Title: Recurrent glioblastoma multiforme - local alpha emitters targeted therapy with 213Bi-DOTA-substance P
Authors: KROLICKI LeszekMORGENSTERN AlfredKUNIKOWSKA JolantaKOZIARA HKROLICKI BJAKUCINSKI MPAWLAK DariuszAPOSTOLIDIS ChristosBRUCHERTSEIFER Frank
Citation: EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING vol. 42 no. Suppl 1 p. S84 (OP197)
Publisher: SPRINGER
Publication Year: 2015
JRC N°: JRC96380
ISSN: 1619-7070
URI: http://publications.jrc.ec.europa.eu/repository/handle/JRC96380
DOI: 10.1007/s00259-015-3198-z
Type: Articles in periodicals and books
Abstract: Glioblastoma multiforme (GBM) is the most common and malignant primary brain tumor. The median survival time is 14.6 months from time of diagnosis, in spite of aggressive surgery, radiation therapy and chemotherapy. Only 3 to 5% of patients survive more than three years. Recurrence of GBM is nearly universal, confers a dismal prognosis with a 6-months progression free survival (6M-PFS) rate of 15% to 21% and a median survival of 6.2 months. Advancements in the past decades have not significantly increased the overall survival of patients with this disease. GBM has been demonstrated NK-1 receptor system and substance P can be used as a ligand for targeted therapy. Alpha emitter, like 213Bi offers the new potential for selective irradiation of tumors, with minimizing damage to adjacent tissue. Material and methods: 21 patients with primary recurrent glia tumor IV after standard therapy were included in the study during two years. Following intracavitary or intratumoral insertion of 1-2 catheter systems, patients were treated with 1-8 doses of 2 GBq 213Bi-DOTA-Substance P (213Bi-SP) in intervals of 2 months. 68Ga-DOTA-Substance P (68Ga-SP) was co-injected with the therapeutic doses to assess biodistribution using PET/CT. Therapeutic response was monitored with MRI. Study was approved by the ethical committee of the Medical University of Warsaw. Results: Treatment with activity up to 13 GBq 213Bi-SP was tolerated well with only mild transient adverse reactions: in 1 patient transient increase of focal neurological symptoms and in 3 patients episodes of epileptic seizures several days after treatment. PET/CT imaging showed high retention of the radiolabeled peptide at the tumor site. Out of 21 evaluable patients, 17 progressed within the follow-up period, 5 of them are alive at the end of follow-up. Four patients were excluded from evaluation due to lack of data. Median progression free survival was 3.7 months, with a 6 months progression free survival rate of 19% . The median overall survival from the first diagnosis was 25.2 months, and from the start of 213Bi-SP was 6.5 months. Follow up of therapeutic responses and toxicity is continued and patient recruitment is ongoing. Conclusions: Treatment of recurrent GBM with 213Bi-SP is safe and well tolerated. Targeted alpha therapy with 213Bi-SP may evolve as a promising novel option for treatment of recurrent GBM.
JRC Directorate:Nuclear Safety and Security

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