Recurrent Glioblastoma Treated with Recombinant Poliovirus

Abstract

Background: The prognosis of patients with recurrent World Health Organization (WHO) grade IV malignant glioma is dismal, and there is currently no effective therapy. We conducted a dose-finding and toxicity study in this population of patients, evaluating convection-enhanced, intratumoral delivery of the recombinant nonpathogenic polio-rhinovirus chimera (PVSRIPO). PVSRIPO recognizes the poliovirus receptor CD155, which is widely expressed in neoplastic cells of solid tumors and in major components of the tumor microenvironment.

Methods: We enrolled consecutive adult patients who had recurrent supratentorial WHO grade IV malignant glioma, confirmed on histopathological testing, with measurable disease (contrast-enhancing tumor of ≥1 cm and ≤5.5 cm in the greatest dimension). The study evaluated seven doses, ranging between 10⁷ and 10¹⁰ 50% tissue-culture infectious doses (TCID₅₀), first in a dose-escalation phase and then in a dose-expansion phase.

Results: From May 2012 through May 2017, a total of 61 patients were enrolled and received a dose of PVSRIPO. Dose level -1 (5.0×10⁷ TCID₅₀) was identified as the phase 2 dose. One dose-limiting toxic effect was observed; a patient in whom dose level 5 (10¹⁰ TCID₅₀) was administered had a grade 4 intracranial hemorrhage immediately after the catheter was removed. To mitigate locoregional inflammation of the infused tumor with prolonged glucocorticoid use, dose level 5 was deescalated to reach the phase 2 dose. In the dose-expansion phase, 19% of the patients had a PVSRIPO-related adverse event of grade 3 or higher. Overall survival among the patients who received PVSRIPO reached a plateau of 21% (95% confidence interval, 11 to 33) at 24 months that was sustained at 36 months.

Conclusions: Intratumoral infusion of PVSRIPO in patients with recurrent WHO grade IV malignant glioma confirmed the absence of neurovirulent potential. The survival rate among patients who received PVSRIPO immunotherapy was higher at 24 and 36 months than the rate among historical controls. (Funded by the Brain Tumor Research Charity and others; ClinicalTrials.gov number, NCT01491893 .).

Figure 1. Overall Survival among Patients Who Received PVSRIPO and Historical Controls

Tick marks indicate censored data. PVSRIPO denotes recombinant nonpathogenic polio–rhinovirus chimera.

Figure 2. Axial T₁-Weighted MRI, Obtained with the Use of Contrast Material, of the First Patient Treated in the Study, at Dose Level 1

Panel A shows the baseline MRI of this patient, who received dose level 1 (10⁸ 50% tissue-culture infectious doses [TCID₅₀]). Panel B shows the expansion of tumor 2 months after the PVSRIPO infusion. Panel C shows the initial tumor contraction 6 months after the infusion, and Panels D and E show the results at 12 months and 24 months, respectively. Panel F shows the contraction of the resection cavity and the treated tumor 58 months after the infusion.

Figure 3. Axial T₁-Weighted MRI, Obtained with the Use of Contrast Material, of the Eighth Patient Treated in the Study, at Dose Level 5

Panel A shows the baseline MRI of this patient, who received dose level 5 (10¹⁰ TCID₅₀). Panel B shows the image obtained after surgery for evacuation of intracranial hemorrhage after the removal of the infusion catheter. Panel C shows the image obtained at the time of disease progression, 7 months after the PVSRIPO infusion. Panel D shows the image obtained after the first cycle of lomustine, and Panel E the image obtained at the completion of nine cycles of lomustine. Panel F shows the results 1 year after the discontinuation of lomustine and 32 months after the PVSRIPO infusion.