Treatment of neuroblastoma with ¹³¹I‐metaiodobenzylguanidine

Abstract

Seven patients with neuroblastoma (six children and one adult) were treated with therapeutic doses of high specific activity 131I-metaiodobenzylguanidine (131I-MIBG). Six patients were in stage IV and unresponsive to conventional treatment. One patient, in stage III, was treated at diagnosis, an approach never previously reported. Single doses of 131I-MIBG varying from 70 to 184 mCi split into two parts were administered by slow i.v. infusion (4 to 8 hours) at 2- to 4-day intervals. The following results were obtained in the six evaluable patients: two patients showed transient stabilization of the disease; three had an objective response, with shrinking of the primary tumor and/or regression of the metastatic lesions. Of these three patients, two suffered relapses at 2 and 7 months, respectively, from the first course of MIBG. The third patient, in whom the residual disease almost completely disappeared following MIBG therapy, is still alive in complete remission after autologous bone marrow transplantation with a follow-up of 14 months. The single patient treated at diagnosis showed a dramatic response to a relatively low dosage of MIBG, with histologically proved disappearance of the tumor mass. Our data indicate that MIBG may be useful in the treatment of neuroblastoma unresponsive to conventional chemotherapy. The complete response observed in the patient treated at diagnosis suggests that the full potentiality of MIBG therapy should be explored in untreated patients.

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.…”

Localisation of [131I]MIBG in nude mice bearing SK-N-SH human neuroblastoma xenografts: effect of specific activity

“…Radioiodinated meta-iodobenzylguanidine (MIBG), which is an analogue of noradrenaline has found widespread application in the management of neuroendocrine tumours such as phaeochromocytoma and neuroblastoma (Feine et al, 1987;McEwan et al, 1985;Sisson et al, 1984;Troncone et al, 1987). With regard to its diagnostic use, [1231]MIBG and ['1I]MIBG imaging has been found to be quite sensitive and specific for lesion localisation.…”

Neuroblastoma

“…The use of 131I-MIBG as a therapeutic modality for patients with advanced NB with refractory/relapsed disease was reported in a number of trials using it as single agent with response rates ranging from 10% to 50%. [129][130][131][132][133] However, the definition of response was often highly subjective and variable in many of these trials, ranging from pain relief or decreased catecholamine excretions to documented disappearance of lesions by imaging studies. Toxicity in these trials was minimal with myelosuppression as the most frequently reported effect.…”