Valganciclovir treatment associated with increased survival in glioblastoma multiforme

Image: PD 

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%). 

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%). 

Evidence Rating Level: 3 (Average) 

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 the NEJM (New England Journal of Medicine)

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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