Combination bacteriolytic therapy for the treatment of tumors
Current approaches for treating cancer are limited, in part, by the inability of drugs to affect the poorly vascularized regions of tumors. We have found that spores of anaerobic bacteria in combination with agents which interact with microtubules can cause the destruction of both the vascular and avascular compartments of tumors. Two classes of microtubule inhibitors were found to exert markedly different effects. Some agents that inhibited microtubule synthesis, such as vinorelbine, caused rapid, massive hemorrhagic necrosis when used in combination with spores. In contrast, agents that stabilized microtubules, such as the taxane docetaxel, resulted in slow tumor regressions that killed most neoplastic cells. Remaining cells in the poorly perfused regions of tumors could be eradicated by sponzlated bacteria. Mechanistic studies showed that the microtubule destabilizers, but not the microtubule stabilizers, radically reduced blood flow to tumors, thereby enlarging the hypoxic niche in which spores could germinate. A single intravenous injection of spores plus selected microtubule-interacting agents was able to cause regressions of several tumors in the absence of excessive toxicity.
1. A method for treating tumors in a mammal comprising:
administering to the mammal spores of a toxin-defective, anaerobic bacterium selected from the group consisting of Clostridium novyi and Clostridium sordellii ; and
administering to the mammal a microtubule stabilizing anti-tumor agent; whereby the tumor regresses or its growth is slowed or arrested.
2. The method of claim 1 wherein the anaerobic bacterium is Clostridium novyi.
3. The method of claim 1 wherein the anaerobic bacterium is Clostridium sordellii.
4. The method of claim 1 wherein the spores are administered intravenously.
5. The method of claim 1 wherein the spores are administered intratumorally.
6. The method of claim 1 wherein all or part of a toxin gene of a wild type form of the anaerobic bacterium is deleted.
7. The method of claim 1 wherein the microtubule stabilizing anti-tumor agent is a taxane.
8. The method of claim 1 wherein the microtubule stabilizing anti-tumor agent is selected from the group consisting of 10-deacetyltaxol; 7-epi-10-deacetyltaxol; 7-xylosyl-10-deacetyltaxol; 7-epi-taxol; cephalomannine; baccatin III; baccatin V; 10-deacetylbaccatin III; 7-epi-10-deacetylbaccatin III; 2-debenzoyl-2-(p-trifluoromethylbenzoyl)taxol; and 20-acetoxy-4-deacetyl-5-epi-20,O-secotaxol.
9. The method of claim 1 wherein the microtubule stabilizing anti-tumor agent is selected from the group consisting of arsenic trioxide, discodermolide, epothilone B, and (+)-14-normethyldiscodermolide.
10. The method of claim 1 wherein the microtubule stabilizing anti-tumor agent is taxol.
11. The method of claim 1 wherein the microtubule stabilizing anti-tumor agent is taxotere.
12. The method of claim 1 wherein the microtubule stabilizing anti-tumor agent is cephalomannine.
13. The method of claim 1 further comprising:
administering a nitric oxide synthetase (NOS) inhibitor to the mammal.
14. The method of claim 1 wherein the spores and microtubule stabilizing anti-tumor agent are administered serially.
15. The method of claim 13 wherein the spores, microtubule stabilizing anti-tumor agent and NOS inhibitor are administered serially.
16. The method of claim 1 wherein the toxicity of the toxin-defective, anaerobic bacterium is reduced by a factor of at least 2 compared to a corresponding wild-type bacterium.
17. The method of claim 2 wherein the toxicity of the toxin-defective Clostridium novyi is reduced by a factor of at least 2 compared to a corresponding Clostridium novyi.
18. A kit for treating tumors, wherein components of the kit are in a divided or undivided container, said components comprising:
spores of a toxin-defective, anaerobic bacterium selected from the group consisting of Clostridium novyi and Clostridium sordellii ; and
a microtubule stabilizing, anti-tumor agent.
19. The kit of claim 18 wherein all or part of a toxin gene of a wild type form of the anaerobic bacterium is deleted in the spores of the anaerobic bacterium.
20. The kit of claim 18 further comprising a nitric oxide synthetase inhibitor.
21. The kit of claim 18 wherein the anaerobic bacterium is Clostridium novyi.
22. The kit of claim 18 wherein the anaerobic bacterium is Clostridium sordellii.
23. The kit of claim 18 wherein the microtubule stabilizing anti-tumor agent is taxol.
24. The kit of claim 18 wherein the microtubule stabilizing anti-tumor agent is taxotere.
25. The kit of claim 18 wherein the microtubule stabilizing anti-tumor agent is cephalomannine.
26. The kit of claim 18 wherein the microtubule stabilizing anti-tumor agent is a taxane.
27. The kit of claim 18 wherein the toxicity of the toxin-defective, anaerobic bacterium is reduced by a factor of at least 2 compared to a corresponding wild-type bacterium.
28. The kit of claim 21 wherein the toxicity of the toxin-defective Clostridium novyi is reduced by a factor of at least 2 compared to a corresponding Clostridium novyi.