Delaloye A B, Delaloye B
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Eur J Nucl Med. 1995 Jun;22(6):571-80. doi: 10.1007/BF00817285.
The initial enthusiasm for the development of diagnostic and therapeutic studies involving the use of monoclonal antibodies was replaced by scepticism as hopes remained unfulfilled. Against this background one needs to ask whether immunoscintigraphy (IS) serves clinical needs effectively and whether radioimmunotherapy (RIT) has a future. The current review considers these questions by reference to relevant studies. Taking colorectal cancer as an example, an appraisal is offered of the ability of IS to detect disease at an early stage and thereby to reduce mortality, and of the influence of the results of IS on patient management. It is concluded that in a limited number of cases of colorectal cancer and other solid tumors, IS will allow surgery to be performed at a stage where cure is still possible because of its ability to detect early recurrence. Turning to RIT, the results of studies in respect of various tumour types are reviewed, with due attention to reported toxicity. As regards colorectal cancer, no consistent therapeutic effects have been achieved, and myelotoxicity is typically the dose-limiting factor. Thus many questions remain to be answered, regarding antigens to be targeted, fractionation schedule, the use of "humanised" antibodies, choice of radionuclide and the use of intact immunoglobulins or fragments. These questions are considered. Overall it is concluded that the most promising application of RIT is as adjuvant therapy in patients with minimal residual disease, and a controlled multicentre trial is recommended. The development of more potent radio-immunoconjugates for therapeutic and ultimately diagnostic purposes will contribute to the improvement and development of IS by increasing its potential to influence prognosis.
由于期望未能实现，对涉及使用单克隆抗体的诊断和治疗研究的最初热情被怀疑所取代。在此背景下，人们需要问免疫闪烁显像（IS）是否有效地满足了临床需求，以及放射免疫疗法（RIT）是否有未来。本综述通过参考相关研究来考虑这些问题。以结直肠癌为例，评估了IS在早期检测疾病从而降低死亡率方面的能力，以及IS结果对患者管理的影响。得出的结论是，在少数结直肠癌和其他实体瘤病例中，IS能够检测早期复发，从而使手术能够在仍有可能治愈的阶段进行。谈到RIT，回顾了针对各种肿瘤类型的研究结果，并适当关注了所报道的毒性。就结直肠癌而言，尚未取得一致的治疗效果，骨髓毒性通常是剂量限制因素。因此，关于靶向抗原、分次给药方案、“人源化”抗体的使用、放射性核素的选择以及完整免疫球蛋白或片段的使用等许多问题仍有待解答。对这些问题进行了探讨。总体而言，得出的结论是，RIT最有前景的应用是作为微小残留病患者的辅助治疗，建议进行一项对照多中心试验。开发更有效的用于治疗以及最终用于诊断目的的放射免疫缀合物，将通过增加其影响预后的潜力，有助于IS的改进和发展。
