Oncolytic Viruses in Peritoneal Cavity Cancer Treatment
Introduction of Peritoneal Cavity Cancer
Peritoneal cavity cancer is a rare type of cancer that spreads along the peritoneal surfaces to affect the peritoneum. The peritoneum tissues inside the wall of the abdomen are made of the thin layer of epithelial cells that allow organs to move smoothly inside the abdomen and protect the organs in the abdomen. Peritoneal cavity cancer has two forms, one is primary peritoneal cancer that starts in the peritoneum itself, and another is secondary peritoneal cancer that usually develops when existing abdominal cancers such as the appendix, colon, rectal, and pancreatic cancers into the peritoneum. This causes tumors to grow throughout the peritoneum. Cancers that spread to the lining surfaces of the peritoneal could be referred to as peritoneal carcinomatosis.
Symptoms
In its early stages, patients often have no apparent symptoms and do not notice symptoms until the disease is relatively advanced. The early symptoms often occur vague and nonspecific and hard to pinpoint, with abdominal swelling, abdominal pain, indigestion, and urinary frequency. As cancer progresses and a watery fluid (ascites) in the abdominal cavity, other symptoms occur, including nausea or vomiting, complete bowel or urinary blockage, abnormal vaginal bleeding, an abdominal mass, and shortness of breath.
Diagnosis and Treatment
Because the symptoms of peritoneal cancer undetected in the early stage, peritoneal cancer is often diagnosed at a late stage. Many different tests can be used to diagnose a patient with peritoneal carcinomatosis. By pelvic examination, tumor nodules in the abdomen or fluid (ascites) may sometimes be felt, but small tumors and microscopic cells sneak by undetected. Using blood tests and imaging studies such as CT scan, ultrasound, or MRI of the abdomen and pelvis can be used to check the tumor markers or to assess the extent of disease in the abdomen.
Based on specific cancer types and stages, some strategies can be used in the treatment of peritoneal cavity cancer to prevent cancer from spreading such as the surgery followed by chemotherapy. This technique, which combines surgery with chemotherapy which can shrink the tumor before surgery or kill any remaining cancerous cells after surgery, has a great promising treatment of peritoneal cavity cancers. In some cases, other clinical trials include targeted therapy, radiation therapy, hormonal therapy, and immunotherapy can be used to treat or prevent peritoneal cavity cancer without harming healthy cells.
Oncolytic Viruses in Peritoneal Cavity Cancer Treatment
- Herpes Simplex Virus
- Vaccinia Virus
Herpes simplex virus-1 (HSV-1) oncolytic mutants are selectively tropic for cancer cells. These mutants replicate within tumor cells, express enhanced green fluorescent protein (EGFP), and demonstrate cytotoxicity against gastric and disseminated peritoneal cancer in preclinical models. They exhibit significant oncolytic activity both in vitro and in vivo, effectively targeting carcinomatosis. Furthermore, EGFP expression within infected intraperitoneal tumor cells facilitates laparoscopic visualization, aiding direct detection and localization of oncolytic viral therapy without impairing its anticancer efficacy.
Two selectively replicating oncolytic HSV have been studied for their anticancer effects in gastric cancer treatment. Both are evaluated in the current studies for their anticancer effects in the treatment of gastric cancer. These viruses effectively infect, replicate, and kill cancer cells at lower concentrations in a murine model of peritoneally disseminated cancer.
The oncolytic vaccinia virus vaccinia virus, a prototype member of the Orthopoxvirus genus, is a double-stranded DNA virus with cytolytic capacity against a broad range of tumor cell types. It has been engineered with foreign integrated transgene cassettes (encoding Ruc-GFP, β-glucuronidase, and β-galactosidase) to disrupt nonessential vaccinia genes, enhancing its tumor-selective targeting and enabling spread within the peritoneal cavity. In a phase I study, this modified virus was evaluated for safety and anti-tumor activity through intraperitoneal administration in patients with advanced peritoneal carcinomatosis. Results showed that the virus was well tolerated, with no dose-limiting toxicities and only transient adverse events, demonstrating its potential clinical efficacy and biologic effects. Comprehensive data support its safety and effectiveness, warranting further development of the intraperitoneal route of virotherapy for peritoneal cavity cancers.
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