title: Pharmacokinetics and Dosimetry Studies for Optimization of Pretargeted Radioimmunotherapy in CEA-Expressing Advanced Lung Cancer Patients.
abstract: OBJECTIVE
  A phase I pretargeted radioimmunotherapy trial (EudractCT 200800603096) was designed in patients with metastatic lung cancer expressing carcinoembryonic antigen (CEA) to optimize bispecific antibody and labeled peptide doses, as well as the delay between their injections.
  
  
  METHODS
  Three cohorts of three patients received the anti-CEA × anti-histamine-succinyl-glycine (HSG)-humanized trivalent bispecific antibody (TF2) and the IMP288 bivalent HSG peptide. Patients underwent a pretherapeutic imaging session S1 (44 or 88 nmol/m(2) of TF2 followed by 4.4 nmol/m(2), 185 MBq, of (111)In-labeled IMP288) and, 1-2 weeks later, a therapy session S2 (240 or 480 nmol/m(2) of TF2 followed by 24 nmol/m(2), 1.1 GBq/m(2), of (177)Lu-labeled IMP288). The pretargeting delay was 24 or 48 h. The dose schedule was defined based on preclinical TF2 pharmacokinetic (PK) studies, on our previous clinical data using the previous anti-CEA-pretargeting system, and on clinical results observed in the first patients injected using the same system in Netherlands.
  
  
  RESULTS
  TF2 PK was represented by a two-compartment model in which the central compartment volume (Vc) was linearly dependent on the patient's surface area. PK was remarkably similar, with a clearance of 0.33 ± 0.03 L/h/m(2). (111)In- and (177)Lu-IMP288 PK was also well represented by a two-compartment model. IMP288 PK was faster (clearance 1.4-3.3 L/h). The Vc was proportional to body surface area, and IMP288 clearance depended on the molar ratio of injected IMP288 to circulating TF2 at the time of IMP288 injection. Modeling of image quantification confirmed the dependence of IMP288 kinetics on circulating TF2, but tumor activity PK was variable. Organ-absorbed doses were not significantly different in the three cohorts, but the tumor dose was significantly higher with the higher molar doses of TF2 (p < 0.002). S1 imaging predicted absorbed doses calculated in S2.
  
  
  CONCLUSIONS
  The best dosing parameters corresponded to the shorter pretargeting delay and to the highest TF2 molar doses. S1 imaging session accurately predicted PK as well as absorbed doses of S2, thus potentially allowing for patient selection and dose optimization.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01221675 (EudractCT 200800603096).
authors.affiliation: Department of Nuclear Medicine, University Hospital Nantes , Nantes , France ; CNRS UMR 6299, Centre Régional de Recherche en Cancérologie Nantes/Angers (CRCNA), INSERM U892 , Nantes , France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bodet-Milin
authors.affiliation: CNRS UMR 6299, Centre Régional de Recherche en Cancérologie Nantes/Angers (CRCNA), INSERM U892 , Nantes , France ; Department of Nuclear Medicine, ICO Cancer Centre , Saint-Herblain , France ; Physics Unit, ICO Cancer Centre , Saint-Herblain , France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Ferrer
authors.affiliation: CNRS UMR 6299, Centre Régional de Recherche en Cancérologie Nantes/Angers (CRCNA), INSERM U892 , Nantes , France ; Department of Nuclear Medicine, ICO Cancer Centre , Saint-Herblain , France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Rauscher
authors.affiliation: Department of Biochemistry, University Hospital Nantes , Nantes , France.
authors.forename: Damien
authors.initials: D
authors.lastname: Masson
authors.affiliation: CNRS UMR 6299, Centre Régional de Recherche en Cancérologie Nantes/Angers (CRCNA), INSERM U892 , Nantes , France.
authors.forename: Latifa
authors.initials: L
authors.lastname: Rbah-Vidal
authors.affiliation: Department of Nuclear Medicine, University Hospital Nantes , Nantes , France ; CNRS UMR 6299, Centre Régional de Recherche en Cancérologie Nantes/Angers (CRCNA), INSERM U892 , Nantes , France.
authors.forename: Alain
authors.initials: A
authors.lastname: Faivre-Chauvet
authors.affiliation: Department of Nuclear Medicine, University Hospital Nantes , Nantes , France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Cerato
authors.affiliation: CNRS UMR 6299, Centre Régional de Recherche en Cancérologie Nantes/Angers (CRCNA), INSERM U892 , Nantes , France ; Department of Nuclear Medicine, ICO Cancer Centre , Saint-Herblain , France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rousseau
authors.affiliation: Department of Pneumology, University Hospital Angers , Angers , France.
authors.forename: José
authors.initials: J
authors.lastname: Hureaux
authors.affiliation: Department of Nuclear Medicine, University Hospital Angers , Angers , France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Couturier
authors.affiliation: Department of Nuclear Medicine, University Hospital Brest , Brest , France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Salaün
authors.affiliation: IBC Pharmaceuticals, Inc. , Morris Plains, NJ , USA ; Immunomedics, Inc. , Morris Plains, NJ , USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Goldenberg
authors.affiliation: Immunomedics, Inc. , Morris Plains, NJ , USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sharkey
authors.affiliation: Department of Nuclear Medicine, University Hospital Nantes , Nantes , France ; CNRS UMR 6299, Centre Régional de Recherche en Cancérologie Nantes/Angers (CRCNA), INSERM U892 , Nantes , France ; Department of Nuclear Medicine, ICO Cancer Centre , Saint-Herblain , France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Kraeber-Bodéré
authors.affiliation: CNRS UMR 6299, Centre Régional de Recherche en Cancérologie Nantes/Angers (CRCNA), INSERM U892 , Nantes , France ; GIP Arronax , Saint-Herblain , France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Barbet
keywords: SPECT; SPECT/CT; dosimetry; lung cancer; pharmacokinetics; pretargeting; radioimmunotherapy; scintigraphy