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General, Urological and Gynaecological Surgery
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
MIBG (meta-iodobenzylguanidine) scanning important for assessing extra-adrenal tumours or adrenal tumours with risk of spread. MIBG is a radiopharmaceutical agent, similar in structure to noradrenaline, so is taken up by adrenergic neurones and concentrated in phaeochromocytomas or paragangliomas.
Non-Surgical Management of Thyroid Cancer
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Prior to treatment, care must be taken to prevent the use of drugs that may interfere with the uptake and retention of mIBG. The following are some examples, but not an exhaustive list: tricyclic antidepressants, phenothiazines, calcium channel blockers, salbutamol and opioids. Administered activities of 131I-mIBG vary and treatment is often given at 2–3-month intervals for three cycles, depending on the patient’s tolerance and the benefits observed.
Neck and endocrine
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
MIBG is taken up by catecholamine granules and is used mainly for localising phaeochromo cytomas in the adrenal and in extra-adrenal sites and for the detection of metastases. Multiple gland involvement can be found in MEN syndromes. Therapeutic doses of MIBG can be used to treat some lesions. MIBG is very specific for catecholamine tumours with very few false positives, although false negatives occur in 5–10%.
Methodological advances in the discovery of novel neuroblastoma therapeutics
Published in Expert Opinion on Drug Discovery, 2022
Miguel F. Segura, Aroa Soriano, Josep Roma, Olga Piskareva, Carlos Jiménez, Ariadna Boloix, Jamie I. Fletcher, Michelle Haber, Juliet C. Gray, Leonor Cerdá-Alberich, Blanca Martínez de Las Heras, Adela Cañete, Soledad Gallego, Lucas Moreno
In addition to the classical external beam radiotherapy, targeted radiotherapy using 131-I-meta-iodo-benzyl-guanidine (mIBG) started in the mid-eighties and is still being used in multiple clinical trials. mIBG is selectively captured by norepinephrine receptors present in neuroblastoma cells. However, the effectiveness of this approach is still controversial, since heterogeneous results have been obtained. Moreover, the avidness uptake of mIBG may differ among patients and change during the course of treatment [95]. Thus, new radiopharmaceuticals based on alternative targets present in neuroblastoma cells are being developed. One example is Octreotate linked to the β-particle-emitting lutetium-177 (177LuDOTATATE) binds with high affinity to somatostatin receptors present in neuroblastoma cells which has shown first signs of safety and effectiveness in neuroblastoma patients [96]. Studies optimizing the treatment schedule are still ongoing.
Emerging therapeutic targets for neuroblastoma
Published in Expert Opinion on Therapeutic Targets, 2020
Natarajan Aravindan, Terence Herman, Sheeja Aravindan
Another strategy is the use of MIBG, a norepinephrine analog that is actively taken up by norepinephrine transporter receptors that are highly localized in NB. Beyond its use in NB diagnosis, MIBG is used in the treatment of relapsed/refractory HR-NB [114–116]. Studies determining the tolerated dose/toxicity in HR-NB patients reported CR/PR rates up to 66% [115]. The availability of 131I-MIBG dosing (fixed, weight-based, radiation yield-based) options allowed the characterization of therapeutic ranges, requirements auto-SCR, toxicity, and patient stratification (age, previous treatments, soft-tissue/bone marrow) [115]. As with any radiotherapy, fractionation allows a high cumulative dose with maximal response. Researchers investigated the benefit of 131I-MIBG serial administrations. Retrospective review of stage-IV HR-NB cohort showed a 37% 5-Year OS; however, the review indicated the requirement for three sessions of 131I-MIBG treatment for prolonged survival [114]. Beyond 131I-MIBG monotherapy, researchers have also documented the tolerance, toxicity, and response rate of 131I-MIBG combination with CT (cisplatin, cyclophosphamide) and auto-SCR [115]. Coupling 131I-MIBG treatment with tandem high-dose CT and auto-SCR produced a 10% increase in OS/EFS of HR-NB patients [116]. Critically, 131I-MIBG treatment prior to the development of chemoresistance displayed a significant and lasting effect as part of induction treatment [115].
Theranostic approaches in nuclear medicine: current status and future prospects
Published in Expert Review of Medical Devices, 2020
Luca Filippi, Agostino Chiaravalloti, Orazio Schillaci, Roberto Cianni, Oreste Bagni
MIBG represents a radiopharmaceutical with clear theranostic implications, since it can be labeled both with 123I (for diagnosis) and 131I (for therapy). In patient candidate for treatment with 131I-MIBG, the pre-therapeutic imaging with 123I-MIBG plays the crucial role of demonstrating in vivo the avidity of NB for the radioligand. Of note, the biodistribution of the two radiotracers is almost identical with the exception of cerebellar uptake which was noted only for 131I-MIBG and not for 123I-MIBG [30]. Although 131I-MIBG was also used for the treatment of adult pheocromocytomas and paragangliomas, 131I-MIBG as a single agent or in combination with other drugs plays a major role for the treatment of children affected by relapsed or chemorefractory NB with response rate between 20% and 40% [31,32]. 131I-MIBG was also successfully introduced as front-line therapy for the down-sizing of NB: a group of 44 patients affected by high-risk NB was administered with at least 2 cycles of 131I-MIBG with a fixed dose of 7.4 and 3.7 GBq, respectively, and then followed by surgery, if feasible, or by neoadjuvant chemotherapy and surgery, with an overall response rate of 73% [33].