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Effects of valganciclovir as an add‐on therapy in patients with cytomegalovirus‐positive glioblastoma: A randomized, double‐blind, hypothesis‐generating study
Author(s) -
Stragliotto Giuseppe,
Rahbar Afsar,
Solberg Nina Wolmer,
Lilja Anders,
Taher Chato,
Orrego Abiel,
Bjurman Birgitta,
Tammik Charlotte,
Skarman Petra,
Peredo Inti,
SöderbergNauclér Cecilia
Publication year - 2013
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.28111
Subject(s) - valganciclovir , placebo , medicine , clinical endpoint , randomized controlled trial , gastroenterology , surgery , human cytomegalovirus , ganciclovir , pathology , immunology , virus , alternative medicine
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 cm 3 , respectively, p = 0.2881) and 6 (3.31 vs . 13.75 cm 3 , 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.