title: Comparison of the Therapeutic Response to Treatment with a 177Lu-Labeled Somatostatin Receptor Agonist and Antagonist in Preclinical Models.
abstract: Peptide receptor scintigraphy and peptide receptor radionuclide therapy using radiolabeled somatostatin receptor (SSTR) agonists are successfully used in the clinic for imaging and treatment of neuroendocrine tumors. Contrary to the paradigm that internalization and the resulting accumulation of radiotracers in cells is necessary for efficient tumor targeting, recent studies have demonstrated the superiority of radiolabeled SSTR antagonists for imaging purposes, despite little to no internalization in cells. However, studies comparing the therapeutic antitumor effects of radiolabeled SSTR agonists versus antagonists are lacking. The aim of this study was to directly compare the therapeutic effect of (177)Lu-DOTA-octreotate, an SSTR agonist, and (177)Lu-DOTA-JR11, an SSTR antagonist.
  
  
  METHODS
  We analyzed radiotracer uptake (both membrane-bound and internalized fractions) and the produced DNA double-strand breaks, by determining the number of p53 binding protein 1 foci, after incubating SSTR2-positive cells with (177)Lu-diethylene triamine pentaacetic acid, (177)Lu-DOTA-octreotate, or (177)Lu-DOTA-JR11. Also, biodistribution studies were performed in tumor-xenografted mice to determine the optimal dose for therapy experiments. Afterward, in vivo therapy experiments comparing the effect of (177)Lu-DOTA-octreotate and (177)Lu-DOTA-JR11 were performed in this same animal model.
  
  
  RESULTS
  We found a 5-times-higher uptake of (177)Lu-DOTA-JR11 than of (177)Lu-DOTA-octreotate. The major part (88% ± 1%) of the antagonist uptake was membrane-bound, whereas 74% ± 3% of the total receptor agonist uptake was internalized. Cells treated with (177)Lu-DOTA-JR11 showed 2 times more p53-binding protein 1 foci than cells treated with (177)Lu-DOTA-octreotate. Biodistribution studies with (177)Lu-DOTA-JR11 (0.5 μg/30 MBq) resulted in the highest tumor radiation dose of 1.8 ± 0.7 Gy/MBq, 4.4 times higher than the highest tumor radiation dose found for (177)Lu-DOTA-octreotate. In vivo therapy studies with (177)Lu-DOTA-octreotate and (177)Lu-DOTA-JR11 resulted in a tumor growth delay time of 18 ± 5 and 26 ± 7 d, respectively. Median survival rates were 43.5, 61, and 71 d for the control group, (177)Lu-DOTA-octreotate group, and the (177)Lu-DOTA-JR11-treated group, respectively.
  
  
  CONCLUSIONS
  On the basis of these results, we concluded that the use of radiolabeled SSTR antagonists such as JR11 might enhance peptide receptor scintigraphy and peptide receptor radionuclide therapy of neuroendocrine tumors and provide successful imaging and therapeutic strategies for cancer types with relatively low SSTR expression.
authors.affiliation: Department of Nuclear Medicine and Radiology, Erasmus MC, Rotterdam, The Netherlands; and s.dalm@erasmusmc.nl.
authors.forename: Simone U
authors.initials: SU
authors.lastname: Dalm
authors.affiliation: Department of Nuclear Medicine and Radiology, Erasmus MC, Rotterdam, The Netherlands; and Department of Genetics, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Julie
authors.initials: J
authors.lastname: Nonnekens
authors.affiliation: Department of Nuclear Medicine and Radiology, Erasmus MC, Rotterdam, The Netherlands; and.
authors.forename: Gabriela N
authors.initials: GN
authors.lastname: Doeswijk
authors.affiliation: Department of Nuclear Medicine and Radiology, Erasmus MC, Rotterdam, The Netherlands; and.
authors.forename: Erik
authors.initials: E
authors.lastname: de Blois
authors.affiliation: Department of Genetics, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Dik C
authors.initials: DC
authors.lastname: van Gent
authors.affiliation: Department of Nuclear Medicine and Radiology, Erasmus MC, Rotterdam, The Netherlands; and.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Konijnenberg
authors.affiliation: Department of Nuclear Medicine and Radiology, Erasmus MC, Rotterdam, The Netherlands; and.
authors.forename: Marion
authors.initials: M
authors.lastname: de Jong
mesh_terms: D000818:Animals; D045744:Cell Line, Tumor; D056831:Coordination Complexes / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004249:DNA Damage; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins / Q000378:metabolism; D051379:Mice; D008807:Mice, Inbred BALB C; D018358:Neuroendocrine Tumors / Q000532:radiotherapy*; D015282:Octreotide / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D010456:Peptides, Cyclic / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011874:Radiometry; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017481:Receptors, Somatostatin / Q000819:agonists* / Q000037:antagonists & inhibitors*; D016019:Survival Analysis; D014018:Tissue Distribution; D000071857:Tumor Suppressor p53-Binding Protein 1; D023041:Xenograft Model Antitumor Assays
chemical_list: C000608228:177Lu-DOTA-octreotate; D056831:Coordination Complexes; D047908:Intracellular Signaling Peptides and Proteins; D010456:Peptides, Cyclic; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; C574734:SSTR2 protein, human; C498301:TP53BP1 protein, human; D000071857:Tumor Suppressor p53-Binding Protein 1; C000608229:177Lu-DOTA-JR11; D015282:Octreotide
keywords: PRRT; agonist; antagonist; somatostatin receptor; therapy