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Melanoma: Genetically Modified Herpes Virus May Improve Treatment
In a phase 2 clinical trial, researchers examined an innovative approach using a genetically modified herpes virus to treat advanced melanoma. The findings were published in JAMA Oncology
The study involved 150 patients with advanced melanoma from various places worldwide.
The Talimogene laherparepvec (T-VEC) is designed to infect and replicate within tumor cells and attract immune cells like T cells and natural killer cells to attack cancer.
The patients they included had a specific type of melanoma that could be surgically removed and had one or more tumors that could be injected with the treatment.
The researchers divided the patients into two groups: one group received injections of neoadjuvant T-VEC followed by surgery (group 1), and the other group had surgery alone without the treatment (group 2).
The treatment the researchers used, T-VEC, was injected directly into the tumors.
They started with a lower dose and gradually increased it over the course of several weeks until the patients had surgery or their tumors were no longer injectable, or they couldn't tolerate the treatment.
The researchers followed the patients for about 5 years. After this time, they found that the group with the T-VEC treatment followed by surgery had a better chance of not having their cancer return (22.3% vs. 15.2% for the surgery-only group).
This suggests that the T-VEC treatment helped reduce the risk of cancer recurrence.
These findings suggest that T-VEC treatment before surgery can make a real difference in how well patients do regarding cancer recurrence, overall survival, and avoiding distant cancer spread. Importantly, the treatment appears to be safe.
The better outcomes are likely due to the treatment triggering the immune system to fight cancer more effectively, as seen from increased levels of certain immune cells after T-VEC treatment.
It's important to note that the study had some limitations in its design, especially in how it defined and measured cancer recurrence.
However, these results provide a strong basis for exploring further studies combining neoadjuvant T-VEC with other treatments like checkpoint inhibitors, aiming to treat high risk melanoma that can be surgically removed.
Dr. Trevan Fischer, surgical oncologist and assistant professor of surgical oncology for Saint John's Cancer Institute at Providence Saint John's Health Center in Santa Monica, CA, not involved in this research, told Medical News Today that "intralesional therapy has been around for decades. This genetically modified virus has several advantages that make it an attractive research therapeutic option. This data reports the final report at 5 years showing an added benefit to using T-VEC before surgery."
However, "many things have changed in the field of melanoma since this trial began in 2015," Dr. Fischer pointed out.
"New and effective systemic agents have been developed and approved. In 2023, it's rare anyone would use T-VEC and surgery alone with these advances and identifying who may need intralesional therapy to turn a "cold tumor into a hot tumor" is research that is needed and ongoing."
– Dr. Trevan Fischer
MNT also spoke with Dr. Wael Harb, hematologist and medical oncologist at Memorial Care Cancer Institute at Orange Coast Medical Center in Fountain Valley, CA,and Vice President of Medical Affairs at Syneos Health, not involved in the research.
Dr. Harb said the "research represents a significant stride in understanding the role and efficacy of neoadjuvant therapies for advanced melanoma."
"The results underscore the potential of combining T-VEC, an oncolytic virus, with surgical interventions to achieve better Recurrence-Free Survival (RFS) and Overall Survival (OS) rates. Adhering to the CONSORT guidelines, the study is a testament to methodological rigor and provides crucial insights into a burgeoning area of melanoma treatment."
– Dr. Wael Harb
Dr. Harb noted how "the demonstrated improvement in RFS and OS suggests that the combination of neoadjuvant T-VEC and surgery might offer a more potent therapeutic regimen for melanoma patients, especially those at the specified stages."
In addition, "it adds another dimension to the therapeutic choices clinicians have at their disposal," Dr. Harb explained.
"While the paper brings forth optimism, it also highlights some limitations, like its smaller sample size and lack of control arms for neoadjuvant Immune Checkpoint Inhibitors (ICIs) or T-VEC combinations. This calls for more comprehensive studies, potentially phase 3 randomized trials, to ascertain these findings' generalizability.
The study also nudges towards exploring the synergistic effects of combining T-VEC with adjuvant immunotherapy or BRAF inhibitors, a direction that could be immensely fruitful given the evolving landscape of melanoma therapeutics."
– Dr. Wael Harb
Another important implication of this research is how it can help to raise hope and awareness.
"Such research shines a beacon of progress, enlightening the general public about melanoma treatment advancements," Dr. Harb pointed out.
"For patients and their loved ones, it represents a beacon of hope, signifying strides towards improved survival rates and enhanced life quality."
Dr. Harb concluded, "This paper accentuates the importance of integrating innovative therapeutic agents with traditional surgical procedures."
"While we celebrate these findings, they also serve as a clarion call for further in-depth research, ensuring that we continue to refine our treatment approaches for the betterment of melanoma patients."
Is There A Natural Cure For Cold Sores?
Cold sores are caused by the herpes simplex virus (HSV). Once it has infected the body, the virus lies dormant, but may reactivate and cause a cold sore at any time, especially when the immune system is weak or run-down. Cold sores typically last for 7 - 10 days, are unsightly, and can cause considerable discomfort. Fortunately, there is much you can do to prevent and treat attacks.
