BACKGROUND: Using a special methodology for radiolabeling lipid nanoparticles with therapeutic radionuclides, we have developed 186Re-nanoliposomes (186RNL). The liposomes, not unlike the membranes of human cells, are composed of a bilayer of distearoylphosphatidylcholine and cholesterol, and confer drug delivery control on beta emitting 186Re. This then permits the delivery of 186Re radiation of high specific activity which is retained within the tumor. METHODS: A phase 1 dose escalation study of 186RNL in recurrent glioma utilizing a standard 3 + 3 design was undertaken to determine the maximum tolerated dose of 186RNL by convection enhanced delivery following stereotactic biopsy. 186RNL is administered by the use of the SmartFlow Flex catheter (BrainLab) by convection enhanced delivery intra-tumorally. Catheter placement is guided using iPlan Flow and the Varioguide systems (BrainLab). Following catheter placement, patients are taken to a nuclear medicine suite where direct visualization of 186RNL infusion is followed under whole body planar imaging and SPECT/CT. Repeat imaging is performed immediately following, and at 1, 5, and 8 days after administration to obtain radiation dosimetry and distribution. RESULTS: Three patients have been treated to date with 1mCi to achieve a treatment field volume of 5mL. Catheter placement for all 3 cases has closely matched the stereotactic plan based upon MRI fusion with SPECT/CT. No treatment related adverse effects have been observed to date despite absorbed doses up to 140Gy (37 MBq). For patient 01, loco-regional retention was 76.8% of administered radioactivity on average from time 0 to 72 hours. During the 120 hour monitoring period, there was a trend toward slow loco-regional dispersion of radioactivity, which is indicated by larger extended radioactivity distribution volumes increasing from 19mL at 40 minutes to 31mL at 120 hours. CONCLUSION: Initial results of 186RNL delivery by CED are promising and the study will continue until an MTD is reached.
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