Positron emission tomography and [18F]BPA: a perspective application to assess tumour extraction of boron in BNCT

Exploring the Biological and Physical Basis of Boron Neutron Capture Therapy (BNCT) as a Promising Treatment Frontier in Breast Cancer

Simple Summary

BNCT is a biologically targeted, densely ionizing form of radiation therapy that allows for increased tumor cell kill, while reducing toxicity to surrounding normal tissues. Although BNCT has been investigated in the treatment of head and neck cancers and recurrent brain tumors, its applicability to breast cancer has not been previoulsy investigated. In this review we discuss the physical and biological properties of various boronated compounds, and advantages and challenges associated with the potential use of BNCT in the treatment of breast cancer.

Abstract

BNCT is a high LET radiation therapy modality that allows for biologically targeted radiation delivery to tumors while reducing normal tissue impacts. Although the clinical use of BNCT has largely been limited to phase I/II trials and has primarily focused on difficult-to-treat malignancies such as recurrent head and neck cancer and recurrent gliomas, recently there has been a renewed interest in expanding the use of BNCT to other disease sites, including breast cancer. Given its high LET characteristics, its biologically targeted and tumor specific nature, as well as its potential for use in complex treatment settings including reirradiation and widespread metastatic disease, BNCT offers several unique advantages over traditional external beam radiation therapy. The two main boron compounds investigated to date in BNCT clinical trials are BSH and BPA. Of these, BPA in particular shows promise in breast cancer given that is taken up by the LAT-1 amino acid transporter that is highly overexpressed in breast cancer cells. As the efficacy of BNCT is directly dependent on the extent of boron accumulation in tumors, extensive preclinical efforts to develop novel boron delivery agents have been undertaken in recent years. Preclinical studies have shown promise in antibody linked boron compounds targeting ER/HER2 receptors, boron encapsulating liposomes, and nanoparticle-based boron delivery systems. This review aims to summarize the physical and biological basis of BNCT, the preclinical and limited clinical data available to date, and discuss its potential to be utilized for the successful treatment of various breast cancer disease states.

Covalent Organic Polymer as a Carborane Carrier for Imaging-Facilitated Boron Neutron Capture Therapy

Boron neutron capture therapy (BNCT) is an atomic targeted radiotherapy that shows fantastic suppression impact on locally intrusive threatening tumors. One key factor for effective BNCT is to aggregate an adequate concentration (>20 ppm) of ¹⁰B in the cytoplasm of the tumor. Carborane-loaded polymer nanoparticles are promising because of their outstanding biocompatibility and plasma steadiness. In this study, a new class of carborane-loaded nanoscale covalent organic polymers (BCOPs) was prepared by a Schiff base condensation reaction, and their solubility was greatly improved in common solvents via alkyl chain engineering and size tailoring. The obtained BCOP-5T was further functionalized by biocompatible 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[amino(polyethylene-glycol)-2000] (DSPE-PEG, molecular weight 2000) to form stable aqueous-phase nanoparticles with a hydrodynamic diameter of around 100 nm. After chelating with radioactive copper-64, DSPE-BCOP-5T was tracked by positron emission tomography (PET) imaging and showed significant accumulation in the tumor. DSPE-BCOP-5T + neutron radiation showed remarkable tumor suppression in 4T1 tumor-bearing mice (murine breast cancer). No obvious physical tissue damage and abnormal behavior were observed, demonstrating that the boron delivery was successful and tumor-selective. To conclude, this study presents a theranostic COP-based platform with a well-defined composition, good biocompatibility, and satisfactory tumor accumulation, which is promising for PET imaging, drug delivery, and BNCT.

