Medical Student University of Texas Medical Branch
Introduction: Oncolytic viruses are a novel class of therapy for recurrent high-grade glioma (rHGG), using viral vectors to improve therapeutic delivery and modify tumor microenvironment for desirable immune response. Their effect on survival in rHGG has not been well characterized.
Methods: A comprehensive search of PubMed, Google Scholar, Cochrane, and Scopus databases was carried out in accordance with the PRISMA guidelines. Random-effects meta-analysis was conducted with a primary endpoint of overall survival.
Results: 17 prospective clinical trials were found totalling 337 patients, treated with adenovirus (N=6 studies, 129 patients), herpesvirus (N=5 studies, 94 patients), reovirus (N=3 studies, 27 patients), polio-rhinovirus (N=2 studies, 69 patients), and parvovirus (N=1 study, 18 patients). Patient’s had a mean age of 41.3 (95%CI:[32.1-50.5]), and 43.03%(139/328,95%CI:[35.89-50.16]) were female. HGG comprised 98.29% (328/337,95%CI:[96.94-99.63]) of treated tumors. When reported, MGMT promoter methylation was found in 61/242 (21.26%,95%CI:[14.14-28.38]) and IDH-1 mutation in 35/278 (9.8%,95%CI:[5.7-13.91]). 65.29% (103/154,95%CI:[46.73-83.85]) received total resection while 31.31% (51/154,95%CI:[19.38-51.13]) received partial resection. 82.06% of viral vectors were delivered intratumorally (272/308,95%CI:[64.58-99.54]). Average overall survival was found to be 16.2 months (95%CI:[10.94-21.49]) and progression-free survival was found to be 3.20 months (95%CI:[1.29-5.12]) after treatment initiation. Overall survival was highest in patients treated with herpesviruses at 20.26 months (95%CI:[16.97-23.54],p < 0.01) and lowest in reoviruses at 6.86 months (95%CI:[0-14.88],p < 0.01); groupwise differences were not found in progression-free survival.
Conclusion : This meta-analysis suggests that oncolytic viruses may offer a survival benefit in rHGG, particularly with herpesvirus-based therapies showing the longest median overall survival. While variability exists between virus types, with reovirus therapies demonstrating shorter survival outcomes, these findings highlight the potential of oncolytic viruses as a therapeutic strategy in rHGG.
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