Lesion-by-lesion comparison of computerized tomography and indium-111-labeled monoclonal antibody C110 radioimmunoscintigraphy in colorectal carcinoma: a multicenter trial.

C110 is an anti-carcinoembryonic antigen murine IgG1 monoclonal antibody. Indium-111-labeled C110 radioimmunoscintigraphy (RIS) in colorectal cancer was studied in 51 presurgical patients at four institutions. Planar and SPECT images were obtained at least twice between 48 and 96 hr after injection of 5 mCi/5 mg of 111In-C110. Fifty-one patients had 87 biopsy-proven lesions at surgery (57 hepatic, 30 extra-hepatic). Thirty-three patients (64.7%) had positive radionuclide scans, while 32 (62.8%) had positive CT scans (p = NS). While CT was better at overall lesion detection (62.1% versus 56%, p < 0.05), radionuclide scans were better than CT for extra-hepatic disease (60% versus 46.7%, p < 0.01). Hepatic metastases (52.6%) were visualized by Mab scans to selectively concentrate radioactivity. Uptake in draining lymph nodes was a significant limitation, making evaluation of these sites difficult. Indium-111-C110 shows selective uptake in metastatic colorectal cancer, including more than half of all hepatic lesions evaluated.

Improved detection of hepatic lesions using MoAb B72.3 and a modified 111In labelling technique in patients with recurrent colon cancer.

In this study, the clinical usefulness of 111In-SCN-Bz-diethylenetriaminepentaacetic acid (DTPA) monoclonal antibody (MoAb) B72.3 in patients with recurrent colorectal carcinoma was evaluated. In previous studies with radiolabelled MoAb B72.3, metastatic liver lesions in patients with colon cancer appeared as areas of either increased (hot lesions) or decreased (cold lesions) activity, and extrahepatic lesions appeared as areas of increased activity. Eleven patients were enrolled in this study, and 12 MoAb imaging study results were correlated with computed tomography/magnetic resonance imaging findings. The improved detection rates (number of hot lesions) in MoAb imaging were 48% (14/29) for hepatic metastases and 60% (6/10) for extrahepatic metastases. This represents a significant improvement in the rate of detection of metastatic disease of the liver in patients with recurrent colon cancer when compared to the rate in previous reports. Seventeen clinically unsuspected hepatic and extrahepatic areas of increased uptake were also identified on MoAb studies, and two of these areas were confirmed as metastatic disease at surgery. The rate of detection of extrahepatic metastases with 111In-SCN-Bz-DTPA MoAb B72.3 was also compared and found to be equal to the detection rates with other radiolabelled immunoconjugates. No major adverse side effects were noted during the administration of the MoAb. Four of nine patients tested had a positive anti-mouse antibody (HAMA) response 3 months after injection. These preliminary data indicate that this 111In-labelled immunoconjugate of MoAb B72.3 demonstrates an improvement in hepatic lesion detection rate than did previously reported preparations in patients with recurrent colon cancer.

Detection of recurrent colon cancer with In-111 labeled MoAb B72.3 in a patient with normal CEA and TAG-72 levels.

The usefulness of radioimmunoscintigraphy with In-111 labeled MoAb B72.3 is illustrated in this case report of a patient with an aggressive cancer of the ascending colon. When used in conjunction with CT, ultrasound examination, and MRI, radioimmunoscintigraphy improved the specificity of these other imaging modalities, although the patient's serum CEA and TAG-72 levels remained within the normal ranges. In addition, MoAb imaging demonstrated superiority over CT in identifying an additional unsuspected lesion. Detection of occult disease by imaging modalities with or without elevated serum CEA levels is discussed.

Detection of hepatic metastases from colorectal carcinoma using indium-111 (111In) labeled monoclonal antibody (mAb): MSKCC experience with mAb 111In-C110.

Sixteen patients with colorectal carcinoma and a rising serum carcinoembryonic antigen (CEA) level and no evidence of extra-abdominal disease were administered 5 mg of an anti-CEA monoclonal antibody (mAb), C110, labeled with approx. 5 mCi of 111In. All patients subsequently underwent exploratory laparotomy, and samples of tumor and normal tissue were obtained. Hepatic lesions (confirmed by histopathology) were visualized as areas of increased radiotracer uptake in 13 of 16 patients. Single photon emission computed tomography (SPECT) considerably aided detection, being positive in two patients with normal planar images. Ten of the 16 patients had positive x-ray computed tomographic (CT) images. The radioimmunodiagnostic study was falsely negative in 3 of 16 patients with subsequently proven hepatic disease, in one of whom CT was also normal. The antibody study was positive in 80% of lesions, thus being, in this small series, significantly more sensitive (P less than 0.01) than CT. 111In-C110 is a promising monoclonal antibody for the detection of hepatic metastases from colorectal carcinoma; this is the first study to show consistently greater concentration of 111In-labeled antibody in hepatic lesions than in surrounding normal hepatic parenchyma.

Characterization of antibody-chelator conjugates: determination of chelator content by terbium fluorescence titration.

Fluorescence titrations were performed by adding varying mole ratios of terbium(III) to antibody conjugates formed by benzyl isothiocyanate derivatives of three different polyaminopolycarboxylate chelators (NTA, EDTA, and DTPA) and the results compared to values for average chelator content obtained by cobalt-57 binding assays. For two different murine monoclonal antibodies, the average chelator content obtained by terbium fluorescence titration correlated closely with that measured by the cobalt-57 binding assay. It is concluded that lanthanide fluorescence titrations provide a useful alternative to radiometal binding assays for the determination of chelator content in protein-chelator conjugates.

An optimized antibody-chelator conjugate for imaging of carcinoembryonic antigen with indium-111.

A monoclonal antibody to carcinoembryonic antigen showing minimal cross-reactivity with blood cells and normal tissues was derivatized with benzylisothiocyanate derivatives of EDTA and DTPA. Seven chelators per immunoglobulin could be incorporated without loss of immunoreactivity. The resulting conjugates, labeled with indium-111, showed low liver uptake in animals. A cold kit, comprising the DTPA conjugate at a molarity of antibody bound chelator exceeding 1 x 10(-4) M, gave radiochemical yields of indium labeled antibody of greater than or equal to 95% and was stable for 1 yr.