In two-step targeting technique using bifunctional antibodies, a nonra
diolabeled immunoconjugate with slow uptake kinetics (several days) is
initially injected, followed by a small radiolabeled hapten with fast
kinetics (several hours) that binds to the bispecific immunoconjugate
already taken up by the tumor target. In patients with colorectal or
medullary thyroid cancer, clinical studies performed with an anti-CEA/
anti-DTPA-indium bifunctional antibody and an indium-111-labeled di-DT
PA-TL bivalent hapten showed that tumor uptake was not modified compar
ed to results for F(ab')(2) fragments of the same anti-CEA antibody di
rectly labeled with indium-lll, whereas the radioactivity of normal ti
ssues was significantly reduced (3- to 6-fold), The fast tumor uptake
kinetics (several hours) and high or very high tumor-to-normal tissue
ratios obtained with the bifunctional antibody technique are favorable
parameters for efficient radioimmunotherapy.