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1. Of more than 250 cases of glioblastoma multiforme (GBM) reviewed by authors, all were cytomegalovirus (CMV) positive except 1. Overall 2 year survival for patients with high-grade CMV infection was much lower versus those with low-grade infections (63.6% vs 17.2%).Â
2. In a retrospective study, patients with GBM receiving adjuvant valganciclovir as an add-on to standard therapy had an increased 2-year survival compared to matched controls (62% vs 18%).Â
Evidence Rating Level: 3 (Average)Â
Study Rundown: Within a large sample of GBM samples reviewed by the study authors, nearly all were CMV positive, with high grade infection associated with significantly lower 2-year survival rates. The Valcyte Treatment of Glioblastoma Patients in Sweden (VIGAS) study did not find a significant reduction in tumor growth after surgery with valganciclovir. However, in follow-up study patients receiving valganciclovir did have a significantly increased 2-year survival compared to matched controls (63.6% vs 17.2%). In a disease like GBM with median overall survival rates of 12-14 months, this study presents the possibility for significant survival gains with a relatively simple and readily available treatment and should encourage further investigation and randomized study targeting CMV in GBM.
Click to read the study in NEJM
Relevant Reading: Cytomegalovirus infection in brain tumors
In-Depth [retrospective, case-controlled]: This study was a follow-up of the Valcyte Treatment of Glioblastoma Patients in Sweden (VIGAS), which did not find any significant reduction in 3 and 6 month tumor growth after surgery in patients receiving valganciclovir treatment. 50 patients received adjuvant valganciclovir for compassionate use as add-on to standard therapy at a single institution. These patients had increased 2-year survival rates of 62% versus 18% in matched controls (P<0.001). The median overall survival was 25.0 months vs 13.5 months (P<0.001). Survival rates were even more dramatically increased with longer intervals of anti-CMV treatment.
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