First-in-Human Study of [Ga-68]Ga-NODAGA-E[c(RGDyK)](2) PET for Integrin alpha(v)beta(3) Imaging in Patients with Breast Cancer and Neuroendocrine Neoplasms: Safety, Dosimetry and Tumor Imaging Ability

Arginine-Glycine-Aspartate (RGD)-recognizing cell surface integrins are involved in tumor growth, invasiveness/metastases, and angiogenesis, and are therefore an attractive treatment target in cancers. The subtype integrin alpha(v)beta(3) is upregulated on endothelial cells during angiogenesis and on tumor cells. In vivo assessment of integrin alpha(v)beta(3) is possible with positron emission tomography (PET). Preclinical data on radiochemical properties, tumor uptake and radiation exposure identified [Ga-68]Ga-NODAGA-E[c(RGDyK)](2) as a promising candidate for clinical translation. In this first-in-human phase I study, we evaluate [Ga-68]Ga-NODAGA-E[c(RGDyK)](2) PET in patients with neuroendocrine neoplasms (NEN) and breast cancer (BC). The aim was to investigate safety, biodistribution and dosimetry as well as tracer uptake in tumor lesions. A total of 10 patients (5 breast cancer, 5 neuroendocrine neoplasm) received a single intravenous dose of approximately 200 MBq [Ga-68]Ga-NODAGA-E[c(RGDyK)](2). Biodistribution profile and dosimetry were assessed by whole-body PET/CT performed at 10 min, 1 h and 2 h after injection. Safety assessment with vital parameters, electrocardiograms and blood tests were performed before and after injection. In vivo stability of [Ga-68]Ga-NODAGA-E[c(RGDyK)](2) was determined by analysis of blood and urine. PET images were analyzed for tracer uptake in tumors and background organs. No adverse events or pharmacologic effects were observed in the 10 patients. [Ga-68]Ga-NODAGA-E[c(RGDyK)](2) exhibited good in vivo stability and fast clearance, primarily by renal excretion. The effective dose was 0.022 mSv/MBq, equaling a radiation exposure of 4.4 mSv at an injected activity of 200 MBq. The tracer demonstrated stable tumor retention and good image contrast. In conclusion, this first-in-human phase I trial demonstrated safe use of [Ga-68]Ga-NODAGA-E[c(RGDyK)](2) for integrin alpha(v)beta(3) imaging in cancer patients, low radiation exposure and favorable uptake in tumors. Further studies are warranted to establish whether [Ga-68]Ga-NODAGA-E[c(RGDyK)](2) may become a tool for early identification of patients eligible for treatments targeting integrin alpha(v)beta(3) and for risk stratification of patients.