Abstract

Background

World Health Organization (WHO)-defined central nervous system (CNS) grade 4 high-grade gliomas (HGGs) are aggressive brain tumors marked by hypoxia and diffuse infiltration, which leaves residual tumor cells after surgery and drives inevitable local recurrence. Here, we propose a novel local therapeutic approach with 64Cu-diacetyl-bis(N4-methylthiosemicarbazone) ([64Cu]Cu-ATSM), a hypoxia-targeting radiopharmaceutical, using HGG-patient-derived xenograft (PDX) models.

Methods

The maximum tolerated dose (MTD) of local injection of [64Cu]Cu-ATSM into the tumor was determined in mice via biodistribution, dosimetry, and toxicity analyses. Intratumoral distribution was evaluated using PET/CT and MRI in multiple HGG-PDX models recapitulating human tumor characteristics. Therapeutic efficacy was assessed by survival analysis, along with evaluation of DNA damage and apoptosis.

Results

The MTD of [64Cu]Cu-ATSM local injection was established at 3.7 MBq. PET/CT demonstrated rapid intratumoral penetration, widespread distribution, and prolonged retention of [64Cu]Cu-ATSM in HGG-PDX tumors. Local treatment significantly extended survival and induced pronounced DNA double-strand breaks and apoptosis within tumors.

Conclusion

Local injection of [64Cu]Cu-ATSM into the tumor is a novel therapeutic strategy for HGG-PDX models, which combines hypoxia-targeted radiotherapy with PET-based treatment monitoring to address residual tumor cells and improve therapeutic outcomes.