Personalisation of Molecular Radiotherapy through Optimisation of Theragnostics
Abstract
:1. Introduction
2. Imaging Biomarkers
2.1. Differentiated Thyroid Cancer
2.2. Neuroblastoma
- Neuroblastoma cells have been shown to be intrinsically highly radiosensitive, with a limited repair capacity [12];
- The disease is often metastatic to bone and bone marrow, and less commonly to other organs [13];
- Immunohistochemistry demonstrated that neuroblastoma cells express the noradrenaline transporter molecule, responsible for the uptake of mIBG, and the somatostatin receptor, responsible for uptake of somatostatin analogues such as DOTATATE [14].
2.3. Metastatic Prostate Cancer
2.4. Liver Metastases
3. Dosimetry
4. Response Assessment
5. Individualised Decision Making and Communication
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Disease to be Treated | Molecular Imaging Radiopharmaceutical | Molecular Radiotherapy Radiopharmaceutical |
---|---|---|
Differentiated thyroid cancer | 123I sodium iodide | 131I sodium iodide |
Neuroblastoma | 123I mIBG 1 | 131I mIBG |
Neuroendocrine cancers | 68Ga DOTATATE 2,3 111In Pentetreotide 4 | 177Lu DOTATATE 90Y DOTATOC 5 |
85Sr strontium chloride | 89Sr strontium chloride | |
Metastatic prostate cancer | 99mTc HDP 6 | 153Sm lexidronam 186Re etidronate 223Ra radium dichloride |
68Ga PMSA 7 | 177Lu PMSA | |
Acute leukaemia | 111In anti-CD66 monoclonal antibody | 90Y anti-CD66 8 monoclonal antibody |
Disease to be Treated | Molecular Radiotherapy Radiopharmaceutical | Dosimetry Notes |
---|---|---|
Differentiated thyroid cancer | 131I sodium iodide | Routinely fixed administered activity. Two means of personalised dosimetry: the lesion/remnant disease-based method; and the bone marrow dose method |
Neuroblastoma | 131I mIBG | Administered activity scaled to weight or body surface area. Can be tailored to individual patients based on whole-body absorbed dose. |
Neuroendocrine cancers | 177Lu DOTATATE 90Y DOTATOC | Routinely fixed administered activity. 177Lu DOTATATE dosimetry can be calculated using the gamma emissions to obtain post therapy planar images; 90Y DOTATOC not routinely possible. |
89Sr strontium chloride | Fixed administered activity. Dosimetry not routinely performed | |
Metastatic prostate cancer | 153Sm lexidronam 186Re etidronate 223Ra radium dichloride | 153Sm lexidronam weight-based administered activity; 186Re etidronate fixed administered activity; no more detailed dosimetry routinely performed. 223Ra photons allow for post-treatment imaging. Low-dose pre-treatment administration also allow potential for greater dosimetric accuracy. |
177Lu PMSA | 68Ga PSMA diagnostic imaging used for pre-therapeutic dosimetric calculation; 177Lu gamma emission allows dosimetric calculation for subsequent therapies. | |
Acute leukaemia | 90Y anti-CD66 monoclonal antibody | 111In labeled anti-CD66 monoclonal antibody single photon emission computed tomography used for dosimetric calculation prior to therapy to ensure bone marrow limit not exceeded. |
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Davis, L.; Smith, A.-L.; Aldridge, M.D.; Foulkes, J.; Peet, C.; Wan, S.; Gains, J.E.; Bomanji, J.B.; Gaze, M.N. Personalisation of Molecular Radiotherapy through Optimisation of Theragnostics. J. Pers. Med. 2020, 10, 174. https://doi.org/10.3390/jpm10040174
Davis L, Smith A-L, Aldridge MD, Foulkes J, Peet C, Wan S, Gains JE, Bomanji JB, Gaze MN. Personalisation of Molecular Radiotherapy through Optimisation of Theragnostics. Journal of Personalized Medicine. 2020; 10(4):174. https://doi.org/10.3390/jpm10040174
Chicago/Turabian StyleDavis, LauraMay, April-Louise Smith, Matthew D. Aldridge, Jack Foulkes, Connie Peet, Simon Wan, Jennifer E. Gains, Jamshed B. Bomanji, and Mark N. Gaze. 2020. "Personalisation of Molecular Radiotherapy through Optimisation of Theragnostics" Journal of Personalized Medicine 10, no. 4: 174. https://doi.org/10.3390/jpm10040174