PodMed TT—Treating Brain Cancer With Polio Virus

Can we use a virus that infects nervous tissue to treat brain cancer? As Rick and I discuss on PodMed TT this week, the answer may be yes, at least for some people with a specific type of tumor, as reported in the New England Journal of Medicine. Researchers infused a modified polio virus, called PVSRIPO, directly into grade IV gliomas in a dose-escalation fashion, with doses calculated on their ability to infect cells in tissue culture. All 61 consecutive patients treated in this trial had experienced recurrent disease.

The median follow-up was 27.6 months in the treatment group, with a median overall survival of 12.5 months, compared with 11.3 months in the historical control group. The authors state, “At the time of this writing, the survival rate at 24 months and 36 months was 21% (95% CI, 11 to 33), with patients remaining alive more than 70 months, more than 69 months, and more than 57 months after the PVSRIPO infusion.” In short, they are cautiously optimistic that such a strategy involving a neurotrophic virus may be helpful in this distressingly fatal disease. They also note that genomic analysis did not contribute much in predicting who was likely to benefit from treatment, but we agree that as this science advances, that certainly seems possible in the future.

Other topics this week include a closed-loop insulin pump for managing glucose in hospitalized people with Type 2 diabetes, also in NEJM; new USPSTF guidelines on osteoporosis screening in JAMA, and in JAMA Internal Medicine, hospital-at-home for avoiding admissions in some people who present to the ED.

Until next week, y’all listen up and make healthy choices.