Survival improvement in patients with medullary thyroid carcinoma who undergo pretargeted anti-carcinoembryonic-antigen radioimmunotherapy: a collaborative study with the French Endocrine Tumor Group.

Abstract

PURPOSE:

No effective therapy is currently available for the management of patients with metastatic medullary thyroid carcinoma (MTC). The efficacy of pretargeted radioimmunotherapy (pRAIT) with bispecific monoclonal antibody (BsMAb) and a iodine-131 (131I) -labeled bivalent hapten is evaluated.

PATIENTS AND METHODS:

Twenty-nine patients with advanced, progressive MTC, as documented by short serum calcitonin doubling times (Ct DTs), received an anti-carcinoembryonic antigen (CEA)/anti-diethylenetriamine pentaacetic acid (DTPA) -indium BsMAb, followed 4 days later by a 131I-labeled bivalent hapten. Overall survival (OS) was compared with 39 contemporaneous untreated MTC patients with comparable prognostic indicators.

RESULTS:

OS was significantly longer in high-risk, treated patients (Ct DT < 2 years) than in high-risk, untreated patients (median OS, 110 v 61 months; P < .030). Forty-seven percent of patients, defined as biologic responders by a more than 100% increase in CtDT, experienced significantly longer survival than nonresponders (median OS, 159 v 109 months; P < .035) and untreated patients (median OS, 159 v 61 months; P < .010). Treated patients with bone/bone-marrow disease had a longer survival than patients without such involvement (10-year OS, 83% v 14%; P < .023). Toxicity was mainly hematologic and related to bone/bone-marrow tumor spread.

CONCLUSION:

pRAIT against CEA induced long-term disease stabilization and a significantly longer survival in high-risk patients with Ct DTs less than 2 years, compared with similarly high-risk, untreated patients. Ct DT and bone-marrow involvement appear to be prognostic indicators in MTC patients who undergo pRAIT.

• Authors: Jean-François Chatal, Loïc Campion, Françoise Kraeber-Bodéré, Stephane Bardet, Jean-Philippe Vuillez, Bernard Charbonnel, Vincent Rohmer, Chien-Hsing Chang, Robert M Sharkey, David M Goldenberg, Jacques Barbet, French Endocrine Tumor Group
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 24 Issue 11 Pg. 1705-11 (Apr 10 2006) ISSN: 1527-7755 [Electronic] United States
• PMID: 16549819 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Indium
• Pentetic Acid
• Calcitonin

Topics

• Antibodies, Monoclonal (therapeutic use)
• Calcitonin (blood)
• Humans
• Indium (therapeutic use)
• Pentetic Acid
• Prognosis
• Radioimmunotherapy (methods)
• Survival Analysis
• Thyroid Neoplasms (mortality, radiotherapy)