Population-Based Modeling Improves Treatment Planning Before (90)Y-Labeled Anti-CD66 Antibody Radioimmunotherapy.

For treatment planning in radioimmunotherapy (RIT), the accurate estimation of time-integrated activity coefficients (TIACs) is essential. To estimate the TIACs in RIT using (90)Y-labeled anti-CD66 antibodies, physiologically based pharmacokinetic (PBPK) models are advantageous. Further optimization in predicting therapeutic TIACs may be achieved by including population-specific parameters. Therefore, the aims of this work were (1) to estimate population parameters and (2) to show the effect of these parameters on prediction accuracy of therapeutic biodistributions. To estimate population values, a PBPK model was fitted to pretherapeutic (gamma camera and serum) and therapeutic (serum) measurements simultaneously using the standard two-stage (STS) and iterated two-stage (ITS) algorithms. Including the estimated population values as Bayesian information, the model parameters of each patient were fitted to pretherapeutic data only (simulating therapeutic TIACs). To validate the prediction accuracy of the therapeutic serum curve, the simulated and fitted TIACs were compared. Prediction accuracy expressed as relative deviation (RD) improved from RD=8%±16% to RD=0%±10% for STS and ITS, respectively. The authors demonstrated a method to estimate and apply population values for RIT using a PBPK model and population fitting. For (90)Y-labeled anti-CD66 antibodies, the prediction accuracy was substantially improved.

Radioimmunotherapy with anti-CD66 antibody: improving the biodistribution using a physiologically based pharmacokinetic model.

UNLABELLED: To improve radioimmunotherapy with anti-CD66 antibody, a physiologically based pharmacokinetic (PBPK) model was developed that was capable of describing the biodistribution and extrapolating between different doses of anti-CD66 antibody. METHODS: The biodistribution of the (111)In-labeled anti-CD66 antibody of 8 patients with acute leukemia was measured. The data were fitted to 2 PBPK models. Model A incorporated effective values for antibody binding, and model B explicitly described mono- and bivalent binding. The best model was selected using the corrected Akaike information criterion. The predictive power of the model was validated comparing simulations and (90)Y-anti-CD66 serum measurements. The amount of antibody (range, 0.1-4 mg) leading to the most favorable therapeutic distribution was determined using simulations. RESULTS: Model B was better supported by the data. The fits of the selected model were good (adjusted R(2) > 0.91), and the estimated parameters were in a physiologically reasonable range. The median deviation of the predicted and measured (90)Y-anti-CD66 serum concentration values and the residence times were 24% (range, 17%-31%) and 9% (range, 1%-64%), respectively. The validated model predicted considerably different biodistributions for dosimetry and therapeutic settings. The smallest (0.1 mg) simulated amount of antibody resulted in the most favorable therapeutic biodistribution. CONCLUSION: The developed model is capable of adequately describing the anti-CD66 antibody biodistribution and accurately predicting the time-activity serum curve of (90)Y-anti-CD66 antibody and the therapeutic serum residence time. Simulations indicate that an improvement of radioimmunotherapy with anti-CD66 antibody is achievable by reducing the amount of administered antibody; for example, the residence time of the red marrow could be increased by a factor of 1.9 +/- 0.3 using 0.27 mg of anti-CD66 antibody.

Short Communication: (18)F-immuno-PET: Determination of anti-CD66 biodistribution in a patient with high-risk leukemia.

The monoclonal antibody anti-CD66 labeled with (99m)Tc is widely used as Scintimun granulocyte for bone marrow immunoscintigraphy. Further, recently performed clinical radioimmunotherapy studies with [(90)Y]Y-anti-CD66 proved to be suitable for the treatment of hematologic malignancies. Before radioimmunotherapy with [(90)Y]Y-anti-CD66, dosimetric estimations are required to minimize radiotoxicity and determine individual applicable activities. Planar imaging, using gamma-emitting radionuclides, is conventionally carried out to estimate the absorbed organ doses. In contrast, immuno-PET (positron emission tomography) enables the quantification of anti-CD66 accumulation and provides better spatial and temporal resolution. Therefore, in this study, a semiautomated radiosynthesis of [(18)F]F-anti-CD66 was developed, using the (18)F-acylation agent, N-succinimidyl-4-[(18)F]fluorobenzoate ([(18)F]SFB). As a proof of concept, an intraindividual comparison between PET and conventional scintigraphy, using (18)F- and (99m)Tc-labeled anti-CD66 in 1 patient with high-risk leukemia, is presented. Both labeled antibodies displayed a similar distribution pattern with high preferential uptake in bone marrow. Urinary excretion of [(18)F]F-anti-CD66 was increased and bone marrow uptake reduced, in comparison to [(99m)Tc]Tc-anti-CD66. Nevertheless, PET-based dosimetry with [(18)F]F-anti-CD66 could provide additional information to support conventional scintigraphy. Moreover, [(18)F]F-anti-CD66 is ideally suited for bone marrow imaging using PET.

Targeting bcl-2 by triplex-forming oligonucleotide--a promising carrier for gene-radiotherapy.

Triplex forming oligonucleotides (TFO) provide a promising tool for gene therapy. DNA damaging agents have been successfully coupled to TFOs and induce site-directed DNA damages. Here, we attempted to apply this antigen strategy using a TFO incorporated with a Conversion-electron-emitter, (99m)technetium, to target bcl-2 gene, the prototypical inhibitor of apoptosis. In the bcl-2 promoter region, we found two TFO binding sites which bind corresponding TFOs with very high specificity and affinity. Both partially and completely phosphorothioated TFOs form stable triplexes and significantly inhibit gene transcription in vitro. We also found that purine motif TFO with a thymidine opposite a thymidine interruption at the polypurine strand can form a stable triplex. In addition, (99m)technetium-conjugated TFOs were found to form a stable triplex and to inhibit bcl-2 gene transcription in vitro. Our results suggest a promising application of this triplex-forming oligonucleotide based Conversion-electron-emitter mediated gene radiotherapy in diseases related to bcl-2 overexpression.