1. Verluma Nofetumomab Merpentan (Fragment)

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

3. Radiopharmaceutical and Dose 5-10 mg Verluma labeled with 15-30 mCi Tc99m in 15-20ml Administered over 3-5 minutes Kit is good for 6 hours

4. Method of Localization and Excretion Recognizes glycoprotein cancer associated antigen expressed on a variety of tumors. 64% renal clearance in 22 hours –Secondary route hepatobiliary

5. Precautions and Patient Prep Possibility of HAMA response Well Hydrate Bowel Prep Use filters/filtered needles during dose preparation and injection.

6. Scanning 14-17 hours post injection –Normally inject at 5pm and image at 7am HIRES/LEAP 15% Window 140keV SPECT –360 o –64 stops Anterior and Posterior –500K or 10 minutes –Head to pelvis –Lateral skulls

7. Findings Normal –Gallbladder –Intestine –Kidneys –Bladder –Pituitary gland –Testes –Thyroid –Salivary glands Abnormal –Hot spot late images cold center, hot ring early images –Uptake other than known tumors, inflammation, recent surgery sites, skin folds

8. False Readings False Positive –Areas of increased blood flow such as infection/inflammation False Negative –Usually brain, bone and small liver lesions

9. Survival Rate Extensive disease –Distant mets located –0-2% survival rate –Chemotherapy only Limited disease –No mets located –2 year survival rate –Chemotherapy and Radiation Therapy

10. Findings 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.

11. Findings Clinical experience with Tc-99m nofetumomab merpentan (Verluma) radioimmunoscintigraphy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=929 8295&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=929 8295&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=929 8295&dopt=Abstract

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