3/30/2015

Using polio to kill cancer: A producers' notebook




Using polio to kill cancer: A producers' notebook

A conversation with Jeff Fager and Michael Radutzky about the 60 Minutes story that followed cancer patients treated with polio
Editor's Note: For more information on the Duke University polio trial or other brain cancer trials, click here or call 919-684-5301

Every once in a while, a story comes through 60 Minutes that has the potential to change lives. This week, Scott Pelley's report on a new medical treatment using the polio virus to kill cancer is that kind of story.
Most people remember polio as the scourge that paralyzed millions of children until a vaccine was developed in the 1950s. Now, researchers at Duke University are injecting a modified polio virus directly into deadly brain tumors. The research is still in early stages and Duke doctors warn that it's impossible to predict how effective the polio treatment will be in a wider population, but they've seen some stunning results in their Phase 1 trial.

"Everybody knows someone who has cancer. I've had multiple members of my family die. I've had friends die."

"One of the scientists told me it takes a killer to kill a killer," says Michael Radutzky, one of the 60 Minutes producers behind the story. "And that's when I started to appreciate that if you're going to kill something as formidable and hydra-headed as cancer, you needed an agent that could do major damage."
Radutzky has been following cancer patients undergoing experimental treatments for more than 30 years for CBS News. And he says reporting on cancer is often very personal for the reporter.
"Everybody knows someone who has cancer," Radutzky tells Ann Silvio of 60 Minutes Overtime (in the above video player). "I've had multiple members of my family die. I've had friends die."
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Michael Radutzky
 CBS NEWS
Radutzky's cousin and uncle died from a type of brain tumor called gliobastoma. Glioblastoma, among the deadliest of human cancers, is at the center of this week's two-part 60 Minutes report. 

"One of the scientists told me it takes a killer to kill a killer. And that's when I started to appreciate that if you're going to kill something as formidable and hydra-headed as cancer, you needed an agent that could do major damage."

For Jeff Fager, 60 Minutes' executive producer, "glioblastoma" is a word he learned as a kid from his father.
"I grew up knowing these terms," says Fager, "and that was one that I knew was hell. Glioblastoma-- that's not good."
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Dr. Charles Fager, third from left
Jeff's father, Dr. Charles Fager, was a prominent neurosurgeon in Massachusetts, well known for his innovative surgical techniques, but Jeff says his father wouldn't operate on glioblastoma.
"He didn't think it was operable, and he didn't want to put people through the suffering of what comes with surgery and chemo and radiation," Fager says.
Dr. Fager died a year ago, at age 90, around the time 60 Minutes began shooting this week's story on the polio trials at Duke University. Jeff Fager tells 60 Minutes Overtime that he wished his dad had lived long enough to see the story.
"If my father was alive to see this 60 Minutes story, he would find it hard to believe because it is such a powerful cancer that is unstoppable," Fager says. 
And yet, at Duke University, the polio virus appears to be stopping glioblastoma. The first two patients in Duke's phase one clinical trial are cancer-free three years after receiving the infusion of polio virus.

"If my father was alive to see this 60 Minutes story, he would find it hard to believe because it is such a powerful cancer that is unstoppable."

Radutzky says the researchers involved with the glioblastoma trial are very optimistic behind-the-scenes. 
"You know, they whisper about a 'cure' but doctors just can't use words like that with patients, especially at such an early stage," says Radutzky. "But words like 'remission' and 'cancer-free,' they're not even hedging on those words."
After Radutzky and fellow producer Denise Cetta first screened their story about the polio treatment for executive producers at 60 Minutes, Fager told them to stay on the story. 
"Stay on it. Don't leave it," Fager recalls saying to the producers. "We should do another version in the fall. We should keep watching it. Who knows how many stories we'll end up doing on this subject, but I wouldn't be surprised if it's many."

The video feature in the above video player was produced by 60 Minutes Overtime producer-editor Lisa Orlando and senior producer Ann Silvio.




























































The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here