International Journal of Nuclear Medicine Research  (Special Issue - 2017)
 Important Clinical Applications of 188Rhenium for Radionuclide Therapy Nuclear
Pages 16-38

Ajit Shinto and F.F. (Russ) Knapp

DOI: http://dx.doi.org/10.15379/2408-9788.2017.03

Published: 31 July 2017

Abstract
Although established clinical utility is of key importance in choosing agents for radionuclide therapy, other key factors include costs and GMP availability of sterile, pyrogen-free, regulatory approved radiopharmaceuticals. No-carrier-added (NCA) 188Rhenium(188Re, 16.9 hour half-life; 155 keV gamma emission) is available on demand as 188Re-perrhenate from saline elution of a 188Tungsten/188Rhenium(188W/188Re) generator. The availability and superb radionuclidic and chemical properties make 188Re an excellent candidate for radionuclide therapy. This radioisotope is readily attached to a variety of targeting agents and also emits high energy beta particles (Emax 2.12 MeV) for therapy. Over the last 30 years the effectiveness of 188Re for a variety of therapeutic applications has been established in multiple clinical studies. This overview provides a brief summary of clinical applications with 188Re-labeled agents as an introduction to the detailed clinical discussions in the following papers. Although 188Re-labeled radiopharmaceuticals for routine clinical use and accompanying reimbursement are not yet commercially available, several agents have been evaluated in clinical studies. In addition, a large number of 188Re radiopharmaceutical agents have been developed and evaluated in pre-clinical studies over the last three decades. This review focuses on providing examples of 188Re-labeled radiopharmaceutical agents which have entered late stage clinical use and have demonstrated good efficacy. These key applications include palliative treatment of skeletal metastases, intra-arterial therapy of liver cancer and post PTCA intravascular inhibition of arterial restenosis. Also, 188Re radiopharmaceuticals had been developed and initially assessed for synovectomy and for marrow suppression. More recently, a unique device-based technology has entered clinical use for therapy of non-melanoma skin cancer using a 188Re topical cream. Finally, 188Re-antibodies are being developed for the potential therapy of infectious disease and this unique new therapeutic strategy is expected to enter clinical trials in the near future.
Keywords
 Bone pain palliation, Cancer therapy, Liver cancer, Skin cancer, 188Rhenium, 188Tungsten/188Rhenium Generator.
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