Abstracts der 56. DGN-Jahrestagung 2018
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Therapie: PSMA Vorsitz: M. Eiber, M. Essler 8:30 - 10:00 Borgward-Saal |
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V144 Bi-213-anti-EGFR-MAb therapy of recurrent bladder cancer K. Scheidhauer1, C. Seidl1, M. Autenrieth2, F. Bruchertseifer3, C. Apostolidis3, F. Kurtz2, T. Horn2, C. Pfob1, M. Schwaiger1, J. Gschwend2, C. D´Alessandria1, A. Morgenstern3 1TU München, Klinikum rechts der Isar, Nuklearmedizin, München; 2TU München, Klinikum rechts der Isar, Urologie, München; 3JRC, Institute for Transuranium, Karlsruhe | |
Ziel/Aim: Following transurethral resection of non-muscle-invasive bladder cancer (carcinoma in situ, CIS) and subsequent chemotherapy and treatment with Bacillus Calmette–Guérin (BCG), up to 40% of patients relapse within 5 years and need complete bladder excision. Therefore, new therapeutic strategies to combat tumor recurrence are needed. Because treatment of mice bearing intravesical human bladder cancer xenografts with Bi-213-anti-EGFR-MAb turned out highly efficient, the aim of this pilot study was to evaluate feasibility, safety and therapeutic efficacy of an alpha-emitter radioimmunoconjugate in recurrent bladder cancer patients.Methodik/Methods: The alpha-emitter Bi-213 was eluted from a Ac-225/Bi-213 generator system and coupled to the anti-EGFR-MAb (cetuximab, Merck, Germany) via the chelating agent CHX-A”-DTPA. 12 patients (10 m, 2 f) suffering from CIS bladder cancer that had shown no response to BCG treatment were intravesically applied with 366-821 MBq (9.9 – 22.2 mCi) of Bi-213-anti-EGFR-MAb in 40 ml of PBS. Distribution of Bi-213-anti-EGFR-MAb was monitored by SPECT/CT. Treatment was terminated by emptying of the radioimmunoconjugate from the bladder up to 120 min after injection. Efficacy was evaluated via endoscopy and histology after eight weeks, and then six-monthly.Ergebnisse/Results: All patients (pts) showed excellent tolerance of the treatment without any side effects. SPECT/CT monitoring clearly revealed location of the Bi-213-anti-EGFR-MAb immunoconjugate in the bladder. Up to now (12 pts, 13 treatments), treatment resulted in a documented complete eradication of tumor cells in four patients (CR lasting 44+, resp. 30+ months, 1 CR lasting 15 months, 1 CR after 2nd therapy 6+months) and remaining / progressive tumor growth in eight patients.Schlussfolgerungen/Conclusions: Intravesical instillation of Bi-213-anti-EGFR-MAb is a promising, well tolerated therapeutic option for treatment of in situ bladder cancer after BCG failure and can help to avoid or postpone radical bladder surgery. Repeated instillation seems to be possible; a follow up study is planned to investigate further improvement of therapeutic efficacy through dose escalation and repeated treatments. |
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