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Oldan JD, Pomper MG, Werner RA, Higuchi T, Rowe SP. The cutting edge: Promising oncology radiotracers in clinical development. Diagn Interv Imaging 2024:S2211-5684(24)00106-2. [PMID: 38744576 DOI: 10.1016/j.diii.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024]
Abstract
Molecular imaging moves forward with the development of new imaging agents, and among these are new radiotracers for nuclear medicine applications, particularly positron emission tomography (PET). A number of new targets are becoming accessible for use in oncologic applications. In this review, major new radiotracers in clinical development are discussed. Prominent among these is the family of fibroblast-activation protein-targeted agents that interact with the tumor microenvironment and may show superiority to 2-deoxy-2-[18F]fluoro-d-glucose in a subset of different tumor histologies. Additionally, carbonic anhydrase IX (CAIX) inhibitors are directed at clear cell renal cell carcinoma, which has long lacked an effective PET imaging agent. Those CAIX agents may also have utility in hypoxic tumors. Pentixafor, which binds to a transmembrane receptor, may similarly allow for visualization by PET of low-grade lymphomas, as well as being a second agent for multiple myeloma that opens theranostic possibilities. There are new adrenergic agents aimed at providing a PET-visible replacement to the single-photon-emitting radiotracer meta-[123I]iodobenzylguanidine (MIBG). Finally, in response to a major development in oncologic chemotherapy, there are new radiotracers targeted at assessing the suitability or use of immunotherapeutic agents. All of these and the existing evidence for their utility are discussed.
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Affiliation(s)
- Jorge D Oldan
- Molecular Imaging and Therapeutics, Department of Radiology, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Martin G Pomper
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Rudolf A Werner
- Goethe University Frankfurt, University Hospital, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Division of Nuclear Medicine, 60590 Frankfurt, Germany
| | - Takahiro Higuchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Steven P Rowe
- Molecular Imaging and Therapeutics, Department of Radiology, University of North Carolina, Chapel Hill, NC 27516, USA.
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Shi M, Simiele E, Han B, Pham D, Palomares P, Aguirre M, Gensheimer M, Vitzthum L, Le QT, Surucu M, Kovalchuk N. First-Year Experience of Stereotactic Body Radiation Therapy/Intensity Modulated Radiation Therapy Treatment Using a Novel Biology-Guided Radiation Therapy Machine. Adv Radiat Oncol 2024; 9:101300. [PMID: 38260216 PMCID: PMC10801639 DOI: 10.1016/j.adro.2023.101300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose The aim of this study was to present the first-year experience of treating patients using intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) with a biology-guided radiation therapy machine, the RefleXion X1 system, installed in a clinical setting. Methods and Materials A total of 78 patients were treated on the X1 system using IMRT and SBRT from May 2021 to May 2022. Clinical and technical data including treatment sites, number of pretreatment kilovoltage computed tomography (kVCT) scans, beam-on time, patient setup time, and imaging time were collected and analyzed. Machine quality assurance (QA) results, machine performance, and user satisfactory survey were also collected and reported. Results The most commonly treated site was the head and neck (63%), followed by the pelvis (23%), abdomen (8%), and thorax (6%). Except for 5 patients (6%) who received SBRT treatments for bony metastases in the pelvis, all treatments were conventionally fractionated IMRT. The number of kVCT scans per fraction was 1.2 ± 0.5 (mean ± standard deviation). The beam-on time was 9.2 ± 3.5 minutes. The patient setup time and imaging time per kVCT was 4.8 ± 2.6 minutes and 4.6 ± 1.5 minutes, respectively. The daily machine output deviation was 0.4 ± 1.2% from the baseline. The patient QA had a passing rate of 97.4 ± 2.8% at 3%/2 mm gamma criteria. The machine uptime was 92% of the total treatment time. The daily QA and kVCT image quality received the highest level of satisfaction. The treatment workflow for therapists received the lowest level of satisfaction. Conclusions One year after the installation, 78 patients were successfully treated with the X1 system using IMRT and/or SBRT. With the recent Food and Drug Administration clearance of biology-guided radiation therapy, our department is preparing to treat patients using positron emission tomography-guidance via a new product release, which will address deficiencies in the current image-guided radiation therapy workflow.
