This article is from WeChat public account: pineapple factor (ID: checkpoint_1) , of: pineapple, from FIG title: visual China
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Malignant glioma is a type of brain tumor and one of the most difficult types of cancer to treat. Common methods include surgery, radiation therapy, chemotherapy, and targeted drugs, but if relapsed, the patient’s average survival time is less than 12 months.
The treatment of malignant brain tumors is not effective. There are two important reasons: the first is that it is difficult to cut the tumor cleanly, it will worry about the damage to the core function of the brain, and the second is the majority of the resistance. It is difficult for cancer drugs to reach the tumor site because the brain has a protective layer called the blood-brain barrier.
What should I do?
Scientists can’t take the usual path and think of a variety of seemingly wonderful ways.
Oncolytic virus is one of them.
Oncolytic virus is not a specific virus, but a virus that tends to infect tumor cells, and can multiply in cancer cells, eventually causing tumor cells to lyse, break, and die. A good oncolytic virus not only kills a part of cancer cells directly, but also activates the immune system to clean up residual cancer cells for better results.
A good oncolytic virus is essentially an immunotherapy.
Recently, an oncolytic virus called PVSRIPO has demonstrated a definite curative effect in recurrent malignant gliomas, and some patients seem to be clinically cured!
The first one to participateThe patient in this clinical trial was treated with oncolytic virus after recurrence on May 11, 2012. He is still alive for more than 7 years, and there is no sign of any tumor in the body!
It is a huge miracle for this kind of ailment that can only survive for an average of one year after recurrence.
As a result of its outstanding results, its first phase of clinical trial results was published in the New England Journal of Medicine. In fact, four years ago I wrote a story about patients who participated in this clinical trial, which was included in my first book, Cancer, Truth: Doctors Are Reading.
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In this phase I clinical trial, 61 patients with recurrent malignant gliomas were treated with oncolytic virus. The results of the first two years are shown below.
If you look at the survival data for the past two years, you will feel that this test has failed, because patients with oncolytic virus have no difference in survival time from the control group. The average survival time is only about 12 months, and the vast majority of patients have died within two years.
Why are everyone still excited?
On the one hand, it is because there are indeed individual patients who work well, such as the one below.
You can clearly see that before treatment, the patient’s tumor has recurred, there is a very obvious brain tumor (Figure A) , use dissolve After the tumor virus, the tumor slowly shrinks, and over time, the effect is getting better and better, and the tumor has no signs of recurrence. After 5 years of brain scan again, I found that the tumor has completely disappeared (Figure F)!
On the other hand, miracles don’t just appear on a patient. As the observation time prolonged, a smearing effect appeared on the survival curve. The study found that patients who did not die within two years could live for three years. And it may be five years or even longer!
As can be seen from the figure below, patients in the control group died almost completely within four years, but 21% of patients who used oncolytic virus remained alive!
Are they cured?
It is still too early to draw conclusions, but this long-term survival advantage has never been seen in such recurrent brain tumor patients, so everyone is very excited!
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This trial alsoAn interesting phenomenon was discovered, that is, even if the oncolytic virus alone fails, it may still help the subsequent chemotherapy to achieve better results.
Clinical findings, some patients after the use of oncolytic virus, although the beginning of a little effect, but after a period of time the tumor has progressed. At this time, the doctor had to start chemotherapy.
It stands to reason that this should be considered a test failure. Surprisingly, some patients have an amazing effect after using chemotherapy, far more than the previous data. Some people used chemotherapy only a few times, and the tumors were greatly reduced or even disappeared.
Like this one.
Figure A is the tumor before treatment, and Figure C is the tumor progression after treatment with oncolytic virus. It can be seen that the tumor has grown up at this time. The doctor had to change a chemotherapy drug called lomustine, and the trial declared “failure.”
No one thought that the tumor would begin to improve after only one course of treatment (Figure D), and after one year, the tumor has completely disappeared. It is. Even after one year of chemotherapy withdrawal, the tumor still showed no signs of recurrence (Figure F). After five years of follow-up, this patient is still alive!
And this is not the only case.
Obviously, for some reasons, malignant gliomas infected with oncolytic viruses, even if they relapse, are not the same as before, and the response to chemotherapy becomes better.
Scientists still don’t know what the cause is, but some data suggest that it may be because short-term chemotherapy can break the immunosuppression of tumor formation, and in combination with oncolytic virus, once again initiate anti-cancer immune response, kill cancer cells, And produce a lasting effect.
This phenomenonTip, “oncolytic virus + short-term chemotherapy” may be better, is a future worthwhile direction.
In the new Phase 2 clinical trial, the researchers did make improvements. Based on the oncolytic virus, the option of 1 chemotherapy was added. We will wait and see for the results of this phase of clinical trials.
Unfortunately, this clinical trial has not been carried out in China. From the online information, this trial is currently recruiting patients in the United States, and interested patients can look at the trial introduction and registration methods themselves:
https://clinicaltrials.gov/ct2/show/NCT02986178
If you have any questions, I suggest you use the contact information on the website directly for consultation.
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Of course, I still have to say that although this study is very exciting, everyone should look at the oncolytic virus rationally.
First of all, the oncolytic virus is not a panacea, the proportion of patients benefiting is not high enough, and there are serious side effects. In addition, different oncolytic viruses vary greatly and cannot be generalized. There are a lot of unreliable people in the market, and they have begun to carry out various scams under the banner of oncolytic virus. Everyone must be careful.
Science has been developing and progressing, and even for malignant gliomas, there has been a breakthrough.
In addition to oncolytic viruses, the recent “electric field treatment” listed in the US and Hong Kong is also a unique innovation.
Not only that, but PD-1 immune drugs that have been ineffective in malignant gliomasThings, when used for new adjuvant therapy, also showed hope.
I believe that one day, many patients with malignant brain tumors can overcome the disease and survive for a long time.
Finally, I sincerely hope that China will have more innovative clinical trials like this in the future, giving patients more choices, and ultimately pushing for better therapies to be listed as soon as possible, benefiting more people.
To pay tribute to life!
References:
1. Recurrent Glioblastoma Treated withRecombinant Poliovirus. N Engl J Med 2018; 379:150-161
2. Effect of Tumor-Treating Fields Plus MaintenanceTemozolomide vs Maintenance Temozolomide Alone on Survival in Patients WithGlioblastoma: A Randomized Clinical Trial. JAMA, 2017. 318(23): p.2306 -2316.
3. Neoadjuvant anti-PD-1 immunotherapypromotes a survival benefit with intratumoral and systemic immune responses inrecurrent glioblastoma. Nat Med. 2019 Mar;25(3):477-486.< /span>
4. Neoadjuvant nivolumab modifies the tumor immunemicroenvironment in resectable glioblasToma. Nat Med. 2019 Mar; 25(3): 470-476.
This article is from WeChat public account: pineapple factor (ID: checkpoint_1) , author: pineapple