title: Phase I/II trial evaluating combined radiotherapy and in situ gene therapy with or without hormonal therapy in the treatment of prostate cancer--a preliminary report.
abstract: OBJECTIVE
  To report the preliminary results of a Phase I/II study combining radiotherapy and in situ gene therapy (adenovirus/herpes simplex virus thymidine kinase gene/valacyclovir) with or without hormonal therapy in the treatment of prostate cancer.
  
  
  METHODS
  Arm A: low-risk patients (T1-T2a, Gleason score <7, pretreatment PSA <10) were treated with combined radio-gene therapy. A mean dose of 76 Gy was delivered to the prostate with intensity-modulated radiotherapy. Arm B: high-risk patients (T2b-T3, Gleason score >or=7, pretreatment PSA >or=10) were treated with combined radio-gene therapy and hormonal therapy. Hormonal therapy was comprised of a 4-month leuprolide injection and 2-week use of flutamide. Arm C: Stage D1 (positive pelvic lymph node) patients received the same regimen as Arm B, with the additional 45 Gy to the pelvic lymphatics. Treatment-related toxicity was assessed using Cancer Therapy Evaluation Program common toxicity score and Radiation Therapy Oncology Group (RTOG) toxicity score.
  
  
  RESULTS
  Thirty patients (13 in Arm A, 14 in Arm B, and 3 in Arm C) completed the trial. Median follow-up was 5.5 months. Eleven patients (37%) developed flu-like symptoms (Cancer Therapy Evaluation Program Grade 1) of fatigue and chills/rigors after gene therapy injection but recovered within 24 h. Four patients (13%) and 2 patients (7%) developed Grade 1 and 2 fever, respectively. There was no patient with weight loss. One patient in Arm B developed Grade 3 elevation in liver enzyme, whereas 11 and 2 patients developed Grade 1 and 2 abnormal liver function tests. There was no Grade 2 or above hematologic toxicity. Three patients had transient rise in creatinine. There was no RTOG Grade 3 or above lower gastrointestinal toxicity. Toxicity levels were as follows: 4 patients (13%), Grade 2; 6 patients (20%), Grade 1; and 20 patients (67%), no toxicity. There was 1 patient with RTOG Grade 3 genitourinary toxicity, 12 patients (40%) with Grade 2, 8 patients (27%) with Grade 1, and 9 patients (30%) with no toxicity. No patient dropped out from the trial or had to withhold treatment because of severe toxicity.
  
  
  CONCLUSIONS
  This is the first trial of its kind in the field of prostate cancer that aims to expand the therapeutic index of radiotherapy by combining in situ gene therapy. Initial experience has demonstrated the safety of this approach. There is no added toxicity to each therapy used alone. Long-term follow-up and larger cohort studies are warranted to evaluate long-term toxicity and efficacy.
authors.affiliation: Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Teh
authors.forename: E
authors.initials: E
authors.lastname: Aguilar-Cordova
authors.forename: K
authors.initials: K
authors.lastname: Kernen
authors.forename: C C
authors.initials: CC
authors.lastname: Chou
authors.forename: M
authors.initials: M
authors.lastname: Shalev
authors.forename: M T
authors.initials: MT
authors.lastname: Vlachaki
authors.forename: B
authors.initials: B
authors.lastname: Miles
authors.forename: D
authors.initials: D
authors.lastname: Kadmon
authors.forename: W Y
authors.initials: WY
authors.lastname: Mai
authors.forename: J
authors.initials: J
authors.lastname: Caillouet
authors.forename: M
authors.initials: M
authors.lastname: Davis
authors.forename: G
authors.initials: G
authors.lastname: Ayala
authors.forename: T
authors.initials: T
authors.lastname: Wheeler
authors.forename: J
authors.initials: J
authors.lastname: Brady
authors.forename: L S
authors.initials: LS
authors.lastname: Carpenter
authors.forename: H H
authors.initials: HH
authors.lastname: Lu
authors.forename: J K
authors.initials: JK
authors.lastname: Chiu
authors.forename: S Y
authors.initials: SY
authors.lastname: Woo
authors.forename: T
authors.initials: T
authors.lastname: Thompson
authors.forename: E B
authors.initials: EB
authors.lastname: Butler
mesh_terms: D000256:Adenoviridae; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005485:Flutamide / Q000627:therapeutic use; D015316:Genetic Therapy / Q000379:methods*; D005822:Genetic Vectors / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D015182:Lymphatic Irradiation; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D018139:Simplexvirus; D013937:Thymidine Kinase / Q000235:genetics
chemical_list: D005485:Flutamide; D013937:Thymidine Kinase; D016729:Leuprolide