Theranostic radiolabeled anti-CD20 sdAb for targeted radionuclide therapy of Non-Hodgkin Lymphoma.

Anti-CD20 radioimmunotherapy is an effective approach for therapy of relapsed or refractory CD20(pos) lymphomas, but faces limitations due to poor tumor penetration and undesirable pharmacokinetics of full antibodies. Camelid single-domain Ab fragments (sdAb) might circumvent some of the limitations of radiolabeled full antibodies. In this study, a set of hCD20-targeting sdAbs was generated, and their capacity to bind hCD20 was evaluated in vitro and in vivo. A lead sdAb, sdAb 9079, was selected on the basis of its specific tumor targeting and significant lower kidney accumulation compared with other sdAbs. SdAb 9079 was then radiolabeled with Ga-68 and Lu-177 for PET imaging and targeted therapy. The therapeutic potential of Lu-177-DTPA-sdAb was compared with that of Lu-177-DTPA-rituximab and unlabeled rituximab in mice bearing hCD20(pos) tumors. Radiolabeled with 68Ga, sdAb 9079 showed specific tumor uptake, with very low accumulation in nontarget organs, except kidneys. The tumor uptake of Lu-177-DTPA-sdAb 9079 after 1.5 h was 3.4 +/- 1.3% ID/g, with T/B and T/M ratios of 13.3 +/- 4.6 and 32.9 +/- 15.6. Peak tumor accumulation of Lu-177-DTPA-rituximab was about 9 times higher, but concomitantly with high accumulation in nontarget organs and very low T/B and T/M ratios (0.8 +/- 0.1 and 7.1 +/- 2.4). Treatment of mice with Lu-177-DTPA-sdAb 9079 significantly prolonged median survival compared with control groups and was as effective as treatment with rituximab or its Lu-177-labeled variant. Taken together, sdAb 9079 displays promising features as a theranostic drug to treat CD20(pos) lymphomas. (C) 2017 AACR.