Azedra (iobenguane I 131) / Lantheus - LARVOL DELTA

Deciphering the structural impact of norepinephrine analog radiopharmaceuticals on organic cation transporter affinity. (PubMed, Biomed Pharmacother) - "This study highlights the critical influence of the compounds' chemical structure on NET and OCT affinities. Structural modifications that reduce OCT-mediated uptake while maintaining high NET affinity could improve the specificity and theranostic potential of NET-targeting ligands. These findings provide insights for designing next-generation radiotracers with enhanced selectivity and clinical utility."

Journal • Neuroendocrine Tumor • Oncology • Solid Tumor • SLC22A1 • SLC22A2

NEUROBLASTOMA MIBG THERAPY PROGRAM AT KFSHRC (SIOP 2025) - "Background and Aims: •The emergence of chemotherapy-resistant tumor cells is the major obstacle to improving initial tumor response and to curing High-Risk neuroblastoma •MIBG labeled with iodine-131 (131I) has demonstrated activity for targeted therapy of neuroblastoma, both in relapsed and newly diagnosed patients • As a single-agent in a Phase 1 dose-escalation study, 131I-MIBG showed a response rate of 37% in children with relapsed neuroblastoma and dose-limiting hematologic toxicity was circumvented with ASCR... •MIBG I 131 may be considered in the management of relapsed Neuroblastoma •Data are encouraging and continue to emerge re; use of MIBG I 131 as an upfront modality in the management of high-risk Neuroblastoma. •Proper preparation of patient, family and healthcare providers is the key of success of the MIBG treatment."

Neuroblastoma • Solid Tumor

PRIMARY HYPOTHYROIDISM AFTER TREATMENT FOR CHILDHOOD CANCER IN THE DUTCH CHILDHOOD CANCER SURVIVOR STUDY (DCCSS-LATER 2; THYR SUB STUDY) (SIOP 2025) - "Radiotherapy including the thyroid gland, 131-I-metaiodobenzylguanidine (131-IMIBG) and hematopoietic stem cell transplantation (HSCT) are known risk factors for hypothyroidism... A novel finding is that CCS treated with chemotherapy only are not at increased risk for the development of primary hypothyroidism. Treatment for childhood cancer, including HSCT, does not increase the risk of anti-TPO antibodies. Furthermore, the use of platinum-based-compounds combined with radiotherapy (involving the thyroid gland) seems to increase the risk of hypothyroidism."

Clinical • Bone Marrow Transplantation • Endocrine Disorders • Oncology

BUSULFAN-BASED VERSUS TREOSULFAN-BASED CONDITIONING REGIMENS IN TANDEM HIGH-DOSE CHEMOTHERAPY FOR PATIENTS WITH HIGH-RISK NEUROBLASTOMA: A COMPARATIVE STUDY (SIOP 2025) - "Background and Aimes Tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/ASCT) combined with 131 I-MIBG therapy has become standard treatment for patients with high-risk neuroblastoma, significantly improving overall survival (OS) and event-free survival (EFS)...Patients received either a busulfan/melphalan regimen (n=20; 2014–2019) or a treosulfan/melphalan regimen (n=16; 2020–2024) during the first HDCT/ASCT cycle. All patients subsequently received thiotepa and cyclophosphamide in the second HDCT cycle...Conclusions Treosulfan-based conditioning regimens administered during the first cycle of HDCT/ASCT for patients with high-risk neuroblastoma reduced severe toxicities, including pulmonary hypertension, CKD, and hepatic VOD, compared to busulfan-based regimens. Further prospective studies with larger patient cohorts and longer follow-up periods are needed to confirm these findings and to fully assess long-term outcomes."

Clinical • Cardiovascular • Chronic Kidney Disease • Febrile Neutropenia • Hepatology • Mucositis • Nephrology • Neuroblastoma • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Solid Tumor

Inbraced: Phase I Study of 131-I mIBG Followed by Nivolumab & Dinutuximab Beta Antibodies in Children With Relapsed/Refractory Neuroblastoma (clinicaltrials.gov) - P1 | N=44 | Active, not recruiting | Sponsor: University Hospital Southampton NHS Foundation Trust | Trial completion date: Jul 2025 ➔ Nov 2025

Trial completion date • Neuroblastoma • Oncology • Solid Tumor

Impact of acquisition timing and background uptake on [131I]meta-iodobenzylguanidine SPECT/CT interpretation in pheochromocytoma and adrenal adenoma. (PubMed, Nucl Med Commun) - "Optimizing imaging background and acquisition time significantly enhances the diagnostic performance of [131I]MIBG SPECT/CT for pheochromocytoma, facilitating timely and effective patient management."

