Multimodal CEA-targeted fluorescence and radioguided cytoreductive surgery for peritoneal metastases of colorectal origin

Jan Marie Gooyer (), Fortuné M. K. Elekonawo, Andreas J. A. Bremers, Otto C. Boerman, Erik H. J. G. Aarntzen, Philip R. Reuver, Iris. D. Nagtegaal, Mark Rijpkema and Johannes H. W. Wilt
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Jan Marie Gooyer: Radboud University Medical Center
Fortuné M. K. Elekonawo: Radboud University Medical Center
Andreas J. A. Bremers: Radboud University Medical Center
Otto C. Boerman: Radboud University Medical Center
Erik H. J. G. Aarntzen: Radboud University Medical Center
Philip R. Reuver: Radboud University Medical Center
Iris. D. Nagtegaal: Radboud University Medical Center
Mark Rijpkema: Radboud University Medical Center
Johannes H. W. Wilt: Radboud University Medical Center

Nature Communications, 2022, vol. 13, issue 1, 1-10

Abstract: Abstract In patients with colorectal peritoneal metastases scheduled for cytoreductive surgery, accurate preoperative estimation of tumor burden and subsequent intraoperative detection of all tumor deposits remains challenging. In this study (ClinicalTrials.gov NCT03699332) we describe the results of a phase I clinical trial evaluating [111In]In-DOTA-labetuzumab-IRDye800CW, a dual-labeled anti-carcinoembryonic antigen (anti-CEA) antibody conjugate that enables both preoperative imaging and intraoperative radioguidance and fluorescence imaging. Primary study outcomes are safety and feasibility of this multimodal imaging approach. Secondary outcomes are determination of the optimal dose, correlation between tracer uptake and histopathology and effects on clinical strategy. Administration of [111In]In-DOTA-labetuzumab-IRDye800CW is well-tolerated and enables sensitive pre- and intraoperative imaging in patients who receive 10 or 50 mg of the tracer. Preoperative imaging revealed previously undetected lymph node metastases in one patient, and intraoperative fluorescence imaging revealed four previously undetected metastases in two patients. Alteration of clinical strategy based on multimodal imaging occurred in three patients. Thus, multimodal image-guided surgery after administration of this dual-labeled tracer is a promising approach that may aid in decision making before and during cytoreductive surgical procedures.

Date: 2022
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DOI: 10.1038/s41467-022-29630-9

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