A Metabolically Stable Boron-Derived Tyrosine Serves as a Theranostic Agent for Positron Emission Tomography Guided Boron Neutron Capture Therapy

Boronophenylalanine (BPA) is the dominant boron delivery agent for boron neutron capture therapy (BNCT), and [¹⁸F]FBPA has been developed to assist the treatment planning for BPA-BNCT. However, the clinical application of BNCT has been limited by its inadequate tumor specificity due to the metabolic instability. In addition, the distinctive molecular structures between [¹⁸F]FBPA and BPA can be of concern as [¹⁸F]FBPA cannot quantitate boron concentration of BPA in a real-time manner. In this study, a metabolically stable boron-derived tyrosine (denoted as fluoroboronotyrosine, FBY) was developed as a theranostic agent for both boron delivery and cancer diagnosis, leading to PET imaging-guided BNCT of cancer. [¹⁸F]FBY was synthesized in high radiochemical yield (50%) and high radiochemical purity (98%). FBY showed high similarity with natural tyrosine. As shown in in vitro assays, the uptake of FBY in murine melanoma B16-F10 cells was L-type amino acid transporter (LAT-1) dependent and reached up to 128 μg/10⁶ cells. FBY displayed high stability in PBS solution. [¹⁸F]FBY PET showed up to 6 %ID/g in B16-F10 tumor and notably low normal tissue uptake (tumor/muscle = 3.16 ± 0.48; tumor/blood = 3.13 ± 0.50; tumor/brain = 14.25 ± 1.54). Moreover, administration of [¹⁸F]FBY tracer along with a therapeutic dose of FBY showed high accumulation in B16-F10 tumor and low normal tissue uptake. Correlation between PET-image and boron biodistribution was established, indicating the possibility of estimating boron concentration via a noninvasive approach. At last, with thermal neutron irradiation, B16-F10 tumor-bearing mice injected with FBY showed significantly prolonged median survival without exhibiting obvious systemic toxicity. In conclusion, FBY holds great potential as an efficient theranostic agent for imaging-guided BNCT by offering a possible solution of measuring local boron concentration through PET imaging.

4-Borono-2-18F-fluoro-L-phenylalanine PET for boron neutron capture therapy-oriented diagnosis: overview of a quarter century of research

4-¹⁰B-Borono-2-¹⁸F-fluoro-L-phenylalanine (¹⁸F-FBPA) was developed for monitoring the pharmacokinetics of 4-¹⁰B-borono-L-phenylalanine (¹⁰B-BPA) used in boron neutron capture therapy (BNCT) with positron emission tomography (PET). The tumor-imaging potential of ¹⁸F-FBPA was demonstrated in various animal models. Accumulation of ¹⁸F-FBPA was higher in melanomas than in non-melanoma tumors in animal models and cell cultures. ¹⁸F-FBPA was incorporated into tumors mediated mainly by L-type amino acid transporters in in vitro and in vivo models. Tumoral distribution of ¹⁸F-FBPA was primarily related to the activity of DNA synthesis. ¹⁸F-FBPA is metabolically stable but is incorporated into melanogenesis non-enzymatically. These in vitro and in vivo characteristics of ¹⁸F-FBPA corresponded well to those of ¹⁰B-BPA. Nuclear magnetic resonance and other studies using non-radioactive ¹⁹F-^10/11B-FBPA also contributed to characterization. The validity and reliability of ^18/19F-FBPA as an in vivo probe of ¹⁰B-BPA were confirmed by comparison of the pharmacokinetics of ¹⁸F-FBPA and ¹⁰B-BPA and direct measurement of both ¹⁸F and ¹⁰B in tumors with various doses of both probes administered by different routes and methods. Clinically, based on the kinetic parameters of dynamic ¹⁸F-FBPA PET, the estimated ¹⁰B-concentrations in tumors with continuous ¹⁰B-BPA infusion were similar to those measured directly in surgical specimens. The significance of ¹⁸F-FBPA PET was verified for the estimation of ¹⁰B-concentration and planning of BNCT. Later ¹⁸F-FBPA PET has been involved in ¹⁰B-BPA BNCT of patients with intractable tumors such as malignant brain tumors, head and neck tumors, and melanoma. Usually a static PET scan is used for screening patients for BNCT, prediction of the distribution and accumulation of ¹⁰B-BPA, and evaluation of treatment after BNCT. In some clinical trials, a tumor-to-normal tissue ratio of ¹⁸F-FBPA > 2.5 was an inclusion criterion for BNCT. Apart from BNCT, ¹⁸F-FBPA was demonstrated to be a useful PET probe for tumor diagnosis in nuclear medicine: better tumor-to-normal brain contrast compared with ¹¹C-methionine, differentiation of recurrent and radiation necrosis after radiotherapy, and melanoma-preferential uptake. Further progress in ¹⁸F-FBPA studies is expected for more elaborate evaluation of ¹⁰B-concentrations in tumors and normal tissues for successful ¹⁰B-BPA BNCT and for radiosynthesis of ¹⁸F-FBPA to enable higher ¹⁸F-activity amounts and higher molar activities.

