Valcyte for glioblastoma – pro
Glioblastoma is notoriously difficult to treat. This is why a letter in the 2013 New England Journal of Medicine aroused great interest. In it, the Swedish Karolinska team reported retrospective data on 50 patients with glioblastoma who received valganciclovir as an add-on to standard therapy at Karolinska University Hospital as adjuvant treatment. The researchers based their approach on their initial results of adding Valcyte to standard therapies and animal work that suggested that CMV may play a role in rlioblastoma.
The median overall survival was 25.0 months, as compared with 13.5 months in the controls (P<0.001). The median survival was higher among 40 patients who received at least 6 months of valganciclovir; their 2-year rate of survival was 70%, and their median overall survival was 30.1 months (P<0.001) (Figure 1B). The survival rate was highest among 25 patients who received continuous valganciclovir treatment after the first 6 months, with a 2-year survival rate of 90% and median overall survival of 56.4 months (P<0.001). The researchers thought it unlikely that any bias in patient selection could have resulted in these high rates of survival. They recommended performing a randomized trial targeting CMV in patients with glioblastomas.
There are interesting but preliminary results. The same group performed the Vigas study, which was a hypothesis generating study. Before all patients received this treatment in lieu of proven therapies, I agree that prospective randomized studies should be done. Until then, the treatment remains interesting but experimental.
Cecilia Söderberg-Nauclér et al, Survival in Patients with Glioblastoma Receiving Valganciclovir, N Engl J Med 2013; 369:985-986September 5, 2013
Taher C, de Boniface J, Mohammad A-A, et al. High prevalence of human cytomegalovirus proteins and nucleic acids in primary breast cancer and metastatic sentinel lymph nodes. PLoS One 2013;8:e56795-e56795
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