The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 200-204, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NR-LU-10 monoclonal antibody scanning. A helpful new adjunct to computed tomography in evaluating non-small-cell lung cancer
V Rusch, H Macapinlac, R Heelan, E Kramer, S Larson, P McCormack, M Burt, N Martini and R Ginsberg
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Computed tomographic scanning has improved the noninvasive staging of lung
cancer but has the deficiency of not distinguishing benign from malignant
lesions. This prospective trial evaluated the usefulness of a new
radiolabeled monoclonal antibody, NR-LU-10, as an adjunct to computed
tomography by assessing its clinical applicability and accuracy in
detecting malignancy in primary lung tumors and mediastinal nodes. NR-LU-10
is a technetium 99m-labeled Fab fragment of a murine immunoglobulin G2b
monoclonal antibody that recognizes a 40 kD glycoprotein expressed in lung
and other epithelial cancers. METHODS: (1) Patients with potentially
resectable non-small-cell lung cancer were eligible; (2) all patients had
computed tomographic scans of the chest; (3) whole body and single photon
emission computed tomographic imaging were performed 14 to 17 hours after
intravenous infusion of 20 to 30 mCi of NR-LU-10; (4) subsequent
mediastinoscopy or thoracotomy with complete mediastinal nodal mapping
provided pathologic correlation. RESULTS: Twenty-four patients were
entered, 14 men and 10 women. No allergic reactions or other adverse
effects were seen. Interference from a prior ventilation-perfusion scan
precluded adequate imaging in 1 patient, but high-quality images were
obtained in the other 23 patients. The 22 primary malignant tumors all had
uptake and there was no uptake in 1 lung nodule found to be benign. In 21
patients who had surgical correlation of mediastinal nodal involvement,
NR-LU-10 was false-positive in 5 and false-negative in 1; results of
computed tomography were false-positive in 6 and false-negative in 1. In
this preliminary study, NR-LU-10 antibody scanning was safe and easily
performed, it produced high-quality images of the lung and mediastinum, and
it was accurate in detecting primary non-small-cell lung cancers. Further
evaluation of its value in staging the mediastinum is needed, in
particular, its role as an adjunct to computed tomography to help
distinguish benign from malignant lesions.
