Vinblastine – syntheses and preliminary imaging in cancer patients

ABSTRACT - Purpose: The primary aim of this work was to establish a radiolabeling procedure of vinblastine, a vinca alkaloid widely used in chemotherapy, with the positron-emitter carbon-11 for application in positron-emission-tomography (PET) studies in cancer patients. The optimized reaction conditions were transferred to an automated radiosynthesizer system for the preparation of vinblastine under GMP conditions for human use. We report about the whole body activity distribution after injection of vinblastine as well as the pharmacokinetic behavior in selected organs and the tumor in two patients that were investigated with vinblastine PET before chemotherapy. Methods: For carbon-11 labeling of vinblastine the reaction conditions were determined with respect to the two possible labeling precursors (i.e. methyl iodide and diazomethane), solvent, reaction temperature and reaction time. Both, diazomethane and methyl iodide were tested as labeling
precursors with the corresponding demethyl compound of vinblastine, i.e. the vinblastine acid and the potassium salt of vinblastine acid. Two patients with renal carcinoma underwent vinblastine PET before chemotherapy. One patient underwent a second scan during infusion of unlabeled vinblastine at a therapeutic dose.
Results: Best results for the labeling procedure were found when methylation was carried out at 100 °C within 20 min using 2 mg/mL of the potassium salt of vinblastine acid in DMSO and methyl iodide as labeling precursor. Based on methyl iodide starting activity a radiochemical yield of up 53 % vinblastine was achieved. In addition, the synthesis was transferred to a remotely controlled module for routine GMP conform production for human use. In large scale production runs up to 1 GBq of vinblastine was obtained ready for injection within 45 min after EOB. In one patient, whole body PET scans 40 min after injection of 112 MBq vinblastine showed a focally increased vinblastine uptake and vinblastine metabolite uptake, respectively in the known metastases, along with a slow but continuous washout during the measurement interval (0-60 min p.i.). Another patient showed no focally increased vinblastine uptake and vinblastine metabolite uptake in the tumor, where radioactivity concentration was comparable to that in the blood. In this patient, a second PET scan during infusion of unlabeled vinblastine revealed similar kinetics with a trend towards delayed hepatic metabolism and higher blood and tumor concentrations. Whereas this patient showed a partial response to chemotherapy, the first patient did not, hypothetically due to the observed vinblastine washout from the tumor. Conclusions: The carbon-11 labeling of vinblastine using methyl iodide is superior to the method using diazomethane. A well working automated radiosynthesis was established for the production of vinblastine for PET-investigations in cancer patients. The individual pharmacokinetic behavior of the chemo-therapeutic agent to the tumor can be assessed with PET, thus, can be considered to be a realistic approach for individualized chemotherapy.