MIBG Therapy: Innovative Neuroblastoma Treatment

MIBG therapy is an innovative targeted therapy for the treatment of neuroblastoma. Neuroblastoma is a rare form of cancer that begins in nerve tissue, or ganglions. It can also develop in the adrenal gland cells, which are located above the kidneys (University of Michigan Health, n.d.). It can be found in other areas of the body along the nerves such as the neck, chest, abdomen, and the spinal cord (University of Michigan Health, n.d.). Neuroblastoma is usually found in children less than five years old and may develop in babies before birth (University of Michigan Health, n.d.).

Sign and Symptoms of Neuroblastoma

The biggest symptom of neuroblastoma is a mass in the abdomen (University of Michigan Health, n.d.).

Other symptoms depend on where the tumor is located and what area of the body it is affecting. This can include:

A mass in the abdomen, chest, neck, or pelvis
Not wanting to eat or drink
Dark circles underneath the eyes or puffy eyes
Anemia or pale-looking skin
Upset stomach, including diarrhea or constipation
Difficulty walking or being unable to walk
Low energy
Pain
High blood pressure
(Cleveland Clinic, 2020)

Receiving a Diagnosis

Diagnosing Neuroblastoma can include getting an MRI or CT scan to look for a mass. An MRI or CT would also allow your medical team to see if the mass has spread to other areas of the body, as it is common for neuroblastoma to have spread by the time symptoms are found. An ultrasound can also be helpful in identifying where a mass may be located (Cleveland Clinic, 2020).

About MIBG Radiation Therapy

After a low-dose MIBG scan, the tumor board can decide if a patient is a good candidate for the Metalodobenzylguanidine (higher dose) radiation therapy. MIBG radiation therapy is “combined with a radioactive material called Iodine-131 (I-131) to produce radioactive MIBG (I-MIBG) which then attack neuroblastoma cells. It is administered through intravenous (IV) tubing which is connected to a syringe with the I-MIGB dose that is then run through an infusion pump located on a lead-shielded cart. The infusion process generally takes 2 to 2 ½ hours” (University of Michigan Health, n.d.).

C.S. Mott Children’s Hospital in Ann Arbor, Michigan, is one of the few children’s hospitals that provide MIBG radiation. They are collaborating with the Children’s Oncology Group as well as the New Advances in Neuroblastoma Consortium to come up with new approaches for neuroblastoma therapies (University of Michigan Health, n.d.). The Solid Tumor Oncology Program Tumor Board and specialists will meet weekly to discuss each patient’s case and decide the best treatment for that specific patient. Patients who qualify for I-MIBG radiation therapy will be required to stay in the hospital for treatment as the medication can only stay active for a short time (University of Michigan Health, n.d.).

Where Can My Child Get I-MIBG Therapy?

There are many other children’s hospitals that provide I-MIBG therapy as well. Here is a list of the children’s hospitals that are currently offering I-MIBG:

Children’s Hospital of Philadelphia, Philadelphia, PA
Vanderbilt Children’s Hospital, Nashville, TN
University of Iowa Stead Family Children’s Hospital, Iowa City, IA
Children’s Healthcare of Atlanta, Atlanta, GA
Wolfson Children’s Hospital, Jacksonville, FL
UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
UW Health Kids, Carbone Cancer Care Center, Madison, WI
Duke Children’s Hospital, Durham, NC
Cohen Children’s Medical Center – Northwell Health, New Hyde Park, NY
Seattle Children’s Hospital, Seattle, WA
Levine Children’s Hospital, Charlotte, NC
Texas Children’s Hospital, Houston, TX
Children’s Medical Center, Dallas, TX
C.S. Mott Children’s Hospital, Ann Arbor, MI
Dana-Farber Cancer Institute, Boston, MA
Children’s Hospital Los Angeles, Los Angeles, VA
University of Chicago Comer Children’s Hospital, Chicago, IL
Nationwide Children’s Hospital, Columbus, OH
St. Louis Children’s Hospital, St. Louis, MO
Children’s Hospital of The Kings Daughters, Norfolk, VA

Case Studies

There are few studies regarding the survivability of neuroblastoma in relation to I-MIBG therapy. Survival rates greatly vary depending on age, concurrent therapies, and stage of neuroblastoma. Each patient’s therapy is tailored to their specific needs, so it is impossible to put exact numbers to this rate.

In a study of 883 patients in 26 clinical trials, “The pooled 1-year survival and 5-year survival rates were 64% and 32%. The pooled occurrence rates of thrombocytopenia and neutropenia in MIBG monotherapy studies were 53% and 58%” (He et al., 2022).

In a second study, 39 patients who experienced relapse or refractory neuroblastoma aged ten and older were reviewed, and “The largest of these was a multi-institution phase II monotherapy trial with 164 patients receiving a prescribed dose of 12 mCi/kg or 18 mCi/kg of ¹³¹I-MIBG.¹² The overall response rate was 36%, with another 34% of patients exhibiting stable disease” (Polishchuk, A. L. et al., 2011).

Conclusion

MIBG radiation therapy continues to evolve with time, research, and technology. As MIBG radiation advances, we can expect to see an improvement in patients’ quality of life. We can also expect to see better outcomes. You are not alone in your neuroblastoma diagnosis and The Sassy Carmen Foundation™ is here to support you. We are happy to connect you with one of our many programs and assist you in your journey. Please reach out at any time if you need assistance.

References

University of Michigan Health (n.d.). Neuroblastoma in Children.

C.S. Mott Children’s Hospital. Retrieved May 19, 2024, from https://www.mottchildren.org/conditions-treatments/ped-cancer/neuroblastoma

University of Michigan Health (n.d.). MIBG Therapy. C.S. Mott Children’s Hospital. Retrieved May 17, 2024, from https://www.mottchildren.org/conditions-treatments/mibg-therapy

Cleveland Clinic (2020, December 4). Neuroblastoma. Retrieved May 18, 2024, from https://my.clevelandclinic.org/health/diseases/14390-neuroblastoma

He, H., Xu, Q., & Yu, C. (2022). The Efficacy and Safety of Iodine-131-metaiodobenzylguanidine Therapy in Patients with Neuroblastoma: A Meta-analysis. BMC Cancer, 22(1). https://bmccancer.biomedcentral.com/articles/10.1186/s12885-022-09329-2

Polishchuk, A. L., Dubois, S. G., Haas-Kogan, D., Hawkins, R., & Matthay, K. K. (2011). Response, survival, and toxicity after iodine-131-metaiodobenzylguanidine therapy for neuroblastoma in preadolescents, adolescents, and adults. Cancer, 117(18), 4286–4293. https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.25987

MIBG Therapy: Innovative Neuroblastoma Treatment