Journal • Oncology • Solid Tumor

Single institution experience with [131I]MIBG for pheochromocytoma and paraganglioma: Long-term outcomes and dosimetry (NANETS 2025) - "The most common toxicity was marrow suppression. These real-world findings support [131I]MIBG as an important option in select patients."

Clinical • Oncology • Solid Tumor • RET • SDHB

Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025. (PubMed, Endocr J) - "Treatment begins with inhibiting catecholamine action using α-blockers, and if that is insufficient, metyrosine is used in combination, followed by laparoscopic tumor removal...Treatment options are selected based on the amount of remaining tumor, symptom severity, and lesion progression, including CVD chemotherapy or radionuclide therapies such as 131I-MIBG or 177Lu-DOTATATE. Genetic testing guides the management of different variants, and significant progress has been made in molecularly targeted drug trials. Therefore, further advances in individualized and long-term management are required."

Clinical guideline • Journal • Cardiovascular • Endocrine Disorders • Genetic Disorders • Hypertension • Neuroendocrine Tumor • Oncology • Pain • Solid Tumor

Evaluation of the Efficacy of Treatment of Metaiodobenzylguanidine (131I-mIBG) in Pediatric Neuroblastoma (EANM 2025) - "The aim of the study is to evaluate the efficacy of ¹³¹I-mIBG treatment in pediatric patients diagnosed with very high-risk neuroblastoma (VHR-NBL) refractory to standard induction chemotherapy (vincristine, cyclophosphamide, cisplatin) treated with high-dose ¹³¹I-mIBG in combination with topotecan and subsequent bone marrow transplantation. Conclusion Treatment with ¹³¹I-mIBG combined with topotecan and followed by myeloablative therapy demonstrates efficacy and safety in pediatric patients with very high-risk neuroblastoma (VHR-NBL), achieving high OS and PFS rates, especially in patients older than 8 years. Despite the heterogeneous outcomes observed in the 4-7 year-old group, the majority attained a favourable response to treatment, confirming its suitability for this pathology."

Clinical • Bone Marrow Transplantation • Hematological Disorders • Immunology • Neuroblastoma • Pediatrics • Solid Tumor

Renal Ewing Sarcoma: “Triple‑Mismatch” Nuclear‑Medicine Signature (EANM 2025) - "Future studies are needed to evaluate the prevalence and diagnostic accuracy of SSTR imaging in renal EWS, which could also open the possibility for theranostic approaches in unresectable or metastatic cases.A non‑mIBG‑avid, mildly DOTANOC‑positive yet highly FDG‑avid renal mass in a child should raise strong suspicion for rEWS. Recognising this nuclear‑medicine signature can fast‑track definitive tissue diagnosis, avoid futile neuroblastoma‑directed therapy and underscores the value of multimodality functional imaging in rare paediatric renal tumours."

Ewing Sarcoma • Kidney Cancer • Nephrology • Neuroblastoma • Pediatrics • Renal Cell Carcinoma • Rhabdomyosarcoma • Sarcoma • Solid Tumor • Wilms Tumor • EWSR1 • SSTR

Phase 1 dose-escalation study on astatine-211 labelled meta-astatobenzylguanidine ([ 211 At]mABG) for treatment of recurrent or refractory high-risk neuroblastoma: study design and rationale (EANM 2025) - "Norepinephrine transporter (NET) positive patients with recurrent and refractory disease can be treated with iodine-131 labelled metaiodobenzylguanidine ([ 131 I]mIBG)...Conclusion Recruitment is expected to begin in 2026, and international patients can be considered. This study will provide the first clinical data on the safety and feasibility of [ 211 At]mABG therapy in patients with recurrent or refractory high-risk NBL and it may lead to a more effective and less burdensome therapeutic intervention."

