title: Initial experience with high-dose radioimmunotherapy of metastatic medullary thyroid cancer using 131I-MN-14 F(ab)2 anti-carcinoembryonic antigen MAb and AHSCR.
abstract: This phase I study was initiated to determine the toxicity and therapeutic potential of high-dose 131I-MN-14 F(ab)2 anti-carcinoembryonic antigen monoclonal antibody (MAb) combined with autologous hematopoietic stem cell rescue (AHSCR) in patients with rapidly progressing metastatic medullary thyroid cancer.
  
  
  METHODS
  Twelve patients were entered into the study. Dose escalation was based on prescribed radiation doses to critical organs (i.e., kidney, lung, and liver). Starting doses were 900 cGy to the kidney and no more than 1200 cGy to the lung and liver, with dose increments of 300 cGy until the maximum tolerable dose is determined. Tumor targeting was assessed by external scintigraphy, toxicity was assessed according to the common toxicity criteria of the National Cancer Institute, and therapy responses were assessed by CT, serum carcinoembryonic antigen, and calcitonin.
  
  
  RESULTS
  One patient received 9.95 GBq 131I-MN-14 F(ab)2, for an initial dose of 656 cGy to critical organs, 8 received 900 cGy (8.69-17.98 GBq), and 3 received 1200 cGy (15.17-17.69 GBq). The MAb scans of all patients showed positive findings. Autologous hematopoietic stem cells were given to all patients 1-2 wk after therapy, when the total body radiation exposure was less than 5.2 x 10(-7) C/kg/h. Dose-limiting toxicity, defined as grade 3 or 4 nonhematologic toxicity, was not seen in the patient who received the 656-cGy dose, and only 1 of the 8 patients treated at the 900-cGy dose level had grade 3 toxicity, which was gastrointestinal and reversible. No dose-limiting toxicity was seen in the 3 patients treated at the 1200-cGy dose level. Except for the instance of grade 3 gastrointestinal toxicity, nonhematologic toxicity was relatively mild, with only grade 1 or 2 toxicity observed in 9 patients. No renal toxicity was seen. Of the 12 patients, 1 had partial remission for 1 y, another had a minor response for 3 mo, and 10 had stabilization of disease lasting between 1 and 16 months.
  
  
  CONCLUSIONS
  The results show the safety of administering high myeloablative doses of 131I-MN-14 F(ab)2 with AHSCR in patients with metastatic medullary thyroid cancer. The antitumor responses in patients with aggressive, rapidly progressing disease are encouraging and warrant further research to optimize the effectiveness of this new treatment.
authors.affiliation: Garden State Cancer Center, Belleville, New Jersey 07109, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Juweid
authors.forename: G
authors.initials: G
authors.lastname: Hajjar
authors.forename: R
authors.initials: R
authors.lastname: Stein
authors.forename: R M
authors.initials: RM
authors.lastname: Sharkey
authors.forename: T
authors.initials: T
authors.lastname: Herskovic
authors.forename: L C
authors.initials: LC
authors.lastname: Swayne
authors.forename: S
authors.initials: S
authors.lastname: Suleiman
authors.forename: M
authors.initials: M
authors.lastname: Pereira
authors.forename: A D
authors.initials: AD
authors.lastname: Rubin
authors.forename: D M
authors.initials: DM
authors.lastname: Goldenberg
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018276:Carcinoma, Medullary / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016499:Radioimmunotherapy; D011879:Radiotherapy Dosage; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D007457:Iodine Radioisotopes; C110010:labetuzumab