Clinical utility of external immunoscintigraphy with the IMMU-4 technetium-99m Fab' antibody fragment in patients undergoing surgery for carcinoma of the colon and rectum: results of a pivotal, phase III trial. The Immunomedics Study Group.

Abstract

PURPOSE:

To assess the performance and the potential clinical impact of a new antibody imaging agent, CEA-Scan (Immunomedics Inc, Morris Plains, NJ), in 210 presurgical patients with advanced recurrent or metastatic colorectal carcinomas.

METHODS:

CEA-Scan, an anti-carcinoembryonic antigen (CEA) Fab antibody fragment labeled with technetium-99m-pertechnetate (99mTc), was injected intravenously (IV), and external scintigraphy was performed 2 to 5 and 18 to 24 hours later. Imaging with conventional diagnostic modalities (CDM) was also performed, and findings were confirmed by surgery and histology.

RESULTS:

The sensitivity of CEA-Scan was superior to that of CDM in the extrahepatic abdomen (55% v 32%; P = .007) and pelvis (69% v 48%; P = .005), and CEA-Scan findings complemented those of CDM in the liver. Among 122 patients with known disease, the positive predictive value was significantly higher when both modalities were positive (98%) compared with each alone (68% to 70%), potentially obviating the need for histologic confirmation when both tests are positive. Imaging accuracy also was significantly improved by adding CEA-Scan to CDM. In 88 patients with occult cancer, imaging accuracy was enhanced significantly by CEA-Scan combined with CDM (61% v 33%). Potential clinical benefit from CEA-Scan was demonstrated in 89 of 210 patients. Only two patients developed human antimouse antibodies (HAMA) to CEA-Scan after a single injection, and none of 19 assessable patients after two injections.

CONCLUSION:

CEA-Scan affords high-quality, same-day imaging, uses an inexpensive and readily available radio-nuclide, adds clinically significant information in assessing extent and location of disease in colorectal cancer patients, and only rarely induces a HAMA response.

• Authors: F L Moffat Jr, C M Pinsky, L Hammershaimb, N J Petrelli, Y Z Patt, F S Whaley, D M Goldenberg
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 14 Issue 8 Pg. 2295-305 (Aug 1996) ISSN: 0732-183X [Print] United States
• PMID: 8708720 (Publication Type: Clinical Trial, Clinical Trial, Phase III, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antibodies, Monoclonal
• Carcinoembryonic Antigen
• Immunoglobulin Fab Fragments
• Sodium Pertechnetate Tc 99m

Topics

• Antibodies, Monoclonal
• Carcinoembryonic Antigen (immunology)
• Colonic Neoplasms (diagnostic imaging)
• Humans
• Immunoglobulin Fab Fragments
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Radioimmunodetection
• Rectal Neoplasms (diagnostic imaging)
• Sensitivity and Specificity
• Sodium Pertechnetate Tc 99m
• United States