Astatine-211 MABG in Malignant Pheochromocytoma and Paragangliomas

Astatine-211 Meta-Astato-Benzyl-Guanidine (211At-MABG) emerges as a groundbreaking advancement in the treatment of malignant pheochromocytoma and paragangliomas, targeting norepinephrine transporters (NET) and marked by astatine-211. This novel therapy, developed at Fukushima University, is a 131I-MIBG analogue specifically designed to leverage the therapeutic benefits of alpha particle radiation. With orphan status for its indication, it addresses a critical need within a niche patient population, with an estimated 320 new cases annually in Japan. The clinical landscape for 211At-MABG is advancing with the initiation of a Phase I/II trial in 2023, aimed at evaluating its safety and efficacy, alongside a parallel trial focusing on 18 patients with pheochromocytomas/paragangliomas. This pioneering approach promises to significantly improve patient outcomes in a field where treatment options have been limited.

Introduction to Astatine-211 MABG

Astatine-211 MABG represents a significant leap forward in the management of malignant pheochromocytoma and paragangliomas, rare tumours originating from chromaffin cells. The development of this therapeutic agent at Fukushima University signifies a novel approach in targeting the norepinephrine transporter (NET), a crucial element in the pathology of these malignancies. The innovative use of astatine-211, an alpha particle-emitting isotope, differentiates 211At-MABG from its predecessor, 131I-MIBG, offering potentially enhanced efficacy due to the highly destructive nature of alpha radiation to tumour cells.

The Need for Advanced Treatments

Malignant pheochromocytoma and paragangliomas are aggressive and rare, with approximately 320 individuals diagnosed annually in Japan. These conditions’ rarity and aggressive nature underscore the urgent need for more effective treatments. The designation of 211At-MABG as an orphan drug highlights its importance in addressing this unmet medical need, promising a new horizon for patients afflicted with these challenging tumours.

Mechanism of Action

211At-MABG mechanism centres on targeting adrenergic tissues through the norepinephrine transporter (NET), facilitating the delivery of astatine-211 directly to tumour cells. This targeted approach ensures that the alpha particle radiation exerts its cytotoxic effects precisely where it is needed, maximising tumour cell eradication while minimising damage to surrounding healthy tissues. The specificity of this mechanism offers a significant advantage over traditional therapies, which cannot often discriminate between healthy and malignant cells.

Clinical Trials and Research

The journey of 211At-MABG from a promising concept to a potential therapeutic reality is marked by rigorous clinical evaluation. The commencement of a Phase I/II clinical trial in 2023 is a pivotal step in this journey, aiming to assess the safety, tolerability, and preliminary efficacy of 211At-MABG in patients with malignant pheochromocytoma and paragangliomas. Additionally, a separate trial initiated in the same year focuses on a cohort of 18 patients, further expanding our understanding of its therapeutic potential. These trials are critical for determining the optimal dosing strategies and for evaluating the therapeutic benefits and risks associated with 211At-MABG treatment.

Future Perspectives

The development of 211At-MABG opens new avenues for the treatment of malignant pheochromocytoma and paragangliomas. Its unique mechanism of action and targeted delivery system hold the promise of a more effective and safer treatment option for patients. As clinical trials progress, the potential for 211At-MABG to become a standard of care in this niche but desperate patient population becomes increasingly tangible. Furthermore, the success of 211At-MABG could pave the way for the development of similar targeted therapies for other types of cancer, significantly impacting the landscape of cancer treatment.


Astatine-211 MABG stands at the forefront of innovative cancer therapy, offering hope to patients with malignant pheochromocytoma and paragangliomas. Its development underscores the importance of targeted, mechanism-based treatments in oncology, providing a blueprint for future therapeutic advances. As clinical trials continue, the potential of 211At-MABG to improve patient outcomes and redefine the standard of care in this challenging field is eagerly anticipated.

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