Azedra (iobenguane I 131) / Lantheus - LARVOL DELTA

Cardiac and renal sympathetic nerve activation in early-stage HFpEF: insights from 131I-MIBG imaging study. (PubMed, Int J Cardiovasc Imaging) - "In the HFpEF group, both 4-h H/Ma and 4-h K/Mp ratios were positively correlated with LVEDP, while HWR and KWR were inversely correlated with these indices (all P < 0.01). Early-stage HFpEF patients show increased cardiac and renal sympathetic activity, highlighting the renal sympathetic nervous system as a potential therapeutic target and suggesting 131I-MIBG scintigraphy as a promising tool for risk stratification and early intervention."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure

The Current Status of Nuclear Medicine in Africa. (PubMed, J Nucl Med) - "177Lu-therapies are restricted to 7 countries, and the availability of [131I]MIBG remains limited...Sustained investment in facilities, training, and regulatory frameworks is essential to achieve equitable access to care. IAEA's regional anchor centers as part of the Rays of Hope initiative exemplifies strategic capacity building, collaboration, and knowledge sharing in the region."

Journal • Endocrine Disorders • Thyroid Gland Carcinoma • SSTR • SSTR2

NANT 2021-02: Randomized MIBG With Vorinostat/Dinutuximab/Vorinostat + Dinutuximab (clinicaltrials.gov) - P2 | N=118 | Not yet recruiting | Sponsor: New Approaches to Neuroblastoma Therapy Consortium

New P2 trial • Neuroblastoma • Oncology • Solid Tumor

Update on Systemic Therapies for Metastatic/Unresectable Pheochromocytomas and Paragangliomas and Future Directions. (PubMed, Cancers (Basel)) - "Radiopharmaceuticals such as 131I-MIBG and 177Lu-DOTATATE continue to play a pivotal role, achieving disease control in many patients. Cytotoxic regimens, particularly temozolomide, remain relevant, with some studies suggesting that SDHB-mutated PPGLs demonstrate a heightened sensitivity associated with MGMT promoter hypermethylation and reduced MGMT expression. Targeted agents are increasingly important: multi-kinase inhibitors such as sunitinib, anlotinib, and cabozantinib have shown meaningful activity. The landmark approval of belzutifan, a HIF-2α inhibitor, in 2025 represents the first oral targeted therapy for advanced/metastatic PPGL, which is particularly relevant for pseudohypoxic Cluster 1 tumors...This review summarizes current evidence and highlights ongoing clinical trials, underscoring a paradigm shift toward precision medicine and rational combination strategies. Collectively, these advances bring cautious optimism that metastatic PPGLs may soon become a..."

IO biomarker • Journal • Review • Endocrine Cancer • Oncology • Solid Tumor • EPAS1 • MGMT • SDHB

Peritoneal implantation of pheochromocytoma - pheochromocytomatosis: a case report and mini review. (PubMed, Front Endocrinol (Lausanne)) - "Imaging revealed a left adrenal tumor, which showed intense radiopharmaceutical uptake on 131I-metaiodobenzylguanidine ([131I]MIBG) scintigraphy...Pheochromocytomatosis is usually characterized by a prolonged asymptomatic postsurgical interval, emphasizing the need for long-term follow-up with close biochemical and radiological surveillance. Treatment strategies parallel those used for advanced/metastatic pheochromocytomas."

Journal • Review • Adrenal Cortex Carcinoma • Oncology • Peritoneal Cancer • Solid Tumor

Experimental study on the treatment of norepinephrine transporter-overexpressing pheochromocytomas and paragangliomas: a synthetic lethality strategy combining 131I-MIBG with PARP inhibitors. (PubMed, Front Oncol) - "This study aims to investigate the therapeutic potential of 131I-MIBG and the PARP inhibitor fluzoparib monotherapies and their combination on two distinct PC12-derived stable cell lines: PC12-NET cells and PC12-NET-SDHB cells...The specificity of PC12-NET cells to the 131I-MIBG was confirmed through desipramine inhibition assays...The combined of 131I-MIBG with PARP inhibitor demonstrated a synergistic antitumor effect in PC12-NET cells. While PC12-NET-SDHB cells display comparable sensitivity to 131I-MIBG as PC12-NET cells, they exhibited heightened responsiveness to PARP inhibitor treatment."

Journal • Oncology • Solid Tumor • SDHB

MIBG for Refractory Neuroblastoma and Pheochromocytoma (clinicaltrials.gov) - P=N/A | N=15 | Completed | Sponsor: Masonic Cancer Center, University of Minnesota | Suspended ➔ Completed | N=100 ➔ 15

Enrollment change • Trial completion • Neuroblastoma • Oncology • Solid Tumor • IL2 • IL6

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