title: Neoadjuvant targeting of glioblastoma multiforme with radiolabeled DOTAGA-substance P--results from a phase I study.
abstract: Complete surgical resection beyond tumor margins cannot be achieved in glioblastoma multiforme (GBM) because of infiltrative nature. In several cancers, neoadjuvant treatment has been implemented to reduce the risk of tumor cell spreading during resection. In GBM, the objective of a neoadjuvant approach is reduction of tumor cells within the main tumor mass and beyond in the infiltration zone. Such an approach can only be performed if elevated intracranial pressure can be medically controlled. In a previous study with recurrent gliomas, we showed that local intratumoral injection of radiolabeled DOTAGA-substance P substantially inhibited further growth and led to radionecrotic transformation of the tumor (CCR 2006). We have now examined this modality as neoadjuvant treatment for GBM, primarily assessing feasibility, toxicity, the extent of resection, and functional outcome. After diagnosis of GBM, 17 patients were included in a prospective phase I study. Repetitive intratumoral injections of radiolabeled DOTAGA-substance P were performed, followed by surgical resection. Chemical synthesis, radiolabeling, and local injection of the peptidic vector [90Yttrium]-DOTAGA-substance P were described previously. Neoadjuvant injection of [90Y]-DOTAGA-substance P was feasible without decompensation of intracranial pressure. Prolonged application of corticosteroids was identified as the main risk factor for side effects. Fifteen patients stabilized or improved their functional status. The mean extent of resection in subsequent surgery was 96%. Neoadjuvant therapy of GBM using locally injected radiolabeled DOTAGA-substance P was feasible and of low toxicity. The high extent of resection and concomitant irradiation of tumor cells in the infiltration zone may be prognostically relevant.
authors.affiliation: Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. cordierd@uhbs.ch
authors.forename: Dominik
authors.initials: D
authors.lastname: Cordier
authors.forename: Flavio
authors.initials: F
authors.lastname: Forrer
authors.forename: Stefan
authors.initials: S
authors.lastname: Kneifel
authors.forename: Martin
authors.initials: M
authors.lastname: Sailer
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Helmut
authors.initials: H
authors.lastname: Mäcke
authors.forename: Jan
authors.initials: J
authors.lastname: Müller-Brand
authors.forename: Adrian
authors.initials: A
authors.lastname: Merlo
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000188:drug therapy* / Q000532:radiotherapy*; D006573:Heterocyclic Compounds, 1-Ring / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D013373:Substance P / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D006573:Heterocyclic Compounds, 1-Ring; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C513199:substance P, 1,4,7,10-tetraazacyclododecane-1-glutaric acid-4,7,10-triacetic acid-arginyl(1)-; D013373:Substance P