Indium-111-labeled trastuzumab scintigraphy in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer
Indium-111-labeled trastuzumab scintigraphy in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer
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DOI：
10.1200/jco.2005.03.8448
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发表时间：
2006-05-20
影响因子：
45.3
通讯作者：
de Vries, Elisabeth G. E.
中科院分区：
文献类型：
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作者：
Perik, Patrick J.;Lub-De Hooge, Marjolijn N.;de Vries, Elisabeth G. E.
目的曲妥珠单抗的心脏和抗肿瘤作用可能分别与曲妥珠单抗在心肌和肿瘤组织中的特异性摄取有关。我们评估了铟-111 (In-111) 标记的曲妥珠单抗闪烁扫描是否可以预测心脏毒性并识别肿瘤病变。此外，我们还评估了心脏功能障碍的血浆标志物是否可用于预测心脏毒性。 患者和方法人表皮生长因子受体 2 (HER2) 阳性转移性乳腺癌患者在注射 150 MBq In-111-二亚乙基三胺五乙酸酐 (DTPA) -曲妥珠单抗后、负荷剂量曲妥珠单抗后以及每周一次后，在 15 分钟至 7 天内进行伽马相机成像曲妥珠单抗给药 11 周，并伴随紫杉醇每 3 周一次。在治疗前以及四个和六个周期后进行心脏评估。采用免疫分析法测定血浆N末端脑钠肽前体(NT-proBNP)和血清肌钙蛋白I。结果17例患者中的15例可用于心脏和肿瘤摄取分析。第一次扫描时，在一名既往患有心律失常的患者中观察到心肌 In-111-DTPA-曲妥珠单抗的摄取，该患者在治疗期间并未出现心力衰竭。三名患者出现严重心脏毒性，最初没有心肌摄取，而一名患者在四个周期后出现心肌摄取微弱。单个肿瘤病灶的检出率为45%。 15 名患者中有 13 名发现了新的肿瘤病灶。治疗前血浆 NT-proBNP 水平在患有心力衰竭的患者中高于无心力衰竭患者（平均值，534 [标准差，2361 v 105 [标准差，791 ng/L；P = 0.009）。结论：放射标记曲妥珠单抗闪烁扫描对于预测转移性乳腺癌患者曲妥珠单抗相关的心脏毒性没有价值，但可以识别 HER2 阳性肿瘤。血浆 NT-proBNP 的测量对于预测曲妥珠单抗相关的心脏毒性很有希望。
PurposeThe cardiac and antineoplastic effects of trastuzumab may be related to specific uptake of trastuzumab in myocardium and tumor tissue, respectively. We evaluated whether indium-111 (In-111) -labeled trastuzumab scintigraphy can predict cardiotoxicity and identify tumor lesions. In addition, we evaluated whether plasma markers for cardiac dysfunction can be used to predict cardiotoxicity.Patients and MethodsPatients with human epidermal growth factor receptor 2 (HER2) -positive metastatic breast cancer underwent gamma camera imaging from 15 minutes to 7 days after injection of 150 MBq In-111-diethylenetriaminepenta-acetic acid anhydride (DTPA) -trastuzumab, after loading-dose trastuzumab, and after once-a-week trastuzumab doses for 11 weeks, and concomitant paclitaxel once every 3 weeks. Cardiac assessments were performed before treatment, and after four and six cycles. Plasma N-terminal probrain natriuretic peptide (NT-proBNP) and serum troponin I were measured with immunoassay.ResultsFifteen of the 17 patients were available for cardiac and tumor uptake analysis. On the first scan, myocardial In-111-DTPA-trastuzumab uptake was observed in one patient with pre-existing cardiac arrhythmias, who did not develop heart failure during treatment. Severe cardiotoxicity occurred in three patients, without initial myocardial uptake, whereas one showed weak myocardial uptake after four cycles. The detection rate of single tumor lesions was 45%. New tumor lesions were discovered in 13 of 15 patients. Pretreatment plasma NT-proBNP levels were higher in patients with than without heart failure (mean, 534 [standard deviation, 2361 v 105 [standard deviation, 791 ng/L; P =.009).ConclusionRadiolabeled trastuzumab scintigraphy was not valuable in predicting trastuzumab-related cardiotoxicity in metastatic breast cancer patients, but can identify HER2-positive tumors. Measurement of plasma NT-proBNP is promising regarding prediction of trastuzumab-related cardiotoxicity.