Treatment of neuroblastoma with metaiodobenzylguanidine: Results and side effects

Abstract

Between April 1984 and December 1985 we treated ten children suffering from neuroblastoma in a total of 25 metaiodobenzylguanidine (MIBG) courses. Five had had a relapse of neuroblastoma stage III or IV, three had never achieved a remission in spite of intensive chemotherapy, and two were treated with an unstable remission. The children were each administered from 1 to 5 courses with a dosage per course of between 1,295 and 9,065 MBq. The sum of the single doses during the whole course of therapy ranged between 3,145 and 21,904 MBq per child. Five of five children suffering from bone pain and fever became free of complaints during the first three treatment days. Six of eight children with manifest tumor at onset of therapy responded well to the treatment: response extended from transitory decrease in elevated catecholamine levels in serum and urine to complete disappearance of large abdominal tumor masses. We also observed a decrease in bone marrow involvement and a stabilization of osteolytic lesions. Seven of these eight children died in spite of a good response from 55 to 350 days after the first MIBG treatment course. The only side effect we witnessed was a reversible bone marrow depression. In three children we combined the MIBG therapy with bone marrow transplantation.

Radionuclide therapy revisited

“…In 1987, data from 80 neuroblastoma patients treated with 13 I I.MIBG by major groups were published together, including the initial 18 from Amsterdam (Bestagno et al 1987;Cottino et al 1987;Fischer et al 1987;Hartmann et al 1987;Sanguinetti 1987;Treuner et al 1987;Troncone et al 1987;Vofite et al 1987). Of 64 evaluable patients, 4 attained complete and 27 partial remission and in 21 patients the disease was arrested, which represented encouraging results, taking into account the fact that most of these patients had stage IV progressive and intensely pretreated disease.…”

Engraftment after myeloablative doses of131I-metaiodobenzylguanidine followed by autologous bone marrow transplantation for treatment of refractory neuroblastoma

“…131 Imetaiodobenzylguanidine (MIBG), a guanethidine derivative, provides a potential for enhanced efficacy with decreased toxicity due to specific uptake in neural crest cells. 131 I-MIBG has been used as targeted radiotherapy for treatment of neural crest tumors for more than 10 years with bone marrow suppression as the major side effect [1][2][3][4][5][6]. Although therapeutic activity has been demonstrated with responses in approximately one-third of patients with recurrent tumors, the most effective dose and timing of administration have not yet been established.…”

Selective serotonin reuptake inhibitors (SSRIs) prevent meta-iodobenzylguanidine (MIBG) uptake in platelets without affecting neuroblastoma tumor uptake

“…1 ). Whereas the iodine-123 radiolabeled form is used as a highly selective radioactive imaging agent [ 5 ], radioactive iodine-131 MIBG is being used since 1984 in patients with relapsed or refractory neuroblastoma to achieve a tumor response [ 6 ]. This treatment in these patients has been accompanied by hematological toxicity, mainly consisting of persistent and severe thrombocytopenia [ 7 – 9 ].…”