VerlumaVerluma

Nofetumomab MerpentanNofetumomab Merpentan

(Fragment)(Fragment)

IndicationsIndications

For the detection For the detection and staging of and staging of previously untreated previously untreated small cell lung small cell lung cancer. It must be cancer. It must be confirmed via biopsy confirmed via biopsy confirmedconfirmed

Radiopharmaceutical and DoseRadiopharmaceutical and Dose

5-10 mg Verluma labeled with 15-30 mCi 5-10 mg Verluma labeled with 15-30 mCi Tc99m in 15-20mlTc99m in 15-20ml

Administered over 3-5 minutesAdministered over 3-5 minutes

Kit is good for 6 hoursKit is good for 6 hours

Method of Localization and Method of Localization and ExcretionExcretion

Recognizes glycoprotein cancer Recognizes glycoprotein cancer associated antigen expressed on a variety associated antigen expressed on a variety of tumors.of tumors.

64% renal clearance in 22 hours64% renal clearance in 22 hours– Secondary route hepatobiliarySecondary route hepatobiliary

Precautions and Patient PrepPrecautions and Patient Prep

Possibility of HAMA responsePossibility of HAMA response

Well HydrateWell Hydrate

Bowel PrepBowel Prep

Use filters/filtered needles during dose Use filters/filtered needles during dose preparation and injection.preparation and injection.

ScanningScanning14-17 hours post injection14-17 hours post injection– Normally inject at 5pm and image at 7amNormally inject at 5pm and image at 7am

HIRES/LEAPHIRES/LEAP

15% Window 140keV15% Window 140keV

SPECTSPECT– 360360oo

– 64 stops64 stops

Anterior and PosteriorAnterior and Posterior– 500K or 10 minutes500K or 10 minutes– Head to pelvisHead to pelvis– Lateral skullsLateral skulls

FindingsFindings

NormalNormal– GallbladderGallbladder– IntestineIntestine– KidneysKidneys– BladderBladder– Pituitary glandPituitary gland– TestesTestes– ThyroidThyroid– Salivary glandsSalivary glands

AbnormalAbnormal– Hot spot late images Hot spot late images

cold center, hot ring cold center, hot ring early imagesearly images

– Uptake other than Uptake other than known tumors, known tumors, inflammation, recent inflammation, recent surgery sites, skin surgery sites, skin foldsfolds

False ReadingsFalse Readings

False PositiveFalse Positive– Areas of increased Areas of increased

blood flow such as blood flow such as infection/inflammationinfection/inflammation

False NegativeFalse Negative– Usually brain, bone Usually brain, bone

and small liver lesionsand small liver lesions

Survival RateSurvival Rate

Extensive diseaseExtensive disease– Distant mets located Distant mets located – 0-2% survival rate0-2% survival rate– Chemotherapy onlyChemotherapy only

Limited diseaseLimited disease– No mets locatedNo mets located– 2 year survival rate2 year survival rate– Chemotherapy and Radiation TherapyChemotherapy and Radiation Therapy

FindingsFindings

Verluma is a monoclonal antibody Fab fragment linked to 99mTc. Verluma identifies advanced-stage disease in patients with small-cell lung cancer (SCLC). The determination of disease stage has important prognostic and therapeutic implications. In the clinical trial involving 89 patients with confirmed SCLC, Tc-labeled Verluma accurately determined whether the disease was extensive or limited 82 percent of the time. If the test indicated extensive disease, the result was true in 94 percent of the patients. However, if the test indicated limited disease, it was less valuable as a diagnostic aid, failing to image tumors in some body organs in approximately 23 percent of the patients. Because of these false negative readings, additional standard diagnostic tests, such as a bone or CT scan or a bone marrow biopsy should be performed when limited disease is found. Verluma was approved August 20, 1996.

this document was a handout at a biweekly inservice training at Beth Israel Deaconess Medical Center Nuclear Medicine Department led by Jeff Cone.

FindingsFindings

Clinical experience with Tc-99m nofetumomab merpentan (Verluma) Clinical experience with Tc-99m nofetumomab merpentan (Verluma) radioimmunoscintigraphy. radioimmunoscintigraphy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9298295&dopt=Abstract

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