Kraeber-Bodéré Françoise, Bodet-Milin Caroline, Rousseau Caroline, Eugène Thomas, Pallardy Amandine, Frampas Eric, Carlier Thomas, Ferrer Ludovic, Gaschet Joëlle, Davodeau François, Gestin Jean-François, Faivre-Chauvet Alain, Barbet Jacques, Chérel Michel
Centre de Recherche en Cancérologie de Nantes-Angers, Inserm, Université de Nantes, Nantes, France; Department of Nuclear Medicine, CHU de Nantes, Nantes, France; Department of Nuclear Medicine, ICO-René Gauducheau, Saint-Herblain, France.
Centre de Recherche en Cancérologie de Nantes-Angers, Inserm, Université de Nantes, Nantes, France; Department of Nuclear Medicine, CHU de Nantes, Nantes, France.
Semin Oncol. 2014 Oct;41(5):613-22. doi: 10.1053/j.seminoncol.2014.07.004. Epub 2014 Jul 22.
Radioimmunotherapy (RIT) has been developed for more than 30 years. Two products targeting the CD20 antigen are approved in the treatment of non-Hodgkin B-cell lymphoma (NHBL): iodine 131-tositumomab and yttrium 90-ibritumomab tiuxetan. RIT can be integrated in clinical practice for the treatment of patients with relapsed or refractory follicular lymphoma (FL) or as consolidation after induction chemotherapy. High-dose treatment, RIT in first-line treatment, fractionated RIT, and use of new humanized monoclonal antibodies (MAbs), in particular targeting CD22, showed promising results in NHBL. In other hemopathies, such as multiple myeloma, efficacy has been demonstrated in preclinical studies. In solid tumors, more resistant to radiation and less accessible to large molecules such as MAbs, clinical efficacy remains limited. However, pretargeting methods have shown clinical efficacy. Finally, new beta emitters such as lutetium 177, with better physical properties will further improve the safety of RIT and alpha emitters, such as bismuth 213 or astatine 211, offer the theoretical possibility to eradicate the last microscopic clusters of tumor cells, in the consolidation setting. Personalized treatments, based on quantitative positron emission tomography (PET), pre-therapeutic imaging, and dosimetry procedures, also could be applied to adapt injected activity to each patient.
放射免疫疗法（RIT）已发展了30多年。两种靶向CD20抗原的产品被批准用于治疗非霍奇金B细胞淋巴瘤（NHBL）：碘131-托西莫单抗和钇90-替伊莫单抗。RIT可纳入临床实践，用于治疗复发或难治性滤泡性淋巴瘤（FL）患者，或作为诱导化疗后的巩固治疗。高剂量治疗、一线治疗中的RIT、分次RIT以及使用新型人源化单克隆抗体（MAb），尤其是靶向CD22的抗体，在NHBL中显示出了有前景的结果。在其他血液病，如多发性骨髓瘤中，临床前研究已证明其疗效。在实体瘤中，由于对辐射更具抗性且大分子如MAb难以到达，临床疗效仍然有限。然而，预靶向方法已显示出临床疗效。最后，具有更好物理性质的新型β发射体，如镥177，将进一步提高RIT的安全性，而α发射体，如铋213或砹211，在巩固治疗中提供了根除最后微小肿瘤细胞簇的理论可能性。基于定量正电子发射断层扫描（PET）、治疗前成像和剂量测定程序的个性化治疗，也可用于根据每位患者的情况调整注射活性。
