The Role of 89Zr-Immuno-PET in Navigating and Derisking the Development of Biopharmaceuticals

The identification of molecular drivers of disease and the compelling rise of biotherapeutics have impacted clinical care but have also come with challenges. Such therapeutics include peptides, monoclonal antibodies, antibody fragments and nontraditional binding scaffolds, activatable antibodies, bispecific antibodies, immunocytokines, antibody-drug conjugates, enzymes, polynucleotides, and therapeutic cells, as well as alternative drug carriers such as nanoparticles. Drug development is expensive, attrition rates are high, and efficacy rates are lower than desired. Almost all these drugs, which in general have a long residence time in the body, can stably be labeled with Zr-89 for whole-body PET imaging and quantification. Although not restricted to monoclonal antibodies, this approach is called Zr-89-immuno-PET. This review summarizes the state of the art of the technical aspects of Zr-89-immuno-PET and illustrates why it has potential for steering the design, development, and application of biologic drugs. Appealing showcases are discussed to illustrate what can be learned with this emerging technology during preclinical and especially clinical studies about biologic drug formats and disease targets. In addition, an overview of ongoing and completed clinical trials is provided. Although Zr-89-immuno-PET is a young tool in drug development, its application is rapidly expanding, with first clinical experiences giving insight on why certain drug-target combinations might have better perspectives than others.

Automated summary

The identification of molecular drivers of disease and the rise of biotherapeutics have impacted clinical care, but also presented challenges. The application of Zr-89-immuno-PET in drug development shows promise in guiding the design, development, and application of biologic drugs, with increasing potential for understanding drug-target combinations in clinical studies.