Polio virus new weapon in fight against cancer

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An ancient scourge - the polio virus - may be an unexpected friend to people battling one of the deadliest brain cancers, new research shows. That rate remained stable at three years, with 21 percent of the vaccine patients still alive, compared with 4 percent of the control group.

The treatment is now entering larger, more comprehensive Phase 2 trials, so hopefully it demonstrates better efficacy over the new few years of experiments. "With the survival rates in this early phase of the poliovirus therapy, we are encouraged and eager to continue with the additional studies that are already underway or planned".

The research represents an 18-year collaboration with the National Cancer Institute and the US Food and Drug Administration.

The Duke results were published online Tuesday by the New England Journal of Medicine to coincide with their presentation at the 22nd International Conference on Brain Tumor Research in Norway. Some breast cancer and melanoma patients will soon be eligible to join clinical trials that expand the therapy beyond brain tumors.

"Our strategy did not start out with the intent to use poliovirus in cancer immunotherapy". Burkitt's lymphoma is the only solid tumor that lacks this poliovirus receptor, a key to the door allowing the virus to enter and kill cancer cells.

The Duke researchers made a decision to try to use a genetically modified version of the poliovirus, which can cause a devastating form of paralysis, because of the virus's ability to infect nervous system cells. The modification involved removal of one of the genes of the virus that prevented it from causing polio.

While that number is low, the survival rate for glioblastoma is normally even lower, usually, a year and a half after diagnosis.

Dr. Allan Friedman of the Preston Robert Tisch Brain Tumor Center at Duke performs neurosurgery to implant a catheter that will deliver poliovirus therapy into a glioblastoma tumor. Once the total 6½ hours of infusion are completed, the catheter is removed. However, at higher dosages, some patients experienced too much inflammation, resulting in seizures, cognitive disturbances, and other adverse events, so the amount infused was reduced.

"I've been doing this for 50 years and I've never seen results like this", Dr. Darell Bigner, of the Duke Cancer Institute, who is helping develop the treatment, told NPR.

It was the first human test of this and it didn't help most patients or improve median survival. "With chemotherapy, once patients fail, they are resistant, and they don't respond". Desjardins said that just like other immunotherapies this viral therapy does not work on all patients.

"These are people who failed everything", Bigner said.

Overall, 21% of the poliovirus patients should remain alive three years after treatment, compared with just 4% of the control patients, statistical analysis suggests. None are sold yet for brain tumors.

Study participants were selected according to strict guidelines based on the size of their recurring tumor, its location in the brain, and other factors designed for patient protection.

Researchers at Duke University have recently revealed the results from a Phase 1 clinical trial investigating the efficacy of an experimental treatment using a genetically modified poliovirus to attack a lethal form of brain cancer.

Medical marijuana is still a controversial topic when it comes to doctors recommending it to their cancer patients.

Choi, who was not involved in the new study but who has published research on the topic, said that "the poliovirus, which otherwise causes a disgusting disease that we've sought to eradicate for over half a century, has now been re-engineered to instead target and attack another deadly disease, in this case glioblastoma, which is the worst form of brain cancer". The modified virus retains the ability to infect and kill brain tumor cells, and also appears to trigger the patient's own immune system cells to attack the tumors, the researchers say. Antigens are toxins that unleash the body's immune reponse. They also plan to combine the treatment with other drugs, including some called checkpoint inhibitors, to harness the immune system to fight cancer. They were treated a second time and Bigner says, "Those that we've been able to follow long enough have responded to the treatment the second time".



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