Low-Dose Iodine-131 Metaiodobenzylguanidine Therapy for Patients With Malignant Pheochromocytoma and Paraganglioma

Shilkrut, Mark; Bar-Deroma, R.; Bar-Sela, Gil; Berniger, A.; Kuten, Abraham

doi:10.1097/coc.0b013e31819e2c28

Cited by 42 publications

(40 citation statements)

References 19 publications

(23 reference statements)

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“…Response to 131 I-MIBG therapy, which is not in the remit of this paper, would be measured hormonally with serum chromogranin A and/or urinary 5-HIAA for NETs. 131 I-meta-iodobenzylguanidine would improve the condition in 40–80% of patients (Loh et al , 1997; Mukherjee et al , 2001; Gedik et al , 2008; Nwosu et al , 2008; Bomanji and Papathanasiou, 2012) and radiologically by demonstrating a reduction in size, though this occurs less often (at 20–30%) and by patients' report of symptoms at 50–89% (Gedik et al , 2008; Nwosu et al , 2008; Shilkrut et al , 2010). …”

mentioning

confidence: 99%

Sequelae and survivorship in patients treated with 131I-MIBG therapy

et al. 2013

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Background:131I-meta-iodobenzylguanidine (131I-MIBG) has been in therapeutic use since 1980s. Newer treatment modalities are emerging for neuroendocrine tumours (NETs) and chromaffin cell tumours (CCTs), but many of these do not yet have adequate long-term follow-up to determine their longer term efficacy and sequelae.Methods:Fifty-eight patients with metastatic NETs and CCTs who had received 131I-MIBG therapy between 2000 and 2011 were analysed. Survival and any long-term haematological or renal sequelae were investigated.Results:In the NET group, the overall median survival and median survival following the diagnosis of metastatic disease was 124 months. The median survival following the commencement of 131I-MIBG was 66 months. For the CCT group, median survival had not been reached. The 5-year survival from diagnosis and following the diagnosis of metastatic disease was 67% and 67.5% for NETs and CCTs, respectively. The 5-year survival following the commencement of 131I-MIBG therapy was 68%. Thirty-two patients had long-term haematological sequelae: 5 of these 32 patients developed haematological malignancies. Two patients developed a mild deterioration in renal function.Conclusion:Long follow up of 131I-MIBG therapy reveals a noteable rate of bone marrow toxicities and malignancy and long term review of all patients receiving radionuclide therapies is recommended.

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confidence: 99%

Sequelae and survivorship in patients treated with 131I-MIBG therapy

et al. 2013

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“…Myelotoxicity is dose-dependent. No, or only sporadic, cases of serious haematological toxicity have been reported with low single doses (below and around 5.5 GBq) [31,32,36]. In the retrospective study of Castellani et al, no single patient [34].…”

Section: Side Effects/toxicitymentioning

confidence: 99%

“…Treatment regimens vary considerably across departments with regard to single-dose activity, total cumulative activity and number of treatment cycles, from low single-dose activities (2.0-5.6 GBq) [31,32] to higher (9.25-12.95 GBq) [33,34] or even myeloablative doses (18.5-30 GBq) given with autologous stem cell support [35]. It is advised that 131 I-MIBG infusion is performed with heart rate and blood pressure monitoring and at a slow rate (>45 min) [30] to avoid catecholamine-induced adverse effects, such as acute hypertension [35].…”

Section: I-mibgmentioning

confidence: 99%

111In-DTPA0-octreotide (Octreoscan), 131I-MIBG and other agents for radionuclide therapy of NETs

Bomanji

Παπαθανασίου

2012

Eur J Nucl Med Mol Imaging

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This paper is a critical review of the literature on NET radionuclide therapy with (111)In-DTPA(0)-octreotide (Octreoscan) and (131)I-MIBG, focusing on efficacy and toxicity. Some potential future applications and new candidate therapeutic agents are also mentioned. Octreoscan has been a pioneering agent for somatostatin receptor radionuclide therapy. It has achieved symptomatic responses and disease stabilization, but it is now outperformed by the corresponding β-emitter agents (177)Lu-DOTATATE and (90)Y-DOTATOC. (131)I-MIBG is the radionuclide therapy of choice for inoperable or metastatic phaeochromocytomas/paragangliomas, which avidly concentrate this tracer via the noradrenaline transporter. Symptomatic, biochemical and tumour morphological response rates of 50-89%, 45-74% and 27-47%, respectively, have been reported. (131)I-MIBG is a second-line radiopharmaceutical for treatment of enterochromaffin carcinoids, mainly offering the benefit of amelioration of hormone-induced symptoms. High specific activity, non-carrier-added (131)I-MIBG and meta-astato((211)At)-benzylguanidine (MABG) are tracers with potential for enhanced therapeutic efficacy, yet their integration into clinical practice awaits further exploration. Amongst other promising agents, radiolabelled exendin analogues show potential for imaging and possibly therapy of insulinomas, while preclinical studies are currently evaluating DOTA peptides targeting the CCK-2/gastrin receptors that are overexpressed by medullary thyroid carcinoma cells.

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“…Multiple doses at intervals of 8-12 wk may be administered with the intention of stabilization of disease or symptoms. MIBG has an established role in symptom relief and palliation; improvement in disease-associated pain and symptoms related to catecholamine excess has been reported in 50%-85% of patients (111,116). However, robust and durable objective and clinical responses are rare, with few complete responses.…”

Section: I/ 131 I-mibg Theranostics For Pheo and Pglmentioning

confidence: 99%

Norepinephrine Transporter as a Target for Imaging and Therapy

Pandit‐Taskar

Modak

2017

J Nucl Med

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The norepinephrine transporter (NET) is essential for norepinephrine uptake at the synaptic terminals and adrenal chromaffin cells. In neuroendocrine tumors, NET can be targeted for imaging as well as therapy. One of the most widely used theranostic agents targeting NET is metaiodobenzylguanidine (MIBG), a guanethidine analog of norepinephrine. 123 I/ 131 I-MIBG theranostics have been applied in the clinical evaluation and management of neuroendocrine tumors, especially in neuroblastoma, paraganglioma, and pheochromocytoma. 123 I-MIBG imaging is a mainstay in the evaluation of neuroblastoma, and 131 I-MIBG has been used for the treatment of relapsed high-risk neuroblastoma for several years, however, the outcome remains suboptimal. 131 I-MIBG has essentially been only palliative in paraganglioma/pheochromocytoma patients. Various techniques of improving therapeutic outcomes, such as dosimetric estimations, high-dose therapies, multiple fractionated administration and combination therapy with radiation sensitizers, chemotherapy, and other radionuclide therapies, are being evaluated. PET tracers targeting NET appear promising and may be more convenient options for the imaging and assessment after treatment. Here, we present an overview of NET as a target for theranostics; review its current role in some neuroendocrine tumors, such as neuroblastoma, paraganglioma/ pheochromocytoma, and carcinoids; and discuss approaches to improving targeting and theranostic outcomes.

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Low-Dose Iodine-131 Metaiodobenzylguanidine Therapy for Patients With Malignant Pheochromocytoma and Paraganglioma

Cited by 42 publications

References 19 publications

Sequelae and survivorship in patients treated with 131I-MIBG therapy

Sequelae and survivorship in patients treated with 131I-MIBG therapy

111In-DTPA0-octreotide (Octreoscan), 131I-MIBG and other agents for radionuclide therapy of NETs

Norepinephrine Transporter as a Target for Imaging and Therapy

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