Radioimmunoimaging and radioimmunotherapy: will these be routine procedures?

Despite major progress made during the past 25 years in the genetic engineering and labeling of monoclonal antibodies (Mab) and in the understanding of the uptake and kinetics of radiolabeled Mab by normal and tumor tissues, immunoscintigraphy never succeeded in becoming a routine procedure, compared with a bone or gallium scan. The more and more generalized availability of positron emission tomography (PET) with Fluorine-18 fluorodeoxyglucose (FDG) for diagnosis and staging of malignant diseases will probably definitively seal the fate of radioimmunodiagnosis as it has been conceived up until now. With respect to the nonspecificity of deoxyglucose uptake by tumor cells, it is not to be excluded that antibodies, or more likely antibody fragments, labeled with positron emitters might be used for tissue characterization. The recent success of radioimmunotherapy, especially in B-cell malignancies, entitles us to expect that RIT will become part of standard therapy of patients with malignancies. In that case, immunoscintigraphy will be needed for treatment planning (patient selection and dosimetry). One might even speculate that the oncologists who are becoming familiar with nuclear medicine tracer techniques for pretreatment evaluation might be interested in extending them to distribution and kinetic studies of other cytotoxic drugs. The close cooperation between nuclear medicine specialists, oncologists, and hematologists is essential to make radioimmunotherapy a routine procedure.