Opportunistic dose amplification for proton and carbon ion therapy via capture of internally generated thermal neutrons

This paper presents Neutron Capture Enhanced Particle Therapy (NCEPT), a method for enhancing the radiation dose delivered to a tumour relative to surrounding healthy tissues during proton and carbon ion therapy by capturing thermal neutrons produced inside the treatment volume during irradiation. NCEPT utilises extant and in-development boron-10 and gadolinium-157-based drugs from the related field of neutron capture therapy. Using Monte Carlo simulations, we demonstrate that a typical proton or carbon ion therapy treatment plan generates an approximately uniform thermal neutron field within the target volume, centred around the beam path. The tissue concentrations of neutron capture agents required to obtain an arbitrary 10% increase in biological effective dose are estimated for realistic treatment plans, and compared to concentrations previously reported in the literature. We conclude that the proposed method is theoretically feasible, and can provide a worthwhile improvement in the dose delivered to the tumour relative to healthy tissue with readily achievable concentrations of neutron capture enhancement drugs.

Carbon-11 and Fluorine-18 Labeled Amino Acid Tracers for Positron Emission Tomography Imaging of Tumors

Tumor cells have an increased nutritional demand for amino acids (AAs) to satisfy their rapid proliferation. Positron-emitting nuclide labeled AAs are interesting probes and are of great importance for imaging tumors using positron emission tomography (PET). Carbon-11 and fluorine-18 labeled AAs include the [1-¹¹C] AAs, labeling alpha-C- AAs, the branched-chain of AAs and N-substituted carbon-11 labeled AAs. These tracers target protein synthesis or amino acid (AA) transport, and their uptake mechanism mainly involves AA transport. AA PET tracers have been widely used in clinical settings to image brain tumors, neuroendocrine tumors, prostate cancer, breast cancer, non-small cell lung cancer (NSCLC) and hepatocellular carcinoma. This review focuses on the fundamental concepts and the uptake mechanism of AAs, AA PET tracers and their clinical applications.

Preloading with L-BPA, L-tyrosine and L-DOPA enhances the uptake of [18F]FBPA in human and mouse tumour cell lines

Aim of this study was to investigate if cellular [¹⁸F]FBPA uptake can be increased upon preloading with amino acids. [¹⁸F]FBPA uptake was assessed in HuH-7, CaCo-2 and B16-F1 cells pretreated with different concentrations or incubation times of L-BPA, L-tyrosine or L-DOPA. Without preloading, highest uptake of [¹⁸F]FBPA was observed in B16-F1 cells, followed by CaCo-2 cells and HuH-7 cells. In all cell lines higher [¹⁸F]FBPA accumulation (up to 1.65-fold) was obtained with increasing L-BPA, L-DOPA and L-tyrosine concentrations.

On the applicability of [18F]FBPA to predict L-BPA concentration after amino acid preloading in HuH-7 liver tumor model and the implication for liver boron neutron capture therapy

INTRODUCTION

In recent years extra-corporal application of boron neutron capture therapy (BNCT) was evaluated for liver primary tumors or liver metastases. A prerequisite for such a high-risk procedure is proof of preferential delivery and high uptake of a ¹⁰B-pharmaceutical in liver malignancies. In this work we evaluated in a preclinical tumor model if [¹⁸F]FBPA tissue distribution measured with PET is able to predict the tissue distribution of [¹⁰B]L-BPA.

