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Saturday, 18 May 2019

Avastin injection into the spinal canal. PVSRIPO.

  • Dear Stephen! Dear all!

    Question # 1. Avastin

    One oncologist told me that there is a practice in Europe of Avastin injection not into the general bloodstream, but into the spinal canal. And that this technique has shown much better results.
    However, I cannot find any articles or clinical trials on this topic. Please help me, as our team of oncologists is ready to reproduce this.
    Unfortunately, absolutely not clear for me and our team:
    1) How many ml of Avastin should be injected into the spinal canal if we inject 600 ml into the general bloodstream (once every 2 weeks)? Our oncologist is talking about dose reduction, but it is only his assumption.
    2) Would it really be effective in the case of glioblastoma, given that it is located just next to the ventricles?
    3) Could we use standard Avastin or some other “special” Avastin, which is more purified?

    Please share any information, links to articles and researches on this issue!

    Question # 2. PVSRIPO

    Due to the fact that Duke will not take us to clinical trials of PVSRIPO (size of the tumor and absence of insurance), I chose Germany. However, I want to be sure that their methodology is the same as in Duke.
    4) How much virus is introduced in Duke? In the first phase of clinical trials (https://clinicaltrials.gov/ct2/show/NCT01491893?term=..)
    there were 5 dosages (maximum - 1.0 x 10 ^ 10), however, I do not understand what dosage they stopped in phase 2 clinical trials (https://clinicaltrials.gov/ct2/show/NCT02986178?term=.. 3)?
    5) Are there any specific tests (blood, tumor analysis) that will show the effectiveness of PVSRIPO in advance for a particular person?
    6) How dangerous is injection of this virus? Our oncologist says that the reaction from the injection is similar to acute encephalitis. Is it true?

    Thank you!

9 comments:

  1. Hi Irina, Wha is the virus they use in Germany ? How is it given to patients ?

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  2. I'm not at all familiar with this method. I have heard of intra-arterial bevacizumab. (When you're looking for scientific papers, make sure to use the term bevacizumab rather than Avastin).

    https://www.ncbi.nlm.nih.gov/pubmed/27849336

    I don't know for sure what PVS-RIPO they're using in phase 2. But I do know that in phase 1, they started out testing dose levels 1-5 in the first 15 patients, but then they decided those doses were too high and the next 46 patients were given doses even lower than dose level 1. Most of the patients in the trial got dose level -1 and -2.

    Regarding question 5, I'm not aware of any validated biomarkers of response. The reason they are testing poliovirus + lomustine in the phase 2 trial is that they found some of the tumors were ultra-responsive to a single round of lomustine after pretreatment with poliovirus.

    These risk factors are reflected into the eligibility criteria for the PVS-RIPO trial. Patients with tumors in locations that are too high risk aren't allowed into the trial. I think adverse inflammatory reactions were one of the reasons they started testing lower dose levels (-1 and -2) in the phase 1 trial.

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    Replies
    1. Stephen, thank you so much for answer!
      What do you think about reservoir ommaya and avastin? I’m trying to find the most effective way of avastin delivery. I’m sorry if my questions is too silly 😔

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    2. I don't know, as I haven't read any papers on that. I would say the general problem with Avastin is not so much the delivery method, as it does wonders for many patients in the short term with standard iv method of delivery. The bigger problem is what happens when the tumor develops resistance to the drug. I have to admit though I'm not at all educated on alternative methods of Avastin delivery, as I haven't done any focused research on it.

      No questions are too silly, we are all trying to learn here :)

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    3. Dear Stephen! Do you know anything about clemastine and gbm? I found some articles, sounds promising.
      https://regenerativetimes.com/2019/05/21/brain-cancer-halted-in-mice-using-antihistamine-drug/

      But no information about dosage...do you have any ideas? Thank you!

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    4. And what do you think about this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6401026/ ?
      Thank you!

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    5. Thank you! Sorry, I didn’t see your comment on my question... the dosage is really ver high

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  3. Dear Irina,
    my husband was diagnosed with gliosarcoma and also was rejected by Duke PVSRIPO clinical trials. Could you provide some information about Germany clinic where PVSRIPO could be applied, please?

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