Oncotarget

Research Papers:

Technetium-99m-labeled rituximab for use as a specific tracer of sentinel lymph node biopsy: a translational research study

Xuejuan Wang _, Zhi Yang, Baohe Lin, Yan Zhang, Shizhen Zhai, Qichao Zhao, Qing Xie, Fei Liu, Xuedi Han, Jinfeng Li and Tao Ouyang

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Oncotarget. 2016; 7:38810-38821. https://doi.org/10.18632/oncotarget.9614

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Abstract

Xuejuan Wang1,*, Zhi Yang1,*, Baohe Lin1, Yan Zhang1, Shizhen Zhai1, Qichao Zhao1, Qing Xie1, Fei Liu1, Xuedi Han1, Jinfeng Li2, Tao Ouyang2

1Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing Cancer Hospital, Beijing 100142, P. R. China

2Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100142, P. R. China

*These authors have contributed equally to this work

Correspondence to:

Xuejuan Wang, email: [email protected]

Keywords: sentinel lymph node, biopsy, CD20, rituximab, specific

Received: September 25, 2015     Accepted: May 04, 2016     Published: May 26, 2016

ABSTRACT

Purpose: We aimed to develop and translate a CD20-antigen-targeted radiopharmaceutical, Technetium-99 m-labeled (99mTc) rituximab, for sentinel lymph node (SLN) detection.

Methods: 99mTc-rituximab was synthesized and tested for stability in human serum. The binding affinity to CD20 was evaluated in Raji cells by flow cytometric analysis. Biodistribution and sentinel node mapping were carried out in bal b/c mice. Eighty-five patients with breast cancer participated in this study. Dynamic sentinel lymphoscintigraphy was first assessed in 12 patients before planar lymphoscintigraphy was assessed in a larger cohort. All patients underwent sentinel lymph node biopsy (SLNB), followed by axillary lymph node dissection.

Results: The cell-binding study showed that 99mTc-rituximab possessed compatible affinity to human CD20. In the mechanism study, 99mTc-labeled anti-mouse CD20 monoclonal antibodies could bind to mouse CD20 and accumulate in the SLN with 2.62±1.25 % of the percentage of injected activity, which could be blocked by excessive unlabeled antibody. Low uptake of non-sentinel nodes and fast clearance from the injection site were observed in the mice. Sentinel nodes were identified in 82 of 85 breast cancer patients (96.5%) by lymphoscintigraphy and SLNB. The sensitivity, specificity, and accuracy were 96.8% (30/31), 100% (51/51), and 98.8% (81/82), respectively.

Conclusion: 99mTc-rituximab, specifically binding to CD20, met most of the requirements of an ideal sentinel mapping agent for use in clinical settings.


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