title: Fractionated radioimmunotherapy of intraperitoneally growing ovarian cancer in nude mice with 211At-MX35 F(ab')2: therapeutic efficacy and myelotoxicity.
abstract: OBJECTIVE
  The aim of this study was to investigate the therapeutic efficacy and myelotoxicity during fractionated radioimmunotherapy of ovarian cancer in mice. The study was performed using the monoclonal antibody MX35 F(ab')(2) labeled with the alpha-particle emitter (211)At.
  
  
  METHODS
  Animals were intraperitoneally inoculated with approximately 1x10(7) cells of the cell line NIH:OVCAR-3. Four weeks later, the mice were given the first treatment. Six groups of animals were intraperitoneally injected with approximately 800, 3x approximately 267, approximately 400, 3x approximately 133, approximately 50 or 3x approximately 17 kBq (211)At-MX35 F(ab')(2) (n=18 in each group). The second and third injections for Groups 2, 4 and 6 were given 4 and 8 days after the first injection, respectively. As controls, animals were treated with unlabeled MX35 F(ab')(2) (n=12). Eight weeks after the last injection, the animals were sacrificed and the presence of macro- and microscopic tumors and ascites was determined. Blood counts were determined for each mouse in Groups 1 and 2 before the first injection and 3, 7, 11, 15 and 23 days after the first injection. The calculation of the mean absorbed dose to the bone marrow was based on the ratio between the (211)At-activity concentration in bone and blood [i.e., the bone-to-blood ratio (BBLR)] as well as that between the (211)At-activity concentration in bone marrow and blood [i.e., the bone-marrow-to-blood ratio (BMBLR)] and the cumulated activity and absorbed fraction of the alpha-particles emitted by (211)At in the bone marrow.
  
  
  RESULTS
  The tumor-free fractions of animals were 56% and 41% when treated with approximately 800 kBq and 3x approximately 267 kBq (211)At-MX35 F(ab')(2), respectively; 39% and 28% when treated with approximately 400 kBq and 3x approximately 133 kBq (211)At-MX35 F(ab')(2), respectively; and 17% and 22% when treated with approximately 50 kBq or 3x approximately 17 kBq (211)At-MX35 F(ab')(2), respectively. The nadir of the white blood cell (WBC) counts was decreased (from 46% to 19%, compared with the baseline WBC counts) and delayed (from Day 4 to Day 11 after the first injection) during the fractionated treatment compared with the single-dose treatment. The percentage of injected activity per gram (%IA/g) for blood, bone and bone marrow all peaked 6 h after injection at 13.80+/-1.34%IA/g, 4.00+/-0.69%IA/g and 8.28+/-1.38%IA/g, respectively. The BBLR and BMBLR were 0.20+/-0.04 and 0.58+/-0.01, respectively. The mean absorbed dose to bone marrow was approximately 0.4 Gy after intraperitoneally injecting approximately 800 kBq (211)At-MX35 F(ab')(2).
  
  
  CONCLUSIONS
  No advantage was observed in the therapeutic efficacy of using a fractionated regimen compared with a single administration, with the same total amount of administered activity. Alleviation of the myelotoxicity was observed during the fractionated regimen in terms of decreased suppression and delayed nadir of the WBC counts. No thrombocytopenia was observed during either regimen.
authors.affiliation: Department of Radiation Physics, The Sahlgrenska Academy at Göteborg University, SE-413 45 Göteborg, Sweden. jorgen.elgqvist@radfys.gu.se <jorgen.elgqvist@radfys.gu.se>
authors.forename: Jörgen
authors.initials: J
authors.lastname: Elgqvist
authors.forename: Håkan
authors.initials: H
authors.lastname: Andersson
authors.forename: Tom
authors.initials: T
authors.lastname: Bäck
authors.forename: Ingela
authors.initials: I
authors.lastname: Claesson
authors.forename: Ragnar
authors.initials: R
authors.lastname: Hultborn
authors.forename: Holger
authors.initials: H
authors.lastname: Jensen
authors.forename: Sture
authors.initials: S
authors.lastname: Lindegren
authors.forename: Marita
authors.initials: M
authors.lastname: Olsson
authors.forename: Stig
authors.initials: S
authors.lastname: Palm
authors.forename: Elisabet
authors.initials: E
authors.lastname: Warnhammar
authors.forename: Lars
authors.initials: L
authors.lastname: Jacobsson
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001853:Bone Marrow / Q000528:radiation effects*; D045744:Cell Line, Tumor; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D051379:Mice; D009942:Organometallic Compounds / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010051:Ovarian Neoplasms / Q000532:radiotherapy*; D010534:Peritoneal Neoplasms / Q000532:radiotherapy*; D016499:Radioimmunotherapy / Q000009:adverse effects
chemical_list: C507514:211At-labeled monoclonal antibody MX35; D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D009942:Organometallic Compounds