Phase 1 Study of Intravenous Oncolytic Poxvirus (vvDD) in Patients With Advanced Solid Cancers.

We have conducted a phase 1 study of intravenous vvDD, a Western Reserve strain oncolytic vaccinia virus, on 11 patients with standard treatment-refractory advanced colorectal or other solid cancers. The primary endpoints were maximum tolerated dose and associated toxicity while secondary endpoints were pharmacokinetics, pharmacodynamics, immune responses, and antitumor activity. No dose-limiting toxicities and treatment related severe adverse events were observed. The most common adverse events were grades 1/2 flu-like symptoms. Virus genomes were detectable in the blood 15-30 minutes after virus administration in a dose-dependent manner. There was evidence of a prolonged virus replication in tumor tissues in two patients, but no evidence of virus replication in non-tumor tissues, except a healed injury site and an oral thrush. Over 100-fold of anti-viral antibodies were induced in patients' sera. A strong induction of inflammatory and Th1, but not Th2 cytokines, suggested a potent Th1-mediated immunity against the virus and possibly the cancer. One patient showed a mixed response on PET-CT with resolution of some liver metastases, and another patient with cutaneous melanoma demonstrated clinical regression of some lesions. Given the confirmed safety, further trials evaluating intravenous vvDD in combination with therapeutic transgenes, immune checkpoint blockade or complement inhibitors, are warranted.

A contemporary analysis of morbidity and outcomes in cytoreduction/hyperthermic intraperitoneal chemoperfusion.

The risks and benefits of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CS/HIPEC) continue to be debated by the oncology community. A retrospective analysis of contemporary data (2003-2011) was performed to provide objective information regarding surgical morbidity, mortality, and survival for patients undergoing CS/HIPEC at a comprehensive cancer center. While procedure-associated morbidity was comparable to other major surgical oncology procedures, there was no operative or 30-day mortality and 60-day mortality was 2.7%. Increasing numbers of bowel resections were found to correlate to an increased incidence of deep surgical site infections (including abscess and enterocutaneous fistula) and need for reoperation which was in turn associated with a decreased overall survival (OS) and progression-free survival (PFS). Five-year OS rates varied by site of tumor origin and histology (disseminated peritoneal adenomucinosis [91.3%], Mesothelioma [80.8%], Appendiceal Adenocarcinoma [38.7%], and Colorectal Adenocarcinoma [38.2%]). With an acceptable morbidity and mortality rate, CS/HIPEC should be included as an effective treatment modality in the multidisciplinary care of select patients with peritoneal metastases.

Giant stomach secondary to juvenile polyposis syndrome.

INTRODUCTION: Juvenile polyposis syndrome (JPS) is a rare, autosomal dominant condition. The polyps predominate in the colon but may be seen less commonly in the stomach or small intestine. We report an unusual case of JPS associated with massive gastric polyposis, resulting in a giant stomach, severe anemia, hematemesis, protein-losing enteropathy, and gastric outlet obstruction. Progressive complications ultimately necessitated a total gastrectomy. CASE: A 27-year-old woman presented in 2005 with severe anemia. Gastroscopy revealed severe gastric polyposis. Histopathology confirmed juvenile polyposis. Gastrectomy was initially declined. Progressive hematemesis, hypoproteinemia, and gastric outlet obstruction, however, resulted in a total gastrectomy 5 years following initial presentation. Massive gastric polyposis resulted in severe gastromegaly.

Antiproliferative effects of 111In- or 177Lu-DOTATOC on cells exposed to low multiplicity-of-infection double-deleted vaccinia virus encoding somatostatin subtype-2 receptor.

Oncolytic viruses may be limited in their ability to infect and lyse tumor cells because of penetration barriers and viral elimination by the immune system. Combining virotherapy with targeted radiotherapy that uses (111)In- or (177)Lu-DOTATOC may address such issues by spatially enhancing antitumor effects through bystander and/or cross-fire phenomena. In this study, a double-deleted vaccinia virus (vvDD) encoding the gene for somatostatin subtype-2 receptor (sstr-2) infected MC-38 murine colon adenocarcinoma cells and increased their sstr-2 expression by 2-fold. A low multiplicity-of-infection (MOI = 0.1) of vvDD and short exposure time (48 hours) preserved MC-38 viability (>80%-90%) for up to 3 days, permitting targeting of sstr-2 by (111)In- or (177)Lu-DOTATOC. (111)In-DOTATOC, alone or in combination with vvDD, was less effective than (177)Lu-DOTATOC at decreasing the growth of sstr-2-gene-transfected human embryonic kidney (HEK)-293 cells or MC-38 cells in monolayer. However, (111)In- or (177)Lu-DOTATOC combined with vvDD provided equivalent growth inhibition of HEK-293 or MC-38 cells as spheroids, suggesting a bystander effect from (111)In-DOTATOC. Growth of the cells was reduced 4-fold (from 20% to <5%) at 8 days in this case. Further evaluation of low-MOI vvDD in combination with (111)In- or (177)Lu-DOTATOC for the treatment of MC-38 tumors in mice is planned.