Targeted radionuclide therapy (radioimmunotherapy) in oncology

Radioimmunotherapy (targeted radionuclide therapy) is a type of targeted therapy that uses monoclonal antibodies labeled with radionuclide to target tumor-associated antigens. In radioimmunotherapy β- and α-emitters are most often used. In preclinical trials the following radiopharmaceuticals were tested: 225Ac, conjugated with PSMA-617 (prostate-specific membrane antigen) for treatment of prostate cancer; lintuzumab, conjugated with 213Bi, 225Ac and 227Th for treatment of myeloid leukemia; 212PB-TCMC-conjugated monoclonal antibodies in ovarian cancer xenografts. In the course of clinical trials, [213Bi]-DOTATOC was tested in patients with progressive neuroendocrine tumors; [213Bi]-DOTA-substance P for treatment of patients with recurrent glioblastoma; 177Lu-labeled PSMA-617 in treatment of metastatic castration-resistant prostate cancer; omburtamab, conjugated with 131I in patients with neuroblastoma. Among the approved drugs for radioimmunotherapy, 90Y-labeled anti-CD20 antibodies ibritumomab-tiuxetan (Zevalin®), 131I-labeled anti-CD20 antibodies tositumomab (Bexxar®), and 177Lu-DOTATATE (Lutathera®) should be noted. Combination of targeted radionuclide therapy with chemotherapeutic 23 drugs, for example, [212Pb]DOTA-MTATE with 5-fluorouracil, [212Pb]-trastuzumab with gemcitabine and paclitaxel, is noteworthy for achieving a synergistic antitumoral effect. Currently, the potential is being created for targeted radionuclide therapy to complement existing forms of oncological care and improve treatment options and quality of life for patients with highly resistant tumors and late-stage cancer. However, due to the high cost of targeted drugs, radiopharmaceuticals and radionuclide generators, new developments in this area are difficult, which makes it relevant to further research in this direction.