Targeted Radionuclide Therapy for Patients with Metastatic Pheochromocytoma and Paraganglioma: From Low-Specific-Activity to High-Specific-Activity Iodine-131 Metaiodobenzylguanidine
Open Access
- 20 July 2019
- Vol. 11 (7), 1018
- https://doi.org/10.3390/cancers11071018
Abstract
Low-specific-activity iodine-131–radiolabeled metaiodobenzylguanidine (I-131-MIBG) was introduced last century as a potential systemic therapy for patients with malignant pheochromocytomas and paragangliomas. Collective information derived from mainly retrospective studies has suggested that 30–40% of patients with these tumors benefit from this treatment. A low index of radioactivity, lack of therapeutic standardization, and toxicity associated with intermediate to high activities (absorbed radiation doses) has prevented the implementation of I-131-MIBG’s in clinical practice. High-specific-activity, carrier-free I-131-MIBG has been developed over the past two decades as a novel therapy for patients with metastatic pheochromocytomas and paragangliomas that express the norepinephrine transporter. This drug allows for a high level of radioactivity, and as yet is not associated with cardiovascular toxicity. In a pivotal phase two clinical trial, more than 90% of patients achieved partial responses and disease stabilization with the improvement of hypertension. Furthermore, many patients exhibited long-term persistent antineoplastic effects. Currently, the high-specific-activity I-131-MIBG is the only approved therapy in the US for patients with metastatic pheochromocytomas and paragangliomas. This review will discuss the historical development of high-specific-activity I-131-MIBG, its benefits and adverse events, and future directions for clinical practice applicability and trial development.Keywords
This publication has 97 references indexed in Scilit:
- 131I/123I-Metaiodobenzylguanidine (mIBG) scintigraphy: procedure guidelines for tumour imagingEuropean Journal of Nuclear Medicine and Molecular Imaging, 2010
- Phase II Study of High-Dose [131I]Metaiodobenzylguanidine Therapy for Patients With Metastatic Pheochromocytoma and ParagangliomaJournal of Clinical Oncology, 2009
- Hydroxytyrosol increases norepinephrine transporter function in pheochromocytoma cellsNuclear Medicine and Biology, 2008
- Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) to Separate Benign From Malignant NeoplasmsThe American Journal of Surgical Pathology, 2002
- Enhanced tumour uptake and in vitro radiotoxicity of no-carrier-added [131i] metaiodobenzylguanidine: Implications for the targeted radiotherapy of neuroblastomaEuropean Journal of Cancer, 1995
- Sympatho‐adrenal secretion in humans: factors governing catecholamine and storage vesicle peptide co‐release *Journal of Autonomic Pharmacology, 1994
- Treatment of neuroblastoma with131I-metaiodobenzylguanidineMedical and Pediatric Oncology, 1987
- 131I‐metaiodobenzylguanidine treatment in neuroblastoma: Report of two casesMedical and Pediatric Oncology, 1987
- Treatment of neuroblastoma with 131I‐metaiodobenzylguanidine: Experience of the Münster/Kassel groupMedical and Pediatric Oncology, 1987
- Scintigraphic Localization of PheochromocytomaNew England Journal of Medicine, 1981