Development and evaluation of (89)Zr-trastuzumab for clinical applications

OBJECTIVE(S): Due to the suitable physical characteristics of (89)Zr as a PET radionuclide and affinity of Trastuzumab monoclonal antibody against HER2, [(89)Zr]Zr-Trastuzumab was prepared and went through preclinical evaluations for ultimate human applications. METHODS: (89)Zr was produced by using (89)Y(p,n)(89)Zr reaction at a 30 MeV cyclotron (radionuclide purity>99.9%, specific activity of 17 GBq/µg). p-SCN-Bn-Deferoxamine (DFO); was conjugated to trastuzumab, followed by labeling with (89)Zr in oxalate form at optimized condition. Cell binding, internalization and, radioimmuno-activity assays were studied using HER2+ BT474 and HER2- CHO cell lines. Finally, the biodistribution of the radioimmunoconjugate was assessed in normal and HER2+ BT474 tumor-bearing mice using tissue counting and imaging at different intervals after injection. Also, a woman with HER2-positive metastatic breast cancer under treatment with Herceptin underwent both [(89)Zr]Zr-Trastuzumab and, [(18)F]FDG PET/CTs. RESULTS: (89)Zr was produced with high radionuclidic and radiochemical purities (>99%) and [(89)Zr]Zr-DFO-Trastuzumab was prepared with radiochemical purity of >98% and specific activity of 9.85 GBq/µmol. The radioimmunoconjugate was stable both in PBS buffer and in human serum for at least 48 h. The radioimmunoactivity assay demonstrated about 70% of [(89)Zr]Zr-DFO-Trastuzumab is bound to the BT474 cells at the number of 250×10(6 )cells. Cell binding studies showed that about 28% of radioimmunoconjugate is attached to BT474 cells after 90 min. Internalization studies showed that 50% of [(89)Zr]Zr-Trastuzumab is internalized to BT474 cells only in 6 h. The biodistribution study of the labeled compound in normal mice demonstrated the same pattern of the monoclonal antibodies which is entirely different from the biodistribution of free (89)Zr. Biodistribution and imaging studies in tumor-bearing mice showed the significant uptake values of [(89)Zr]Zr-Trastuzumab in tumor sites. [(89)Zr]Zr-Trastuzumab PET/CT revealed metastatic lesions documented previously with [(18)F]FDG PET/CT scan in a woman with breast cancer who was under treatment with Herceptin. Although the [(18)F]FDG PET/CT scan had better quality images, the valuable and unique advantage of [(89)Zr]Zr-Trastuzumab PET/CT is delineating HER2+ metastasis, which is essential in diagnosis and HER2-based treatments. CONCLUSION: The prepared [(89)Zr]Zr-Trastuzumab has a high potential radio-pharmaceutical for immune-PET imaging of the patients with HER2+ tumors.