P1 data • Neuroblastoma • Solid Tumor

SIOPEN Semiquantitative Score Adapted to 68Ga‑DOTANOC PET/CT: A Superior Disease‑Burden Biomarker (EANM 2025) - "Conclusion Applying the SIOPEN scoring to high‑resolution DOTANOC MIPs amplifies disease‑burden discrimination across established risk strata and correlates robustly with marrow involvement. DOTANOC‑SIOPEN scoring could refine upfront risk allocation and response quantification in future multicentre trials."

Biomarker • Neuroblastoma • Solid Tumor

Comparative diagnostic performance of 68Ga‑DOTANOC PET/CT versus 131I‑mIBG SPECT/CT in newly diagnosed pediatric neuroblastoma- a prospective single centre study. (EANM 2025) - "Conclusion Whole‑body 68Ga‑DOTANOC PET/CT significantly outperforms 131I‑mIBG SPECT/CT for lesion enumeration and metastatic staging—including cryptic marrow disease—without sacrificing primary‑tumour sensitivity. These findings support use of DOTANOC as a first‑line functional tracer where generator‑based gallium is available, and reserve mIBG chiefly for theranostic stratification."

Clinical • Neuroblastoma • Pediatrics • Solid Tumor

Testing the Addition of 131I-MIBG or Lorlatinib to Intensive Therapy in People With High-Risk Neuroblastoma (NBL) (clinicaltrials.gov) - P3 | N=750 | Recruiting | Sponsor: Children's Oncology Group | Trial completion date: Sep 2026 ➔ Sep 2030 | Trial primary completion date: Sep 2026 ➔ Sep 2030

Trial completion date • Trial primary completion date • Ganglioneuroblastoma • Neuroblastoma • Oncology • Solid Tumor • MYCN

Testing the Addition of 131I-MIBG or Lorlatinib to Intensive Therapy in People With High-Risk Neuroblastoma (NBL) (clinicaltrials.gov) - P3 | N=750 | Recruiting | Sponsor: Children's Oncology Group | Active, not recruiting ➔ Recruiting

Enrollment open • Ganglioneuroblastoma • Neuroblastoma • Oncology • Solid Tumor • MYCN

Simplified Imaging-Based Dosimetry of Organs and Inherently Heterogeneous Tumors for 131 I-MIBG Therapy Using Combined Pretherapy 123 I-MIBG and Posttherapy 131 I-MIBG SPECT Imaging (ASTRO 2025) - "This study proposes a simplified imaging-based dosimetry approach for 131I-MIBG neuroblastoma treatment by combining pretherapy 123I-MIBG and posttherapy 131I-MIBG imaging. Associated techniques, including SPECT image calibration, TIA estimation, and S-value determination, were developed and preliminarily validated. This method could reduce the number of imaging sessions required, simplify the clinical workflow, and enhance treatment planning."

Heterogeneity • Neuroblastoma • Oncology • Solid Tumor

Radiation Oncology at the Interface of Pediatric Cancer Biology and Data Science (ASTRO 2025) - P=N/A | "KIDSROBIN focuses on two pediatric cancers of neuro-ectodermal origin, diffuse midline glioma (DMG) and high-risk neuroblastoma (NBL), the former treated by external beam RT, and the latter by the radiopharmaceutical 131I-MIBG... TBD. ClinicalTrials.gov: NCT06000787."

Clinical • Tumor mutational burden • Brain Cancer • Diffuse Midline Glioma • Glioma • Neuroblastoma • Oncology • Solid Tumor • RAD51 • TMB • TP53BP1 • XRCC1

Industry Sponsorship and Disease Site Focus in Therapeutic Radiopharmaceutical Clinical Trials Over the Past Decade. (PubMed, Int J Radiat Oncol Biol Phys) - "RPT trials demonstrated consistent growth over the past decade, largely driven by robust industry support, and have predominantly focused on targeted 177Lu-based RPTs for the treatment of prostate adenocarcinoma and gastrointestinal neuroendocrine tumors.Manuscript."

Journal • Gastrointestinal Cancer • Neuroendocrine Tumor • Oncology • Prostate Adenocarcinoma • Prostate Cancer • Solid Tumor

131I-MIBG and 18F-FDG PET/CT in a Case of Synchronous Right Pheochromocytoma and Undifferentiated Uterine Carcinoma. (PubMed, Clin Nucl Med) - "The incidental detection of such an aggressive malignancy in a patient undergoing evaluation for pheochromocytoma is exceedingly rare and poses significant diagnostic and therapeutic challenges. Here, we present a case of a 63-year-old woman who was being evaluated for right pheochromocytoma and underwent 131I-MIBG scan for the same, which led to incidental detection of synchronous uterine carcinoma."

