title: [131I]iodometomidate for targeted radionuclide therapy of advanced adrenocortical carcinoma.
abstract: BACKGROUND
  In advanced adrenocortical carcinoma (ACC), many patients have progressive disease despite standard treatment, indicating a need for new treatment options. We have shown high and specific retention of [123I]metomidate ([123I]IMTO) in ACC lesions, suggesting that labeling of metomidate with 131I offers targeted radionuclide therapy for advanced ACC.
  
  
  OBJECTIVE
  Safety and efficacy of radionuclide therapy with [131I]IMTO in advanced ACC.
  
  
  METHODS
  This monocentric case series comprised 19 treatments in 11 patients with nonresectable ACC.
  
  
  METHODS
  Between 2007 and 2010, patients with advanced ACC not amenable to radical surgery and exhibiting high uptake of [123I]IMTO in their tumor lesions were offered treatment with [131I]IMTO (1.6-20 GBq in one to three cycles of [131I]IMTO).
  
  
  METHODS
  Tumor response was assessed according to response evaluation criteria in solid tumors (RECIST version 1.1) criteria, and side effects were assessed by Common Toxicity Criteria (version 4.0).
  
  
  RESULTS
  Best response was classified as partial response in one case with a change in target lesions of -51% from baseline, as stable disease in five patients, and as progressive disease in four patients. One patient died 11 d after treatment with [131I]IMTO unrelated to radionuclide therapy. In patients responding to treatment, median progression-free survival was 14 months (range, 5-33) with ongoing disease stabilization in three patients at last follow-up. Treatment was well tolerated, but transient bone marrow depression was observed. Adrenal insufficiency developed in two patients.
  
  
  CONCLUSIONS
  Radionuclide therapy with [131I]IMTO is a promising treatment option for selected patients with ACC, deserving evaluation in prospective clinical trials.
authors.affiliation: Endocrinology and Diabetes Unit, Department of Medicine I, University of Wuerzburg, Oberduerrbacher Strasse 6, D-97080 Wuerzburg, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hahner
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kreissl
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
authors.forename: Heribert
authors.initials: H
authors.lastname: Haenscheid
authors.forename: Pascal
authors.initials: P
authors.lastname: Knoedler
authors.forename: Katharina
authors.initials: K
authors.lastname: Lang
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Buck
authors.forename: Christoph
authors.initials: C
authors.lastname: Reiners
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.forename: Andreas
authors.initials: A
authors.lastname: Schirbel
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000532:radiotherapy*; D018268:Adrenocortical Carcinoma / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005045:Etomidate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; C084586:metomidate; D005045:Etomidate