title: Applying PET to broaden the diagnostic utility of the clinically validated CA19.9 serum biomarker for oncology.
abstract: Despite their considerable advantages, many circulating biomarkers have well-documented limitations. One prominent shortcoming in oncology is a high frequency of false-positive indications for malignant disease in upfront diagnosis. Because one common cause of false positivism is biomarker production from benign disorders in unrelated host tissues, we hypothesized that probing the sites of biomarker secretion with an imaging tool could be a broadly useful strategy to deconvolute the meaning of foreboding but inconclusive circulating biomarker levels.
  
  
  METHODS
  In preparation to address this hypothesis clinically, we developed (89)Zr-5B1, a fully human, antibody-based radiotracer targeting tumor-associated CA19.9 in the preclinical setting.
  
  
  RESULTS
  (89)Zr-5B1 localized to multiple tumor models representing diseases with undetectable and supraphysiologic serum CA19.9 levels. Among these, (89)Zr-5B1 detected orthotopic models of pancreatic ductal adenocarcinoma, an elusive cancer for which the serum assay is measured in humans but with limited specificity in part because of the frequency of CA19.9 secretion from benign hepatic pathologies.
  
  
  CONCLUSIONS
  In this report, a general strategy to supplement some of the shortcomings of otherwise highly useful circulating biomarkers with immunoPET is described. To expedite the clinical validation of this model, a human monoclonal antibody to CA19.9 (a highly visible but partially flawed serum biomarker for several cancers) was radiolabeled and evaluated, and the compelling preclinical evidence suggests that the radiotracer may enhance the fidelity of diagnosis and staging of pancreatic ductal adenocarcinoma, a notoriously occult cancer.
authors.affiliation: Program in Molecular Pharmacology and Chemistry, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Nerissa Therese
authors.initials: NT
authors.lastname: Viola-Villegas
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Rice
authors.forename: Sean
authors.initials: S
authors.lastname: Carlin
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Wu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Evans
authors.forename: Kuntal K
authors.initials: KK
authors.lastname: Sevak
authors.forename: Marija
authors.initials: M
authors.lastname: Drobjnak
authors.forename: Govind
authors.initials: G
authors.lastname: Ragupathi
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Sawada
authors.forename: Wolfgang W
authors.initials: WW
authors.lastname: Scholz
authors.forename: Philip O
authors.initials: PO
authors.lastname: Livingston
authors.forename: Jason S
authors.initials: JS
authors.lastname: Lewis
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000493:pharmacokinetics; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D045744:Cell Line, Tumor; D002471:Cell Transformation, Neoplastic; D005260:Female; D006801:Humans; D051379:Mice; D009369:Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011868:Radioisotopes; D015040:Zirconium
chemical_list: D000911:Antibodies, Monoclonal; D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D011868:Radioisotopes; C578959:carbohydrate antigen 199, human; D015040:Zirconium
keywords: CA19.9; PET imaging; pancreatic adenocarcinoma
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