Universität zu Köln

Schmidt, Matthias, Hero, Barbara and Simon, Thorsten (2016). I-131-mIBG therapy in neuroblastoma: established role and prospective applications. Clin. Transl. Imaging, 4 (2). S. 87 - 102. MILAN: SPRINGER-VERLAG ITALIA SRL. ISSN 2281-7565

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Abstract

The following review aims to summarise contemporary information on I-131-meta-iodobenzylguanidine (I-131-mIBG) therapy in neuroblastoma being the most common paediatric extracranial solid cancer characterized by mIBG avidity in >= 90 % of patients. Pathophysiologic basis for mIBG uptake is the expression of the norepinephrine transporter on the tumor cell membrane. Meta-iodobenzylguanidine was introduced in 1979 by Dr. Donald Wieland for imaging the adrenal medulla. Uptake in neuroblastoma cells is known since 1984 and mIGB has been in use as diagnostic and therapeutic tool in neuroblastoma patients for more than 30 years. A European guideline published by the European Association of Nuclear Medicine is available. Most therapy studies report about the use of I-131-mIBG in refractory or relapsed neuroblastoma. More recent studies combine I-131-mIBG with non-myeloablative or myeloablative chemotherapy regimens and stem cell transplantation. Response rates are in the range of 30-40 %. In Germany, I-131-mIBG therapy is scheduled in the first-line treatment at the end of induction chemotherapy in patients with residual non-progressing mIBG-avid lesions present before myeloablative chemotherapy and autologous stem cell transplantation using 444 MBq (12 mCi) I-131-mIBG/kg body weight. In The Netherlands, I-131-mIBG therapy is also integrated upfront in first-line neuroblastoma treatment protocols. I-131-mIBG is also widely used in case of recurrent disease. Monotherapy with low activities of I-131-mIBG can achieve good pain reduction in the terminal ill patient. Ongoing efforts aim to optimise I-131-mIBG treatment by better patient selection, using no-carrier-added I-131mIBG, increasing norepinephrine transporter expression or increasing radiosensitivity of neuroblastoma cells by combining radionuclide with chemotherapy. Further efforts include a more standardized approach including patient and tumour dosimetry. Despite more than 30 years of experience with I-131-mIBG therapy there no definite conclusion about its optimal clinical use and there is a definite lack of prospective randomized clinical trials. Nuclear medicine can deliver I-131-mIBG treatment. However, the implementation of a prospective trial with I-131-mIBG needs crucial input from pediatric oncologists and a solid infrastructure allowing to perform investigator-initiated trials. New radionuclide treatment options include peptide receptor radionuclide therapy.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schmidt, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Hero, Barbara UNSPECIFIED UNSPECIFIED UNSPECIFIED Simon, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-278997
DOI:	10.1007/s40336-016-0173-z
Journal or Publication Title:	Clin. Transl. Imaging
Volume:	4
Number:	2
Page Range:	S. 87 - 102
Date:	2016
Publisher:	SPRINGER-VERLAG ITALIA SRL
Place of Publication:	MILAN
ISSN:	2281-7565
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language HIGH-RISK NEUROBLASTOMA; STEM-CELL TRANSPLANTATION; TARGETED RADIONUCLIDE THERAPY; CARRIER-ADDED SYNTHESIS; HIGH-DOSE CHEMOTHERAPY; STAGE 4 NEUROBLASTOMA; REFRACTORY NEUROBLASTOMA; NORADRENALINE TRANSPORTER; IN-VITRO; PHASE-I Multiple languages Radiology, Nuclear Medicine & Medical Imaging Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27899