Combination of 9 repurposed drugs with low-dose chemotherapy in brain cancer
A proof-of-concept clinical trial assessing the safety of the coordinated undermining of survival paths by 9 repurposed drugs combined with metronomic temozolomide for recurrent glioblastoma (CUSP9v3).
- Brain cancer
Why this trial?
Glioblastoma multiforme (GBM) is the most common and most aggressive type of brain tumours in humans. It is a rare cancer type, affecting 2-3 people annually per 100,000 in Europe and North America.
Currently available treatment consists of surgery, radiation, and chemotherapy using temozolomide. In general, only 15-20% of patients are still alive 5 years after first treatment. For decades, new experimental therapies have repeatedly failed to improve the outcome of patients relapsing after initial treatment of glioblastoma.
There is a clear unmet need for more and better options for these patients.
Why this drug?
In 2013, investigators Marc-Eric Halatsch and Richard Kast suggested that the repeated failures of new experimental therapies could be due to the capability of glioblastoma to escape the action of a single therapy. Glioblastoma studies have identified many mechanisms that cause the growth of tumours. Many drugs currently marketed for other indications than cancer have shown to suppress one or more of these systems, and could therefore possibly be used to suppress mechanisms involved in tumour growth. A group of researchers led by Marc-Eric Halatsch and Richard Kast performed an extensive literature search to identify drugs that could qualify.
After a thorough examination of existing scientific data, taking into account low side effect profile, good quality of life (QOL) maintenance, and adequate clinical experience with the drug in question as additional selection criteria, the researchers identified and selected 9 drugs.
The 9 drugs are, with their main mechanism of action in parentheses: Aprepitant (NK-1 Receptor inhibitor), Minocycline (tetracycline antibiotic), Auranofin (gold complex), Disulfiram (ALDH inhibitor), Ritonavir (protease inhibitor), Itraconazole (triazole antifungal agent), Captopril (ACE inhibitor), Sertraline (SSRI) and Celecoxib (COX inhibitor).
In this monocentre ‘proof of concept’ clinical trial 10 patients will be treated with the 9 drugs, administered simultaneously and together with low-dose, uninterrupted daily temozolomide.
The optimal dose of each of the 9 drugs will be determined for each patient by adding the drugs one by one at a low dose, and gradually increasing the doses while carefully monitoring the side effects (induction and up-dosing cycle) while administering temozolomide daily. Thereafter, each patient will be treated with the nine drugs at doses established in the induction and up-dosing cycle, in addition to temozolomide.
The objectives of this trial are to assess the safety and preliminary indication of the efficacy of the treatment plan.
- Prof. Marc-Eric Halatsch,Ulm University Hospital, Ulm, Germany (Principal Investigator)
- Prof. Dr. Lars Bullinger, Ulm University Hospital, Ulm, Germany (Sub Investigator)
- Ulm University Hospital, Ulm, Germany
ACF co-funding partner:
- Fondation Dutmala
More info on clinicaltrials.gov: NCT02770378
Kast RE, Boockvar JA, Brüning A, Cappello F, Chang W-W, Cvek B, et al. A conceptually new treatment approach for relapsed glioblastoma: coordinated undermining of survival paths with nine repurposed drugs (CUSP9) by the International Initiative for Accelerated Improvement of Glioblastoma Care. Oncotarget 2013;4:502–30.
Kast RE, Karpel-Massler G, Halatsch M. CUSP9* treatment protocol for recurrent glioblastoma: aprepitant, artesunate, auranofin, captopril, celecoxib, disulfiram, itraconazole, ritonavir, sertraline augmenting continuous low dose temozolomide. Oncotarget 2014;5:8052–82.
Omuro A, DeAngelis LM. Glioblastoma and other malignant gliomas: a clinical review. JAMA 2013;310:1842–50.
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJB, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352:987– 96.
Last updated: june 2018.