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A phase Ib/IIa trial of 9 repurposed drugs combined with temozolomide for the treatment of recurrent glioblastoma: CUSP9v3

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Item Type:Article
Title:A phase Ib/IIa trial of 9 repurposed drugs combined with temozolomide for the treatment of recurrent glioblastoma: CUSP9v3
Creators Name:Halatsch, M.E. and Kast, R.E. and Karpel-Massler, G. and Mayer, B. and Zolk, O. and Schmitz, B. and Scheuerle, A. and Maier, L. and Bullinger, L. and Mayer-Steinacker, R. and Schmidt, C. and Zeiler, K. and Elshaer, Z. and Panther, P. and Schmelzle, B. and Hallmen, A. and Dwucet, A. and Siegelin, M.D. and Westhoff, M.A. and Beckers, K. and Bouche, G. and Heiland, T.
Abstract:BACKGROUND: The dismal prognosis of glioblastoma (GBM) may be related to the ability of GBM cells to develop mechanisms of treatment resistance. We designed a protocol called Coordinated Undermining of Survival Paths combining 9 repurposed non-oncological drugs with metronomic temozolomide - version 3 - (CUSP9v3) to address this issue. The aim of this phase Ib/IIa trial was to assess the safety of CUSP9v3. METHODS: Ten adults with histologically confirmed GBM and recurrent or progressive disease were included. Treatment consisted of aprepitant, auranofin, celecoxib, captopril, disulfiram, itraconazole, minocycline, ritonavir, and sertraline added to metronomic low-dose temozolomide. Treatment was continued until toxicity or progression. Primary endpoint was dose-limiting toxicity defined as either any unmanageable grade 3–4 toxicity or inability to receive at least 7 of the 10 drugs at ≥ 50% of the per-protocol doses at the end of the second treatment cycle. RESULTS: One patient was not evaluable for the primary endpoint (safety). All 9 evaluable patients met the primary endpoint. Ritonavir, temozolomide, captopril, and itraconazole were the drugs most frequently requiring dose modification or pausing. The most common adverse events were nausea, headache, fatigue, diarrhea, and ataxia. Progression-free survival at 12 months was 50%. CONCLUSIONS: CUSP9v3 can be safely administered in patients with recurrent GBM under careful monitoring. A randomized phase II trial is in preparation to assess the efficacy of the CUSP9v3 regimen in GBM.
Keywords:Chemotherapy, Clinical Trial, Drug Repurposing, Glioblastoma, Multi-Drug Combination
Source:Neuro-Oncology Advances
Publisher:Oxford University Press
Page Range:vdab075
Date:7 August 2021
Official Publication:https://doi.org/10.1093/noajnl/vdab075
PubMed:View item in PubMed

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