The number that made people look twice was 82 percent. In a trial out of the University of Calgary, 82 percent of newly diagnosed glioblastoma patients were still free of disease progression at six months, against a historical benchmark of about 54 percent. What the team had added to the standard regimen of chemotherapy and radiation was niacin. Vitamin B3, the same molecule that gives you a hot flush if you take too much on an empty stomach.

To understand why that lands as a surprise rather than a footnote, you have to know how little has moved in this disease. The standard of care for glioblastoma, surgery followed by radiation and the chemotherapy drug temozolomide, was set by the Stupp trial in 2005, which established a median survival of roughly fifteen months. Two decades and a long line of expensive, patented, mechanistically elegant drugs later, that benchmark has barely shifted. “Survival of patients with this condition hasn’t changed significantly for 20 years,” said Dr. Gloria Roldan Urgoiti, the oncologist running the trial, and coming from inside the field that is not a sales line. It is the wall everyone keeps hitting.

So the reflex of anyone who has read a few hundred of these announcements is not a cheer but a narrowing of the eyes. The add-on being a drugstore vitamin is what makes you read the thing again.

At its actual size, the result is this. In a phase I-II trial run out of the Hotchkiss Brain Institute, Roldan Urgoiti and the neuroimmunologist Dr. Wee Yong gave newly diagnosed patients a controlled-release, high-dose form of niacin on top of the usual chemoradiation. This is not the flush tablet from the supplement aisle, though it is the same unpatentable compound. In the 24 patients reported so far, 82 percent showed no tumor progression at six months against the roughly 54 percent historical rate, a 28-point gap. The study had been built to shut itself down if niacin failed to beat the historical mark by at least 20 points, so clearing that threshold is what kept it alive, and the team is now enrolling toward 48 patients, with completion expected by the end of 2026 or early 2027.

The cautions are the ordinary ones, and they matter. This is a single arm measured against historical controls, not a randomized trial with a placebo group running alongside it. Six-month progression-free survival is a soft, early endpoint, not overall survival, and glioblastoma is notorious for letting patients look stable on a scan right until they don’t. Twenty-four people is a sample you could seat in a classroom. None of that makes the signal fake; it makes it the kind of signal that earns a real randomized trial instead of a press tour. What it has not yet earned is the verb “works.”

What separates this from the usual hopeful brain-cancer story is that the mechanism was worked out before the patients were enrolled, not after. Yong’s lab spent years on why a vitamin should touch a tumor at all, and the route runs through the immune system rather than the cancer cell. Glioblastoma is expert at disarming the body’s defenses; it floods the blood with immunosuppressive myeloid cells, the nonclassical monocytes that should be policing tissue but instead get drafted into shielding the tumor. In a 2020 Science Translational Medicine paper, the Calgary group showed that niacin reactivates those cells, and that niacin-exposed monocytes slowed the growth of tumor-initiating cells taken from real glioblastoma patients. The companion immune analysis from the human trial, published this year, found the same shift in living people: circulating memory T cells and natural killer cells rose, the suppressive nonclassical monocytes fell, and IL-12 climbed. The blood moved the way the biology said it should.

Which brings up the part of this that has nothing to do with science. Niacin is generic. It has been off-patent since before most practicing oncologists were born, and nobody can charge two hundred thousand dollars a year for a vitamin. That is the market’s read, not the trial’s, but it explains a lot: the molecules that get the big randomized trials, the sales forces, and the conference booths are the ones somebody can sell, and this is not one of them. The funding here came from the Canadian Institutes of Health Research and the Alberta Cancer Foundation, public and charitable money, the kind that pays for questions the market has no reason to ask. It is hard to imagine a pharma sponsor writing the check for a drug it could never own.

The drug pipeline is very good at finding things it can sell and much worse at finding things that merely help. A two-dollar vitamin just posted a number that twenty years of patented chemistry has not, in a sample small enough to demand caution and on a mechanism solid enough to demand a real trial. Whether it holds at 48 patients, and then at a randomized 480, is the open question. The more uncomfortable one is how many other cheap answers are sitting on the shelf, untested, because no one stands to make four hundred million dollars proving they work.

Sources

  1. University of Calgary – Common vitamin B3 (niacin) investigated for glioblastoma
  2. Poon et al., “Niacin Modulates Immune Responses in a Phase I Dose-Escalation Clinical Trial of Newly Diagnosed Glioblastoma,” Neurology: Neuroimmunology & Neuroinflammation (2026)
  3. Sarkar et al., “Control of brain tumor growth by reactivating myeloid cells with niacin,” Science Translational Medicine (2020)
  4. Roldan Urgoiti, Yong, et al., “A phase I-II study of niacin in patients with newly diagnosed glioblastoma,” Journal of Neuro-Oncology (2026)
  5. Stupp et al., “Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma,” NEJM (2005)