title: Predictive patient-specific dosimetry and individualized dosing of pretargeted radioimmunotherapy in patients with advanced colorectal cancer.
abstract: OBJECTIVE
  Pretargeted radioimmunotherapy (PRIT) with bispecific antibodies (bsMAb) and a radiolabeled peptide reduces the radiation dose to normal tissues. Here we report the accuracy of an (111)In-labeled pretherapy test dose for personalized dosing of (177)Lu-labeled IMP288 following pretargeting with the anti-CEA × anti-hapten bsMAb, TF2, in patients with metastatic colorectal cancer (CRC).
  
  
  METHODS
  In 20 patients bone marrow absorbed doses (BMD) and doses to the kidneys were predicted based on blood samples and scintigrams acquired after (111)In-IMP288 injection for individualized dosing of PRIT with (177)Lu-IMP288. Different dose schedules were studied, varying the interval between the bsMAb and peptide administration (5 days vs. 1 day), increasing the bsMAb dose (75 mg vs. 150 mg), and lowering the peptide dose (100 μg vs. 25 μg).
  
  
  RESULTS
  TF2 and (111)In/(177)Lu-IMP288 clearance was highly variable. A strong correlation was observed between peptide residence times and individual TF2 blood concentrations at the time of peptide injection (Spearman's ρ = 0.94, P < 0.0001). PRIT with 7.4 GBq (177)Lu-IMP288 resulted in low radiation doses to normal tissues (BMD <0.5 Gy, kidney dose <3 Gy). Predicted (177)Lu-IMP288 BMD were in good agreement with the actual measured doses (mean ± SD difference -0.0026 ± 0.028 mGy/MBq). Hematological toxicity was mild in most patients, with only two (10 %) having grade 3-4 thrombocytopenia. A correlation was found between platelet toxicity and BMD (Spearman's ρ = 0.58, P = 0.008). No nonhematological toxicity was observed.
  
  
  CONCLUSIONS
  These results show that individual high activity doses in PRIT in patients with CEA-expressing CRC could be safely administered by predicting the radiation dose to red marrow and kidneys, based on dosimetric analysis of a test dose of TF2 and (111)In-IMP288.
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Rafke
authors.initials: R
authors.lastname: Schoffelen
authors.forename: Wietske
authors.initials: W
authors.lastname: Woliner-van der Weg
authors.forename: Eric P
authors.initials: EP
authors.lastname: Visser
authors.forename: David M
authors.initials: DM
authors.lastname: Goldenberg
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sharkey
authors.forename: William J
authors.initials: WJ
authors.lastname: McBride
authors.forename: Chien-Hsing
authors.initials: CH
authors.lastname: Chang
authors.forename: Edmund A
authors.initials: EA
authors.lastname: Rossi
authors.forename: Winette T A
authors.initials: WT
authors.lastname: van der Graaf
authors.forename: Wim J G
authors.initials: WJ
authors.lastname: Oyen
authors.forename: Otto C
authors.initials: OC
authors.lastname: Boerman
mesh_terms: D000328:Adult; D000368:Aged; D018033:Antibodies, Bispecific / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D002272:Carcinoembryonic Antigen / Q000276:immunology; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006241:Haptens / Q000276:immunology; D006573:Heterocyclic Compounds, 1-Ring / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D007205:Indium Radioisotopes / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D008187:Lutetium / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D057285:Precision Medicine / Q000379:methods*; D011829:Radiation Dosage; D016499:Radioimmunotherapy; D011874:Radiometry / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D018033:Antibodies, Bispecific; D002272:Carcinoembryonic Antigen; C515662:DOTA-tyrosyl-lysyl(histaminyl-succinyl-glycyl)-glutamyl-lysyl(histaminyl-succinyl-glycyl)amide; D006241:Haptens; D006573:Heterocyclic Compounds, 1-Ring; D007205:Indium Radioisotopes; D009842:Oligopeptides; D008187:Lutetium