METHODS

Tumor bearing mice (hepatocellular carcinoma cell line, HuH-7) were either subject of a [¹⁸F]FBPA-PET scan with subsequent measurement of radioactivity content in extracted organs using a gamma counter or injected with [¹⁰B]L-BPA with tissue samples analyzed by prompt gamma activation analysis (PGAA) or quantitative neutron capture radiography (QNCR). The impact of L-tyrosine, L-DOPA and L-BPA preloading on the tissue distribution of [¹⁸F]FBPA and [¹⁰B]L-BPA was evaluated and the pharmacokinetics of [¹⁸F]FBPA investigated by compartment modeling.

RESULTS

We found a significant correlation between [¹⁸F]FBPA and [¹⁰B]L-BPA uptake in tumors and various organs as well as high accumulation levels in pancreas and kidneys as reported in previous studies. Tumor-to-liver ratios of [¹⁸F]FBPA ranged from 1.2 to 1.5. Preloading did not increase the uptake of [¹⁸F]FBPA or [¹⁰B]L-BPA in any organ and compartment modeling showed no statistically significant differences in [¹⁸F]FBPA tumor kinetics.

CONCLUSIONS

[¹⁸F]FBPA-PET predicts [¹⁰B]L-BPA concentration after amino acid preloading in HuH-7 hepatocellular carcinoma models. Preloading had no effect on tumor uptake of [¹⁸F]FBPA.

ADVANCES IN KNOWLEDGE

Despite differences in chemical structure and administered dose [¹⁸F]FBPA and [¹⁰B]L-BPA demonstrate an equivalent biodistribution in a preclinical tumor model. IMPLICATIONS FOR PATIENT CARE: [¹⁸F]FBPA-PET is suitable for treatment planning and dose calculations in BNCT applications for liver malignancies. However, alternative tracers with more favorable tumor-to-liver ratios should be investigated.

In vivo spatial correlation between (18)F-BPA and (18)F-FDG uptakes in head and neck cancer

BACKGROUND AND PURPOSE

Borono-2-(18)F-fluoro-phenylalanine ((18)F-BPA) has been used to estimate the therapeutic effects of boron neutron capture therapy (BNCT), while (18)F-fluorodeoxyglucose ((18)F-FDG) is the most commonly used positron emission tomography (PET) radiopharmaceutical in a routine clinical use. The aim of the present study was to evaluate spatial correlation between (18)F-BPA and (18)F-FDG uptakes using a deformable image registration-based technique.

MATERIAL AND METHODS

Ten patients with head and neck cancer were recruited from January 2014 to December 2014. All patients underwent whole-body (18)F-BPA PET/computed tomography (CT) and (18)F-FDG PET/CT within a 2-week period. For each patient, (18)F-BPA PET/CT and (18)F-FDG PET/CT images were aligned based on a deformable image registration framework. The voxel-by-voxel spatial correlation of standardized uptake value (SUV) within the tumor was analyzed.

RESULTS

Our image processing framework achieved accurate and validated registration results for each PET/CT image. In 9/10 patients, the spatial distribution of SUVs between (18)F-BPA and (18)F-FDG showed a significant, positive correlation in the tumor volume.

CONCLUSIONS

Deformable image registration-based voxel-wise analysis demonstrated a spatial correlation between (18)F-BPA and (18)F-FDG uptakes in the head and neck cancer. A tumor sub-volume with a high (18)F-FDG uptake may predict high accumulation of (18)F-BPA.

Fluorine-18 patents (2009-2015). Part 1: novel radiotracers

The most commonly utilized PET radionuclide is fluorine-18 ((18)F) because of its convenient half-life and excellent imaging properties. In this review, we present the first analysis of patents issued for radiotracers labeled with fluorine-18 (between 2009 and 2015), and provide perspective on current trends and future directions in PET radiotracer development.

Low energy positron interactions with uracil--total scattering, positronium formation, and differential elastic scattering cross sections

Measurements of the grand total and total positronium formation cross sections for positron scattering from uracil have been performed for energies between 1 and 180 eV, using a trap-based beam apparatus. Angular, quasi-elastic differential cross section measurements at 1, 3, 5, 10, and 20 eV are also presented and discussed. These measurements are compared to existing experimental results and theoretical calculations, including our own calculations using a variant of the independent atom approach.