Technetium-99m tilmanocept
The purpose-built tracer for sentinel lymph node mapping in breast cancer, melanoma and oral cancer, replacing off-label sulfur colloid.
Overview
Technetium-99m tilmanocept is a mannosylated dextran labelled with technetium-99m that binds CD206, the mannose receptor on macrophages in lymph nodes. Because it is small it drains rapidly from the injection site, and because it binds a receptor it stays in the sentinel node rather than passing through to second-echelon nodes, which simplifies surgery. It was the first agent purpose-built for sentinel lymph node mapping, replacing off-label sulfur colloid. The FDA approved it in March 2013 for breast cancer and melanoma, in 2014 for sentinel node localisation in oral cavity squamous cell carcinoma, where mapping showed 97.8% sensitivity, and extended it to children in 2017; the EU approved it in 2014. It is detected with a handheld gamma counter in theatre. Tilmanocept finds the first node a cancer would spread to so that only that node needs removal.
- Gamma camera (rotates)
- Single photons (Tc-99m, Lu-177)
1.Technetium-99m tilmanocept binds its target on the cancer cell or is taken up by it.
- Medicare
- Part B (clinician-administered)
Radiopharmaceutical for sentinel lymph node mapping, billed with the nuclear medicine procedure under Part B; when used in the operating room it is bundled into the surgical payment.
- Commercial insurance
- covered on label
Covered as part of the sentinel node procedure for breast cancer, melanoma and oral cancer; no separate authorisation.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B) · Medicare.gov: Diagnostic non-laboratory tests (imaging). Not medical or financial advice; verify with your plan.
- Notes
- EU-licensed sentinel node tracer; NHS sentinel node biopsy mostly uses Tc-99m nanocolloid. No TA.
- NHS England
- Not routinely funded
Sources: NICE search: technetium-99m tilmanocept. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
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Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2013 | Lymphatic mapping with a handheld gamma counter in breast cancer and melanoma |
| US | 2014 | Sentinel lymph node localisation in oral cavity squamous cell carcinoma |
| EU | 2014 | Sentinel node imaging in breast cancer, melanoma, oral SCC |
Trials
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Latest papers
topQuery for this drug: (TITLE:"Technetium-99m tilmanocept" OR ABSTRACT:"Technetium-99m tilmanocept" OR TITLE:"Lymphoseek" OR ABSTRACT:"Lymphoseek") AND (radiopharmaceutical OR radioligand OR radionuclide OR theranostic OR "nuclear medicine" OR "molecular imaging" OR radiotracer OR scintigraphy OR cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Technetium-99m tilmanocept, not a curated reading list.
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