<i>Trans</i>-Cyclooctene Tag with Improved Properties for Tumor Pretargeting with the Diels–Alder Reaction

Radioimmunotherapy (RIT) of solid tumors is hampered by low tumor-to-nontumor (T/NT) ratios of the radiolabeled monoclonal antibodies resulting in low tumor doses in patients. Pretargeting technologies can improve the effectiveness of RIT in cancer therapy by increasing this ratio. We showed that a pretargeting strategy employing in vivo chemistry in combination with clearing agents, proceeds efficiently in tumor-bearing mice resulting in high T/NT ratios. A dosimetry study indicated that the chemical pretargeting technology, which centered on the bioorthogonal Diels–Alder click reaction between a radiolabeled tetrazine probe and a <i>trans</i>-cyclooctene-oxymethylbenzamide-tagged CC49 antibody (CC49–TCO­(<b>1</b>)), can match the performance of clinically validated high-affinity biological pretargeting approaches in mice (Rossin J Nucl Med. 2013, 54, 1989−1995). Nevertheless, the increased protein surface hydrophobicity of CC49–TCO­(<b>1</b>) led to a relatively rapid blood clearance and concomitant reduced tumor uptake compared to native CC49 antibody. Here, we present the in vivo evaluation of a TCO-oxymethylacetamide-tagged CC49 antibody (CC49–TCO­(<b>2</b>)), which is highly reactive toward tetrazines and less hydrophobic than CC49–TCO­(<b>1</b>). CC49–TCO­(<b>2</b>) was administered to healthy mice to determine its blood clearance and the in vivo stability of the TCO. Next, pretargeting biodistribution and SPECT studies with CC49–TCO­(<b>2</b>), tetrazine-functionalized clearing agent, and radiolabeled tetrazine were carried out in nude mice bearing colon carcinoma xenografts (LS174T). CC49–TCO­(<b>2</b>) had an increased circulation half-life, a 1.5-fold higher tumor uptake, and a 2.6-fold improved in vivo TCO stability compared to the more hydrophobic TCO-benzamide–CC49. As a consequence, and despite the 2-fold lower reactivity of CC49–TCO­(<b>2</b>) toward tetrazines compared with CC49–TCO­(<b>1</b>), administration of radiolabeled tetrazine afforded a significantly increased tumor accumulation and improved T/NT ratios in mice pretargeted with CC49–TCO­(<b>2</b>). In conclusion, the TCO-acetamide derivative represents a large improvement in in vivo Diels–Alder pretargeting, possibly enabling application in larger animals and eventually humans