ImmunoPET with Anti-Mesothelin Antibody in Patients with Pancreatic and Ovarian Cancer before Anti-Mesothelin Antibody-Drug Conjugate Treatment. 
Mesothelin (MSLN) is frequently overexpressed in pancreatic and ovarian cancers, making it a potential drug target.  We performed an (89)Zr-PET imaging study with MMOT0530A, a MSLN antibody, in conjunction with a phase I study with the antibody-drug conjugate DMOT4039A, containing MMOT0530A bound to MMAE.  The aim was to study antibody tumor uptake, whole-body distribution, and relation between uptake, response to treatment, and MSLN expression.  Before DMOT4039A treatment, patients received 37 MBq (89)Zr-MMOT0530A followed by PET/CT imaging 2, 4, and 7 days postinjection.  Tracer uptake was expressed as standardized uptake value (SUV).  MSLN expression was determined with immunohistochemistry (IHC) on archival tumor tissue.  Eleven patients were included, 7 with pancreatic and 4 with ovarian cancer.  IHC MSLN expression varied from absent to strong.  Suitable tracer antibody dose was 10 mg MMOT0530A and optimal imaging time was 4 and 7 days postinjection.  Tumor tracer uptake occurred in 37 lesions with mean SUVmax of 13.1 (±7.5) on PET 4 days postinjection, with 11.5 (±7.5) in (N= 17) pancreatic and 14.5 (±8.7) in (N= 20) ovarian cancer lesions.  Within patients, a mean 2.4-fold (±1.10) difference in uptake between tumor lesions existed.  Uptake in blood, liver, kidneys, spleen, and intestine reflected normal antibody distribution.  Tracer tumor uptake was correlated to IHC.  Best response to DMOT4039A was partial response in one patient.  With (89)Zr-MMOT0530A-PET, pancreatic and ovarian cancer lesions as well as antibody biodistribution could be visualized.  This technique can potentially guide individualized antibody-based treatment.