was dose dependent. The mode of cell death was predominantly by apoptosis and necrosis with both the radioimmunoconjugates. Conclusions: The results indicated that the efficacy of both the radioimmunoconjugates, in terms of inducing cell death, was similar thereby ascertaining their potential as good therapeutic agents for patients with breast cancer.

Evaluation of Radiolabeled Girentuximab In Vitro and In Vivo

Girentuximab (cG250) targets carbonic anhydrase IX (CAIX), a protein which is expressed on the surface of most renal cancer cells (RCCs). cG250 labeled with 177Lu has been used in clinical trials for radioimmunotherapy (RIT) of RCCs. In this work, an extensive characterization of the immunoconjugates allowed optimization of the labeling conditions with 177Lu while maintaining immunoreactivity of cG250, which was then investigated in in vitro and in vivo experiments. cG250 was conjugated with S-2-(4-isothiocyanatobenzyl)-1,4,7,10-tetraazacyclododecane tetraacetic acid (DOTA(SCN)) by using incubation times between 30 and 90 min and characterized by mass spectrometry. Immunoconjugates with five to ten DOTA(SCN) molecules per cG250 molecule were obtained. Conjugates with ratios less than six DOTA(SCN)/cG250 had higher in vitro antigen affinity, both pre- and postlabeling with 177Lu. Radiochemical stability increased, in the presence of sodium ascorbate, which prevents radiolysis. The immunoreactivity of the radiolabeled cG250 tested by specific binding to SK-RC-52 cells decreased when the DOTA content per conjugate increased. The in vivo tumor uptake was < 10% ID/g and independent of the total amount of protein in the range between 5 and 100 µg cG250 per animal. Low tumor uptake was found to be due to significant necrotic areas and heterogeneous CAIX expression. In addition, low vascularity indicated relatively poor accessibility of the CAIX target.

Applying near-infrared photoimmunotherapy to B-cell lymphoma: comparative evaluation with radioimmunotherapy in tumor xenografts

Objective

Radioimmunotherapy (RIT) has proven effective for patients with relapsed and refractory lymphoma. However, new types of therapy are strongly desired as B-cell lymphoma remains incurable for many patients. Photoimmunotherapy (PIT) is an emerging targeted cancer therapy that uses photosensitizer (IR700)-conjugated monoclonal antibodies (mAbs) to specifically kill cancer cells. To evaluate the usefulness and potential role of PIT for treating B-cell lymphoma in a comparison with RIT, we performed in vivo PIT and RIT studies with an IR700 or ⁹⁰Y-conjugated anti-CD20 mAb, NuB2.

Methods

IR700 or ⁹⁰Y were conjugated to NuB2. Since cell aggressiveness greatly affects the therapeutic effect, we selected both an indolent (RPMI 1788) and an aggressive (Ramos) type of B-cell lymphoma cell line. The in vitro therapeutic effect of PIT and the biodistribution profiles of IR700–NuB2 were evaluated. In vivo PIT and RIT studies were performed with 100 or 500 μg of IR700–NuB2 and 150 μCi/20 μg of ⁹⁰Y-NuB2, respectively, in two types of B-cell lymphoma-bearing mice.

Results

The in vitro studies revealed that Ramos was more sensitive than RPMI 1788 to PIT. The therapeutic effect of PIT with 500 µg IR700–NuB2 was superior to any other therapies against aggressive Ramos tumors, whereas RIT showed the highest therapeutic effect in indolent RPMI 1788 tumors. Since the uptake levels and intratumoral distribution of IR700–NuB2 were comparable in both tumors, a possible cause of this difference is the tumor growth rate. The PIT with 500 µg (IR700–NuB2) group showed a significantly greater therapeutic effect than the PIT with 100 µg group due to the higher and more homogeneous tumor distribution of IR700–NuB2.

Conclusions

PIT was effective for both indolent and aggressive B-cell lymphoma, and the higher dose provided a better therapeutic effect. In aggressive tumors, PIT was more effective than RIT. Thus, PIT would be a promising strategy for the locoregional treatment or control of B-cell lymphoma. Since PIT and RIT have distinctive advantages over each other, they could play complementary rather than competitive roles in B-cell lymphoma treatment.

Engineered Recognition of Tetravalent Zirconium and Thorium by Chelator-Protein Systems: Toward Flexible Radiotherapy and Imaging Platforms

Targeted α therapy holds tremendous potential as a cancer treatment: it offers the possibility of delivering a highly cytotoxic dose to targeted cells while minimizing damage to surrounding healthy tissue. The metallic α-generating radioisotopes ²²⁵Ac and ²²⁷Th are promising radionuclides for therapeutic use, provided adequate chelation and targeting. Here we demonstrate a new chelating platform composed of a multidentate high-affinity oxygen-donating ligand 3,4,3-LI(CAM) bound to the mammalian protein siderocalin. Respective stability constants log β₁₁₀ = 29.65 ± 0.65, 57.26 ± 0.20, and 47.71 ± 0.08, determined for the Eu^III (a lanthanide surrogate for Ac^III), Zr^IV, and Th^IV complexes of 3,4,3-LI(CAM) through spectrophotometric titrations, reveal this ligand to be one of the most powerful chelators for both trivalent and tetravalent metal ions at physiological pH. The resulting metal-ligand complexes are also recognized with extremely high affinity by the siderophore-binding protein siderocalin, with dissociation constants below 40 nM and tight electrostatic interactions, as evidenced by X-ray structures of the protein:ligand:metal adducts with Zr^IV and Th^IV. Finally, differences in biodistribution profiles between free and siderocalin-bound ²³⁸Pu^IV-3,4,3-LI(CAM) complexes confirm in vivo stability of the protein construct. The siderocalin:3,4,3-LI(CAM) assembly can therefore serve as a "lock" to consolidate binding to the therapeutic ²²⁵Ac and ²²⁷Th isotopes or to the positron emission tomography emitter ⁸⁹Zr, independent of metal valence state.