The HSV virus needs an amino acid called arginine to multiply in the body. Arginine is found in high concentration in nuts (especially peanuts and cashews), chocolate and grains, and many individuals report that eating these foods can bring on a flare-up of symptoms. Avoiding these foods, especially at the first sign of an attack, may help to prevent problems.
While arginine encourages growth of the HSV, another amino acid, lysine, actually inhibits it. Most studies which have looked into this association show that lysine can reduce the frequency and severity of cold sore attacks. Take 500 mg per day, and increase this to 1 g, two - three times a day during an acute attack. To this regime I would also add vitamin C and bioflavonoids, a combination of which has also been found to reduce the duration of symptoms by more than half.
Take 200 mg of vitamin C and 200 mg of biofavonoids, three to five times each day at the first sign of an attack. Another nutrient which may be used as a general preventive is selenium. This trace mineral has been shown to inhibit several viruses, including the herpes virus. Take 300 - 400 mcg per day.
For topical relief, I recommend vitamin E. Take a soft gelatine vitamin E capsule and soak a small piece of tissue with its contents. Apply this to the cold sore for a full fifteen minutes. Do this twice during the day. Quite often, this approach can resolve a cold sore within a day or two.
{"status":"error","code":"499","payload":"Asset id not found: readcomments comments with assetId=48711, assetTypeId=1"}What Can Cause A Sore Vagina?
There's literally no worse feeling than having a sore vagina. And while the vagina is an incredible organ (um, childbirth much??), it can be sensitive and there are things that can cause discomfort such as vaginal tearing, mystery lumps and bumps, HPV, thrush, or god forbid, shaving injuries.
Sex or sex-related issues can also sometimes cause some pain or soreness down there. It's important to remember that sex, including penetrative sex isn't supposed to be painful, so if you're experiencing vaginal pain from sex, it's a good idea to look into what could be causing it.
We asked experts from London Gynaecology about some of the main sexual causes of vaginal soreness, how to identify them and how to manage them.
Sore vagina - Vaginal drynessLubrication is the key to comfy, chafe-free sex. That's why we go on about it so much. Not enough lubrication can make penetrative sex uncomfortable or even painful. Vaginal dryness is most common among postmenopausal women or people who are breastfeeding - but everyone experiences it and it's totally normal and common at any age. It can also be a side effect of progesterone-only contraception.
If you're not lubricated enough, a sore vagina is a likely outcome of sex and masturbation because the skin of the vulva and vagina is some of the most sensitive on the body! Vaginal dryness can cause "discomfort during sex and also occasional bleeding or brownish/pink discharge.It can occasionally indicate a more significant pathology," explains Mr Narendra Pisal, consultant gynaecologist at London Gynaecology. If you're experiencing pain and seeing this sort of discharge a lot it's important to seek medical attention. "Discomfort during sex is not only due to dryness but also due to microtears within the lining," says Pisal. Which might be why you experience a burning sensation during and after sex.
The best and simplest solution for vaginal dryness is our BFF; lube. "Water-soluble lubricants are a good choice if vaginal irritation or sensitivity is a problem. Silicone-based lubricants last longer and tend to be more slippery than water-soluble lubricants. Do not use petroleum jelly, baby oil, or mineral oil with condoms. They can dissolve the latex and cause the condom to break," says Pisal. Good to know.
If you happen to be menopausal (some medical conditions such as endometriosis can lead to early menopause), treatments such as local oestrogen gel or HRT can be useful. Pisal advises that if your symptoms are affecting your quality of life, speak to your doctor or arrange to speak with a specialist ASAP.
Sore vagina - UTIsAnother offender when it comes to sore vag issues is the humble UTI; Urinary tract infections are as common as they are painful - which is to say, very. They occur when bacteria enters the urinary tract - which includes the kidneys, bladder, uterus and urethra. Also known as cystitis, UTIs can be caused by having a lot of sex, not peeing after sex or even using the drip dry method after you pee.
Peter Cade
"Urinary tract infections usually occur when bacteria enter the urinary tract through the urethra. They are more common in women because the female urethra, the tube carrying urine from the bladder out of the body, is shorter and closer to the anus and vagina where bacteria such as E-coli are more common. This makes it easier for bacteria to enter the urinary tract," explains Dr Paul Ettlinger, GP at The London General Practice. "The anatomy of women also means sexual intercourse can increase the risk of getting a UTI as sexual contact can allow bacteria near the vagina to get into the urethra. Also using a diaphragm or spermicide for birth control can lead to UTIs by increasing bacteria growth."
As well as being a possible cause, pain during sex is a tell-tale symptom. But if you have a UTI you might also experience -
Carol Yepes
Sometimes, UTIs will heal up on their own, but if you suspect you might have one, it's a good idea to see your GP. "UTIs are treated with antibiotics that can kill the bacteria causing the infection. The antibiotic prescribed will depend on the type of bacteria causing your UTI," says Dr Ettlinger.
