生物与医学2024mdpi.com
乳腺癌新辅助溶瘤病毒治疗的非常规病例研究
Unconventional Case Study of Neoadjuvant Oncolytic Virotherapy for Breast Cancer
进阶 · 约 30 分钟读完前置知识：肿瘤生物学基础、免疫学基础、溶瘤病毒概念
导读
这篇论文报告了一例非常规的乳腺癌溶瘤病毒治疗案例：患者本身是病毒学专家，在肿瘤两次复发后，在常规治疗之前自行向肿瘤内注射溶瘤病毒，并由肿瘤科医生监测进展。结果显示治疗有效，患者从原本可能耐药、致命的癌症中康复。
HN 关注点：的焦点是自我实验的伦理与可及性问题：这种疗法之所以可行，是因为患者恰好具备专业知识和资源，普通人无法复制。
HN 评论精选
这几条评论里：支持 2 质疑 1 补充 1
支持质疑监管过度保守，认为不确定的新疗法或许整体上能挽救更多人
治疗起效了，她似乎已从原本可能耐药、致命的癌症中康复。但她能做到这一点，是因为具备自我施治所需的技能和资源。每年有多少人因为我们不敢让这类不确定疗法冒死亡风险而死去？这些疗法当然不会完美，但净收益呢？
Filligree查看英文原文
So the treatment worked, and she appears to be recovered from what might otherwise have been treatment-resistant, fatal cancer. But she was only able to do so because of having the skill and access needed to self-administer the cure. How many people die every year because we don't dare risk any deaths from uncertain treatments like these? Sure, they aren't ever going to be perfect, but- what's the net?
补充指出论文的关键争议点：自我实验绕过了伦理审查，可行性完全依赖患者的专业身份
科学本身并不新鲜，这篇论文引人注目的原因是伦理审查声明部分：这是自我实验的案例，因此不需要伦理委员会审查。研究之所以可行，是因为患者同时也是专业病毒学家，她充分了解自己的病情和可用疗法，在肿瘤两次复发后想以科学严谨的方式尝试创新方法。她的肿瘤科医生（克罗地亚乳腺癌领域的权威）同意监测治疗进展，主要目的是在出现不良反应或肿瘤进展时停止注射并改用常规治疗。
folli查看英文原文
The science is not new, but the reason why this paper is raising some eyebrows is the following: Institutional Review Board Statement This is a case of self-experimentation. As such, it does not require ethics committee review [33,34,35]. The study was feasible only due to the unique situation in which the patient was also an expert virologist. The patient was fully aware of her illness as well as of available therapies, and as a scientist in the field of virology, she was aware of the potential of oncolytic virotherapy. After two recurrences of the same tumour, she wanted to try an innovative approach in a scientifically sound way. Her oncologists (the leading oncologists in Croatia for breast cancer) accepted to monitor the progress of the treatment, primarily with the aim of discontinuing the injections and intervening with conventional therapy if there were untoward effects or if the tumour progressed.
支持赞赏先病毒后化疗的治疗顺序设计，认为这保留了免疫系统对肿瘤的清除作用
患者预判复发肿瘤会是三阴性乳腺癌（TNBC）表型，而针对它的现有疗法效果有限，于是在接受任何其他治疗之前，先告知肿瘤医生她要向肿瘤内注射类似溶瘤病毒的病毒。在化疗之前使用病毒疗法非常聪明，因为化疗会抑制免疫系统，而免疫系统可能在肿瘤软化并充满病毒后进一步清除肿瘤。
pazimzadeh查看英文原文
> The patient, who is also an expert virologist, anticipating that the recurrent tumour would be of TNBC phenotype for which therapies of only limited efficacies exist, informed her oncologists that she was going to treat this tumour by the i.t. administration of viruses similar to oncolytic viruses (that were in clinical development for BC) before undergoing any other treatment. Really smart to use the viral therapy before chemotherapy, since chemotherapy dampens the immune system, and the immune system probably promotes further tumor clearance once the tumors soften and are full of viruses.
质疑联想到《我是传奇》情节，对溶瘤病毒疗法的潜在风险表示担忧
用病毒治疗癌症真的很迷人，就像电影《我是传奇》的开场：Krippin 博士创造了治疗癌症的病毒，声称 10009 例临床试验全部治愈成功，但后来发现病毒是致命的。希望这项研究不会落得那样的结局。
v3ss0n查看英文原文
Really facinating. Using Virus to cure cancer. Just like from I Am Legend movie. ``` The movie opens with a scene of Dr. Alice Krippin, who created the virus to cure cancer, discussing her work. Krippin states that 10,009 clinical trials were completed and all of the participants were successfully cured. However, it is later discovered that the virus is lethal. A genetically modified measles virus kills most humans and turns some people into mutant creatures. ``` I hope it wont end up like `I Am Legend` movie. How long those research are being there , the movie script is a coincidence?
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