title: Long-term treatment of malignant gliomas with intramuscularly administered polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose: an open pilot study.
abstract: Polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose (poly-ICLC) (10-50 mcg/kg, administered intramuscularly one to three times weekly) was given for < or = 56 months to 38 patients with malignant gliomas. There was minimal or no toxicity. Twenty of 30 patients (66%) receiving at least twice weekly poly-ICLC showed regression or stabilization of gadolinium-enhancing tumor, as revealed by magnetic resonance imaging (median = 65% volume decrease). All but one patient with anaplastic astrocytomas who received continuous poly-ICLC remain alive, with a median progression-free survival of 54 months from diagnosis. Median Kaplan-Meier survival is 19 months for patients with glioblastomas who receive at least twice weekly poly-ICLC treatments. Tumor response was associated with 2',5' -oligoadenylate synthetase activation (P = 0.03) but not with serum interferon. We hypothesize clinical activation by poly-ICLC of a basic host tumor suppressor system. Prolonged, quality survival with tumor stabilization or regression confirmed by magnetic resonance imaging for most patients with anaplastic astrocytomas and glioblastomas suggests that more extensive laboratory and controlled clinical studies are warranted. The concept of long-term, broad spectrum stimulation of host defenses with nontoxic, inexpensive double-stranded ribonucleic acids, such as low-dose poly-ICLC, may be applicable to the treatment of other malignancies.
authors.affiliation: Uniformed Services University of the Health Sciences, Washington, District of Columbia, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Salazar
authors.forename: H B
authors.initials: HB
authors.lastname: Levy
authors.forename: S
authors.initials: S
authors.lastname: Ondra
authors.forename: M
authors.initials: M
authors.lastname: Kende
authors.forename: B
authors.initials: B
authors.lastname: Scherokman
authors.forename: D
authors.initials: D
authors.lastname: Brown
authors.forename: H
authors.initials: H
authors.lastname: Mena
authors.forename: N
authors.initials: N
authors.lastname: Martin
authors.forename: K
authors.initials: K
authors.lastname: Schwab
authors.forename: D
authors.initials: D
authors.lastname: Donovan
authors.forename: D
authors.initials: D
authors.lastname: Dougherty
authors.forename: M
authors.initials: M
authors.lastname: Pulliam
authors.forename: M
authors.initials: M
authors.lastname: Ippolito
authors.forename: M
authors.initials: M
authors.lastname: Graves
authors.forename: H
authors.initials: H
authors.lastname: Brown
authors.forename: A
authors.initials: A
authors.lastname: Ommaya
mesh_terms: D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002266:Carboxymethylcellulose Sodium / Q000008:administration & dosage / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007369:Interferon Inducers / Q000008:administration & dosage* / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D010865:Pilot Projects; D011070:Poly I-C / Q000008:administration & dosage* / Q000009:adverse effects; D011107:Polylysine / Q000008:administration & dosage / Q000009:adverse effects; D015996:Survival Rate
chemical_list: D007369:Interferon Inducers; D011107:Polylysine; D002266:Carboxymethylcellulose Sodium; D011070:Poly I-C