The CD44 protein family consists of isoforms with tissuespecific expression, which are encoded by standard exons and up to 9 alternatively spliced variant exons (v2-v10) of the same gene. The murine MAbs U36 and BIWA-1, directed against overlapping epitopes within the v6 region of CD44, have previously been shown to efficiently target HNSCC. We herein report on the construction of 1 chimeric (BIWA-2) and 2 humanized (BIWA-4 and BIWA-8) derivatives of BIWA-1. Together with U36 and BIWA-1, these new antibodies were evaluated for affinity to the antigen in vitro as well as for biodistribution and efficacy in RIT using nude mice bearing the HNSCC xenograft line HNX-OE. As determined by surface plasmon resonance, the MAbs bound to CD44v6 with an up to 46-fold difference in affinity (K d ranging from 1.1 ؋ 10 -8 to 2.4 ؋ 10 -10 M) with the following ranking: mMAb U36 < hMAb BIWA-4 < hMAb BIWA-8 < mMAb BIWA-1 ϳ cMAb BIWA-2. To evaluate their in vivo tumortargeting properties, 2 MAbs with identical murine or human isotype were labeled with either 131 I or 125 I and administered simultaneously (50 g/10 Ci each) as pairs showing a stepwise decrease in the difference in affinity: U36 vs. BIWA-1 (35.0-fold difference), BIWA-4 vs. BIWA-2 (14.0-fold) and BIWA-4 vs. BIWA-8 (4.0-fold). Biodistribution was assessed at 1, 2, 3 or 4 and 7 days after injection. Remarkably, for all 3 MAb pairs tested, the lower-affinity MAb showed a higher degree and specificity of tumor localization. The difference in tumor localization was more pronounced when the difference in affinity was larger. For example, 3 days after injection, the lower-affinity mMAb U36 showed a 50% higher tumor uptake than the higher-affinity mMAb BIWA-1, while blood levels and uptake in organs were similar. After labeling with 186 Re (300 or 400 Ci), the same MAb pairs showed RIT efficacy consistent with the biodistribution data: 186 The use of radiolabeled MAbs has been recognized as a realistic option for improvement of diagnosis and treatment of cancer. While in the last decade MAbs have been administered to thousands of patients with various types of tumor for both diagnostic and therapeutic purposes, the application of MAbs in head-andneck oncology has not kept pace. One of the main reasons for this slow progress has been the lack of MAbs with a high specificity for head-and-neck cancer, in particular for HNSCC, which accounts for approximately 90% of head-and-neck tumors.In recent years, a panel of MAbs has been developed that is capable of selective HNSCC targeting, as demonstrated in clinical radioimmunoscintigraphy/biodistribution studies with HNSCC patients. Among the best-qualified antibodies are the mMAbs U36 and BIWA-1 (formerly VFF18). 1,2 U36 and BIWA-1 bind to overlapping epitopes in the variable domain v6 of the cell-surface antigen CD44 and have been characterized extensively. 3,4 CD44 isoforms, which arise from differential splicing of up to 9 variant exons, show a tissue-specific expression pattern. Homogenous expression of v6-containing CD44 isofo...