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Review
. 2023 Dec 23;17(1):25.
doi: 10.3390/ph17010025.

Radiopharmaceuticals for Treatment of Adrenocortical Carcinoma

Kerstin Michalski  1 , Wiebke Schlötelburg  1 , Philipp E Hartrampf  1 , Aleksander Kosmala  1 , Andreas K Buck  1 , Stefanie Hahner  2 , Andreas Schirbel  1
Affiliations
Review

Radiopharmaceuticals for Treatment of Adrenocortical Carcinoma

Kerstin Michalski et al. Pharmaceuticals (Basel). .

Abstract

Adrenocortical carcinoma (ACC) represents a rare tumor entity with limited treatment options and usually rapid tumor progression in case of metastatic disease. As further treatment options are needed and ACC metastases are sensitive to external beam radiation, novel theranostic approaches could complement established therapeutic concepts. Recent developments focus on targeting adrenal cortex-specific enzymes like the theranostic twin [123/131I]IMAZA that shows a good image quality and a promising therapeutic effect in selected patients. But other established molecular targets in nuclear medicine such as the C-X-C motif chemokine receptor 4 (CXCR4) could possibly enhance the therapeutic regimen as well in a subgroup of patients. The aims of this review are to give an overview of innovative radiopharmaceuticals for the treatment of ACC and to present the different molecular targets, as well as to show future perspectives for further developments since a radiopharmaceutical with a broad application range is still warranted.

Keywords: IMAZA; adrenocortical carcinoma; endoradiotherapy; theranostics.

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Conflict of interest statement

K.M. has received speaker honoraria from Novartis. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
[131I]IMAZA therapy in a 53-year-old patient with metastatic adrenocortical cancer. FDG PET maximum intensity projection (MIP) is shown at baseline (A). Post-therapeutic whole-body scintigraphy 2 days after first therapy (B) shows concordant tracer accumulation to FDG PET/CT. Response assessment after 3 and 8 months (C,D) shows a significant decrease in metabolic activity and a reduction in the diameter of the target lesion of 26%. After a progression-free survival of 18 months, a second therapy with [131I]IMAZA was applied. The patient died after an overall survival of 56 months after the first [131I]IMAZA therapy.
Figure 2
Figure 2
Schematic depiction of possible theranostic targets in adrenocortical carcinoma (black font) and the respective therapeutic radiopharmaceuticals (exemplary, blue font).
Figure 3
Figure 3
Chemical structure of possible theranostic radiopharmaceuticals for treatment of ACC. To date, [131I]IMAZA is the only compound that has been already used in patients.
Figure 4
Figure 4
Photo and scheme of module for radiosynthesis of [131I]IMAZA.
See this image and copyright information in PMC

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