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Evaluation of ¹¹¹In-DTPA-Folate as a Receptor-Targeted Diagnostic Agent for Ovarian Cancer: Initial Clinical Results

¹ Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
² Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
³ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
⁴ Department of Nuclear Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas
⁵ Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
⁶ Department of Radiology, Veterans Affairs Medical Center, Indianapolis, Indiana
⁷ Endocyte, Inc., West Lafayette, Indiana
⁸ Division of Nuclear Pharmacy, Department of Industrial and Physical Pharmacy, Purdue University, West Lafayette, Indiana
⁹ Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas

The cell-membrane folate receptor is a potential molecular target for tumor-selective drug delivery, including radiolabeled folate-chelate conjugates for diagnostic imaging. We report here the initial clinical study of such an agent, ¹¹¹In-diethylenetriaminepentaacetic acid (DTPA)-folate, evaluated for diagnosis of ovarian malignancy. Methods: Thirty-five women were enrolled in a phase I/II clinical study, with 33 completing the surgical follow-up required by the study protocol for definition of disease status. Patients either had a pathologically proven malignancy or were scheduled for surgery for suspected new ovarian cancer (n = 26), recurrent ovarian cancer (n = 5), or endometrial cancer (n = 2). ¹¹¹In-DTPA-folate was administered as an intravenous bolus, and whole-body images were obtained at 30 min, 4 h, and (for the first 19 patients) 24 h after injection; SPECT also was done at the delayed imaging times. For 19 of the patients, unlabeled free folic acid was injected before administration of ¹¹¹In-DTPA-folate to also assess the impact of folate loading on tracer biodistribution. Masked and unmasked readings of the images by 2 nuclear medicine physicians were compared with the pathologic findings after surgery. Results: Among 33 patients who had surgical intervention, 14 had new or recurrent malignant tumors. All of 7 newly diagnosed ovarian carcinomas were identified by both masked readers (sensitivity, 100%). The sensitivity for detection of 7 recurrent malignancies was 38% for masked readings and 85% for unmasked readings, indicating that correlation with anatomic imaging studies (CT) was highly important in diagnosis of these lesions. Eighteen of the studied patients were found to have benign masses; for this limited population, the specificity of ¹¹¹In-DTPA-folate scintigraphy was 76% and 82% for the masked and unmasked analyses, respectively. Conclusion: ¹¹¹In-DTPA-folate is safe, and possibly effective, for scintigraphy differentiating between malignant and benign ovarian masses.

Key Words: folate receptor • tumor imaging • ¹¹¹In • ovarian carcinoma

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