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MIBG imaging and 131I-MIBG therapy

A noradrenaline look-alike that neuroblastoma cells swallow: labelled with a small amount of radioactivity it shows the tumour on a scan; with a large amount it treats it.

123I-MIBG scintigraphy/SPECT is the standard staging scan (Curie score) in neuroblastoma, being partly replaced by 18F-MFBG PET. Therapeutic 131I-MIBG produces responses in ~30% of relapsed patients; COG ANBL1531 tested adding it to induction (results awaited). Also used in pheochromocytoma/paraganglioma (Azedra, discontinued 2024).

Generic schematic · not to scale · placeholder for the radiopharma front
Receptor (PSMA / SSTR) · Ligand + Lu-177 · β⁻ track ~2 mm, crossfire

How it works

Norepinephrine transporter (NET) uptake concentrates radio-iodinated MIBG in adrenergic tumours; 131I delivers beta radiation.

Strengths
  • Theranostic pair with decades of use
  • Targets NET-positive disease irrespective of GD2
Limitations
  • Prolonged isolation and radiation precautions in children
  • Myelosuppression requiring stem-cell support at high doses
  • Azedra withdrawal reduced supply
Since
1985

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