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Affiliation(s)
- Mengying Shi
- Department of Radiation Oncology, Stanford University, Stanford, California
- Department of Radiation Oncology, University of California, Irvine, Orange, California
| | - Eric Simiele
- Department of Radiation Oncology, Stanford University, Stanford, California
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Bin Han
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Daniel Pham
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Paul Palomares
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Michaela Aguirre
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Michael Gensheimer
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Lucas Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Nataliya Kovalchuk
- Department of Radiation Oncology, Stanford University, Stanford, California
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Radaram B, Glazer SE, Yang P, Li CW, Hung MC, Gammon ST, Alauddin M, Piwnica-Worms D. Evaluation of 89Zr-Labeled Anti-PD-L1 Monoclonal Antibodies Using DFO and Novel HOPO Analogues as Chelating Agents for Immuno-PET. ACS OMEGA 2023; 8:17181-17194. [PMID: 37214681 PMCID: PMC10193402 DOI: 10.1021/acsomega.3c01547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 05/24/2023]
Abstract
Programmed death ligand 1 (PD-L1) is a type 1 transmembrane immunosuppressive protein that is expressed on a wide range of cell types, including cancer cells. Anti-PD-L1 antibodies have revolutionized cancer therapy and have led to improved outcomes for subsets of cancer patients, including triple-negative breast cancer (TNBC) patients. As a result, PET imaging of PD-L1 protein expression in cancer patients has been explored for noninvasive detection of PD-L1 expressing tumors as well as monitoring response to anti-PD-L1 immune checkpoint therapy. Previous studies have indicated that the in vivo stability and in vivo target detection of antibody-based radio-conjugates can be dramatically affected by the chelator used. These reports demonstrated that the chelator HOPO diminishes 89Zr de-chelation compared to DFO. Herein, we report an improved HOPO synthesis and evaluated a series of novel analogues for thermal stability, serum stability, PD-L1-specific binding using the BT-549 TNBC cell line, PET imaging in vivo, as well as biodistribution of 89Zr-labeled anti-PD-L1 antibodies in BT-549 xenograft murine models. A new chelator, C5HOPO, demonstrated high stability in vitro and afforded effective PD-L1 targeting in vivovia immuno-PET. These results demonstrated that an improved HOPO chelator is an effective chelating agent that can be utilized to image therapeutically relevant targets in vivo.
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Affiliation(s)
- Bhasker Radaram
- Department
of Cancer Systems Imaging and Department of Molecular & Cellular
Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030, United States
| | - Sarah E. Glazer
- Department
of Cancer Systems Imaging and Department of Molecular & Cellular
Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030, United States
| | - Ping Yang
- Department
of Cancer Systems Imaging and Department of Molecular & Cellular
Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030, United States
| | - Chia-Wei Li
- Department
of Cancer Systems Imaging and Department of Molecular & Cellular
Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030, United States
| | - Mien-Chie Hung
- Department
of Cancer Systems Imaging and Department of Molecular & Cellular
Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030, United States
| | - Seth T. Gammon
- Department
of Cancer Systems Imaging and Department of Molecular & Cellular
Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030, United States
| | - Mian Alauddin
- Department
of Cancer Systems Imaging and Department of Molecular & Cellular
Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030, United States
| | - David Piwnica-Worms
- Department
of Cancer Systems Imaging and Department of Molecular & Cellular
Oncology, The University of Texas MD Anderson
Cancer Center, Houston, Texas 77030, United States
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Natarajan A, Khan S, Liang X, Nguyen H, Das N, Anders D, Malik N, Oderinde OM, Chin FT, Rosenthal E, Pratx G. Preclinical Evaluation of 89Zr-Panitumumab for Biology-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00056-1. [PMID: 36669541 DOI: 10.1016/j.ijrobp.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE Biology-guided radiation therapy (BgRT) uses real-time line-of-response data from on-board positron emission tomography (PET) detectors to guide beamlet delivery during therapeutic radiation. The current workflow requires 18F-fluorodeoxyglucose (FDG) administration daily before each treatment fraction. However, there are advantages to reducing the number of tracer injections by using a PET tracer with a longer decay time. In this context, we investigated 89Zr-panitumumab (89Zr-Pan), an antibody PET tracer with a half-life of 78 hours that can be imaged for up to 9 days using PET. METHODS AND MATERIALS The BgRT workflow was evaluated preclinically in mouse colorectal cancer xenografts (HCT116) using small-animal positron emission tomography/computed tomography (PET/CT) for imaging and image-guided kilovoltage conformal irradiation for therapy. Mice (n = 5 per group) received 7 MBq of 89Zr-Pan as a single dose 2 weeks after tumor induction, with or without fractionated radiation therapy (RT; 6 × 6.6 Gy) to the tumor region. The mice were imaged longitudinally to assess the kinetics of the tracer over 9 days. PET images were then analyzed to determine the stability of the PET signal in irradiated tumors over time. RESULTS Mice in the treatment group experienced complete tumor regression, whereas those in the control group were killed because of tumor burden. PET imaging of 89Zr-Pan showed well-delineated tumors with minimal background in both groups. On day 9 postinjection, tumor uptake of 89Zr-Pan was 7.2 ± 1.7 in the control group versus 5.2 ± 0.5 in the treatment group (mean percentage of injected dose per gram of tissue [%ID/g] ± SD; P = .07), both significantly higher than FDG uptake (1.1 ± 0.5 %ID/g) 1 hour postinjection. To assess BgRT feasibility, the clinical eligibility criteria was computed using human-equivalent uptake values that were extrapolated from preclinical PET data. Based on this semiquantitative analysis, BgRT may be feasible for 5 consecutive days after a single 740-MBq injection of 89Zr-Pan. CONCLUSIONS This study indicates the potential of long-lived antibody-based PET tracers for guiding clinical BgRT.
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Affiliation(s)
| | - Syamantak Khan
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Xuanwei Liang
- Department of Physics, Foothill College, Los Altos, California
| | - Hieu Nguyen
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Neeladrisingha Das
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - David Anders
- Department of Radiology, Stanford University, Stanford, California
| | - Noeen Malik
- Department of Radiology, Stanford University, Stanford, California
| | | | - Frederick T Chin
- Department of Radiology, Stanford University, Stanford, California
| | - Eben Rosenthal
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Guillem Pratx
- Department of Radiation Oncology, Stanford University, Stanford, California.
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