Iodine-131-labeled antitenascin monoclonal antibody 81C6 treatment of patients with recurrent malignant gliomas: Phase I trial results

Purpose: To determine the maximum-tolerated dose (MTD) of iodine 131 (¹³¹I)-labeled 81C6 monoclonal antibody (mAb) in brain tumor patients with surgically created resection cavities (SCRCs) and to identify any objective responses to this treatment. Methods: In this phase I trial, eligible patients were treated with a single injection of ¹³¹I-labeled 81C6. Cohorts of three to six patients were treated with escalating dosages of ¹³¹I (starting dose of 20 mCi with a 20-mCl escalation in subsequent cohorts) administered through an Ommaya reservoir in the SCRC. Patients were followed up for toxicity and response until death or for a minimum of 1 year after treatment. The SCRC patients, who were previously irradiated, were followed up without additional treatment unless progressive disease was identified. Results: We administered 36 treatments of ¹³¹I doses up to 120 mCi to 34 previously irradiated patients with recurrent or metastatic bran tumors. Dose-limiting toxicity was reached at 120 mCi and was limited to neuro-logic or hematologic toxicity. None of the patients treated with less than 120 mCi developed significantly neurologic toxicity; one patient developed major hematologic toxicity (MHT). The estimated median survival for patients with glioblastoma multiforme (GBM) and for all patients was 56 and 60 weeks, respectively. Conclusion: The MTD for administration of ¹³¹I- labeled 81C6 into the SCRCs of previously irradiated patients with recurrent primary or metastatic brain tumors was 100 mCi. The dose-limiting toxicity was neurologic toxicity. We are encouraged by the minimal toxicity and survival in this phase I trial. Radiolabeled mAbs may improve the current therapy for brain tumor patients.