title: Effects of valganciclovir as an add-on therapy in patients with cytomegalovirus-positive glioblastoma: a randomized, double-blind, hypothesis-generating study.
abstract: Cytomegalovirus is highly prevalent in glioblastomas. In 2006, we initiated a randomized, double-blind, placebo-controlled, hypothesis-generating study to examine the safety and potential efficacy of Valganciclovir as an add-on therapy for glioblastoma. Forty-two glioblastoma patients were randomized in double-blind fashion to receive Valganciclovir or placebo in addition to standard therapy for 6 months. Magnetic resonance images were obtained before and immediately and 3 and 6 months after surgery to evaluate treatment efficacy by measuring contrast enhancing tumor volume (primary end point). Survival data were analyzed for patients and controls in explorative analyses to aid the design of future randomized trials. Trends but no significant differences were observed in tumor volumes in Valganciclovir and placebo patients at 3 (3.58 vs. 7.44 cm3, respectively, p = 0.2881) and 6 (3.31 vs. 13.75 cm3, p = 0.2120) months. Median overall survival (OS) was similar in both groups (17.9 vs. 17.4 months, p = 0.430). Patients could take Valganciclovir for compassionate use after the study phase. Explorative analyses showed an OS of 24.1 months (95% CI, 17.4-40.3) in patients receiving >6 months of Valganciclovir (Val > 6M) versus 13.1 months (95% CI, 7.9-17.7, p < 0.0001) in patients receiving Valganciclovir for 0 or <6 months, and 13.7 months (95% CI, 6.9-17.3, p = 0.0031) in contemporary controls. OS at 4 years was 27.3% in Val>6M patients versus 5.9% in controls (p = 0.0466). Prolonged OS in Val>6M patients suggest that future randomized trials are warranted and should evaluate whether continuous antiviral treatment can improve outcome in glioblastoma patients.
authors: Department of Neurology, Karolinska University Hospital, Sweden.
authors: Giuseppe
authors: G
authors: Stragliotto
authors: Afsar
authors: A
authors: Rahbar
authors: Nina Wolmer
authors: NW
authors: Solberg
authors: Anders
authors: A
authors: Lilja
authors: Chato
authors: C
authors: Taher
authors: Abiel
authors: A
authors: Orrego
authors: Birgitta
authors: B
authors: Bjurman
authors: Charlotte
authors: C
authors: Tammik
authors: Petra
authors: P
authors: Skarman
authors: Inti
authors: I
authors: Peredo
authors: Cecilia
authors: C
authors: Söderberg-Nauclér
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality / Q000821:virology*; D003587:Cytomegalovirus / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005909:Glioblastoma / Q000401:mortality / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: cytomegalovirus; glioblastoma; valganciclovir