Journal • Cardiovascular • Endometrial Cancer • Hypertension • Oncology • Solid Tumor • Uterine Cancer

Therapeutic Innovation in Pediatric Neuroblastoma: Age and Stage-Specific Strategies from Prenatal to Early Childhood-A Review Article. (PubMed, Iran J Child Neurol) - "Emerging approaches such as GD2-targeted immunotherapy with monoclonal antibodies like dinutuximab, CAR-T cell therapy, 131I-MIBG and Lutetium-177-Dotatate radionuclide treatments, metronomic chemotherapy, oncolytic virotherapy, and tailored chemotherapy are showing promise, with autologous stem cell transplantation (ASCT) becoming integral to multimodal regimens. Rigorous clinical trials will be key to refining these innovations and establishing protocols for widespread use. In summary, advancements in therapy offer hope, yet achieving durable remissions and improved survival still demands intensive research innovation to address current gaps and resistance mechanisms in this complex pediatric malignancy."

IO biomarker • Journal • Review • Neuroblastoma • Oncology • Pediatrics • Solid Tumor • Transplantation

Advancing 131I-MIBG Therapy-New Horizons in Treating Malignant Pheochromocytoma and Paraganglioma (PubMed, Gan To Kagaku Ryoho) - "Although it is not strong, as for the 131I-MIBG therapy, the cytoreductive effect controls progress and is effective in the decrease in serum catecholamine level. In this report, we speak a summary of the 131I-MIBG therapy, a fact of the treatment, toxicities, curative effect, present situation and the future prospects."

Journal • Oncology • Solid Tumor

Clinical Profile, Outcomes, and Predictors of Malignant Pheochromocytoma and Paraganglioma: Insights From a Single-Center Cohort. (PubMed, Clin Endocrinol (Oxf)) - "Malignant PPGLs had a variable clinical course and were amenable to multimodal therapeutic strategies with a favorable outcome in about 67% of the patients. Although mPPGL had larger tumor diameter compared to non-mPPGL, no particular size cut-off could accurately predict metastases. Adjuvant 131I MIBG therapy is a useful treatment option in resource limited settings."

Journal • Adrenal Cortex Carcinoma • Oncology • Solid Tumor

[18F]MFBG PET/CT is an effective and preferable imaging modality for neuroblastoma in a prospective comparison with SSTR PET. (PubMed, Eur J Nucl Med Mol Imaging) - P, P1 | "In this head-to-head comparison, [18F]MFBG PET/CT demonstrates excellent diagnostic performance in neuroblastoma, comparable to SSTR-targeted PET. These findings suggest that routine dual-tracer imaging is not recommended and should be reserved for patients based on specific therapeutic consideration, including the clinical need for [131I]MIBG radionuclide therapy or peptide receptor radionuclide therapy (PRRT)."

Journal • Neuroblastoma • Oncology • Pediatrics • Solid Tumor • SSTR

Potentially fatal crisis after 177Lu-DOTATATE therapy for paraganglioma: a case report with review of literature. (PubMed, Endocr J) - "At the age of 49, he received 131I-MIBG therapy for the recurrence of pheochromocytoma with bone metastasis. In conclusion, while 177Lu-DOTATATE therapy is generally considered safe, our findings underscore the potential risks of fatal crisis after therapy. Careful monitoring of patients with PPGL should be performed after treatment."

Journal • Cardiovascular • Endocrine Cancer • Hematological Disorders • Musculoskeletal Pain • Neuroendocrine Tumor • Oncology • Pain • Solid Tumor • SSTR

Dosimetry-Guided [131I]MIBG Therapy in a Hemodialysis-Dependent Paraganglioma Patient. (PubMed, J Nucl Med) - " Dosimetry-guided treatment with [131I]MIBG in patients requiring hemodialysis is feasible. With appropriate dose reduction, the treatment can be effective with limited side effects."

Journal • Endocrine Cancer • Nephrology • Oncology • Renal Disease • Solid Tumor