4.7 Article

Preoperative characterisation of clear-cell renal carcinoma using iodine-124-labelled antibody chimeric G250 (I-124-cG250) and PET in patients with renal masses: a phase I trial

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LANCET ONCOLOGY
卷 8, 期 4, 页码 304-310

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ELSEVIER SCIENCE INC
DOI: 10.1016/S1470-2045(07)70044-X

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Background Preoperative identification of tumour type could have important implications for the choice of treatment for renal cancers. Antibody cG250 reacts against carbonic anhydrase-IX, which is over-expressed in dear-cell renal carcinomas. We aimed to assess whether iodine-124-labelled antibody chimeric G250 (I-124-cG250) PET predicts clear-cell renal carcinoma, the most common and aggressive renal tumour. Methods 26 patients with renal masses who were scheduled to undergo surgical resection by laparotomy received a single intravenous infusion of 185 MBq/10 mg of I-124-cG250 over 20 min in this open-label pilot study. Surgery was scheduled 1 week after I-124-cG250 infusion. PET and CT scanning of the abdomen, including the kidneys, within 3 h before surgery was planned for all patients. The obtained images were graded as positive (defined as a tumour-to-healthy-kidney ratio > 3 to 1) or negative for antibody uptake, and the surgeon was informed of the scan results before surgery. After surgery, resected tumours were histopathologically classified as clear-cell renal carcinoma or otherwise. The trial is registered on the clinical trials site of the National Cancer Institute website http://clinicaltrials.gov/ct/ show/NCT00199888. Findings One patient received inactive antibody and was excluded from analysis. 15 of 16 clear-cell carcinomas were identified accurately by antibody PET, and all nine non-clear-cell renal masses were negative for the tracer. The sensitivity of I-125-cG250 PET for dear-cell kidney carcinoma in this trial was 94% (95% CI 70-100%); the negative predictive value was 90% (55-100%), and specificity and positive predictive accuracy were both 100% (66-100% and 78-100%, respectively). Interpretation PET with (124)-cG250 can identify accurately clear-cell renal carcinoma; a negative scan is highly predictive of a less aggressive phenotype. Stratification of patients with renal masses by (124)-cG250 PET can identify aggressive tumours and help decide treatment.

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