Staying well hydrated is also important and anecdotal, lots of people swear by cranberry juice - although there's no medical evidence to support it as a treatment. To avoid a UTI, pee after sex, drink plenty of water and make sure your body isn't depleted of the natural salts and sugars it needs. Cystitis medicine from a pharmacy can help with topping up these vital minerals.
Sore vagina - Bartholin's CystsYou may not have heard of a Bartholin's cyst but you have probably had one.
"Bartholin's glands are small pea-sized glands at the entrance of the vagina, behind the lips (labia minora). Secretions of these glands provide some of the lubrication during sexual intercourse. A Bartholin's cyst, also known as Bartholin's duct cyst, is formed when the duct of one of these glands is blocked," explains Mr Saurabh Phadnis, consultant gynaecologist at London Gynaecology.
Mostly, Bartholin's Cysts are painless, but if they get too big they can cause discomfort during sex or even during your day to day activities. You might be able to feel them and they can feel like an ingrown hair. The best thing to do is not to squeeze or press the bump as it will probably go away on its own. However, if it feels very painful and seems to be growing larger, speak to your doctor.
"Bartholin's cysts which are painless do not require treatment. A large or painful cyst may need treatment either by excision or by a procedure called 'marsupalisation," says Phadnis.
"Bartholin's abscesses can be treated with antibiotics (often successful if started early) but if resistant may require drainage of the pus and a marsupalisation procedure. This is a minor surgical procedure carried out as a day case procedure under short general anaesthesia"
Maskot
One thing you should absolutely not do is attempt to break the skin or 'pop' the cyst. It's deep in the vaginal tissue and you can cause yourself plenty of issues which could be much more painful, so leave the lump alone and speak to a professional if you're worried or your vagina is sore.
Sore vagina - VaginismusVaginismus is a condition that causes the vaginal muscles to involuntarily contract. It affects around 1%-6% of people who have a vagina. It's a pretty miserable condition to live with but it is treatable with a mixture of different physical and mental therapies and practices.
"The vagina is surrounded by a ring of muscles that need to be relaxed in order to allow intercourse to occur. In vaginismus the muscles contract so tightly that the vagina is effectively closed and sexual intercourse can be impossible or painful," explains Pisal.
"Often patients will present with the inability to have penetrative sexual intercourse or vulval or vaginal pain during sex. When they attempt sexual intercourse the vaginal muscles contract and prevent penetration. This is out of the control of the woman and occurs as a reflex action. Unsurprisingly this can lead to relationship and psychological issues," he continues.
Vaginismus is most often caused by previous difficult sexual experiences or pain during sex. Because it is connected to anxiety around sex or penetration, therapies such as CBT are sometimes offered to patients who want to have penetrative sex. Other treatments include topical anaesthetic gels or dilators, breathwork and pelvic physio and exercises.
Pain during sex can be horrible but there are ways to deal with it so don't give up on your sex life if vaginismus is affecting you.
Sore Vagina - STIsThis one can be trickier to self diagnose as many STIs fly under the radar and some cause very few to no symptoms at all. Sexually transmitted infections can cause a range of symptoms, depending on what kind of STI it is, but some common symptoms in women include itching, a burning sensation when urinating, vaginal pain, abnormal discharge or bleeding, or pelvic pain. "They don't always cause symptoms and can often be silent," warns Dr Priyanka Patel, GP at London Gynaecology. So it's worth getting tested regularly if you're having unprotected sex, just to be on the safe side. Undetected STIs can often lead to other issues like long-term pelvic inflammatory disease and infertility.
"Small blisters or sores around the genitals are potential symptoms of genital herpes and syphilis. Blisters/sores of herpes are often painful and could cause pain felt around the vagina. Pelvic inflammatory disease (PID) is an infection of the female reproductive system which includes the womb, fallopian tubes and ovaries. PID can cause deep pain with sex" she adds.
Tatiana Buzmakova
The most common STI among women are chlamydia, gonorrhoea and genital warts. "All infections can exist without symptoms, but particularly chlamydia is often asymptomatic. This just highlights the importance of safe sex and routine checks when you enter a new relationship," notes Dr Ayanthi Gunasekera, Senior Obs and Gynae Registrar and Medical Information Lead at London Gynaecology.
The UK has seen rates of gonorrhoea and syphilis rise rapidly in the UK in the last few years - with a 50% increase in gonorrhoea in 2022. So, it's super important to test regularly and stay on top of your sexual health. Plus, these types of infection may be on the rise but they aren't the only ones you can catch from a sexual partner. The likes of trichomoniasis, ureaplasma and mycoplasma can feel like a UTI and cause long-term problems so get yourself to the clinic on the regular and pee in that cup!
"Infections are often treated by simple antibiotics. It is necessary to treat your partner as well as sexual contacts in the recent past. Sometimes, a test of cure is necessary to ensure that the infection has been satisfactorily treated," explains Mr Narendra Pisal, consultant gynaecologist at London Gynaecology
If you're sore below the belt, it could be caused by just about anything. What's important is that you recognise the signs and symptoms of different causes and get yourself checked out as soon as possible. Health is wealth, especially when it comes to your vagina.
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