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Recombinant coxsackievirus B3 (recombinant CVB3) is an experimental, unapproved oncolytic virotherapy. It is a genetically engineered version of coxsackievirus B3, a non-enveloped, positive-sense single-stranded RNA enterovirus in the Picornaviridae family. Recombinant CVB3 is designed to selectively infect and lyse tumor cells while stimulating systemic antitumor immune responses. To improve safety and reduce cardiotoxicity, pancreatitis, and hepatitis associated with wild-type CVB3, various engineered variants have been developed, including those carrying microRNA target sequences (such as miR-CVB3, CVB3-miRT, and CVB3-BHP) that restrict viral replication in normal tissues. Other variants incorporate basic peptides (such as CVB3-4pep5 and CVB3-9pep) to enhance antitumor efficacy. The virus enters cells primarily through the coxsackievirus and adenovirus receptor (CAR) and decay-accelerating factor (DAF/CD55), as well as heparan sulfate for certain strains. Preclinical and early clinical development covers solid tumors, including non-small cell lung cancer, small cell lung cancer, triple-negative breast cancer, colorectal cancer, pancreatic cancer, and cervical squamous cell carcinoma.
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