German researchers have shown that a combination therapy of Lomustine with Temozolomide plus radiotherapy delivers significantly increased survival times in patients with methylating GBM.
The randomised, phase 3 trial, enrolled patients from 17 different German university hospitals (1). All had newly diagnosed glioblastoma with methylated MGMT promoter and were 18-70 years of age.
Half received standard temozolomide chemoradiotherapy (75 mg/m 2 per day alongside radiotherapy followed by six courses of temozolomide 150–200 mg/m 2 per day on the first 5 days of the 4-week course). The other half received Lomustine on day 1 (100 mg/m 2) ) plus temozolomide (100–200 mg/m 2 per day) on days 2–6 for a total of 6 weeks, with the same level of radiotherapy as the first group.
Between June 17, 2011, and April 8, 2014, 141 patients were randomly assigned to the treatment groups; 129 patients (63 in the temozolomide and 66 in the lomustine temozolomide group) were followed.
Median overall survival was improved from 31·4 months in the temozolomide group to 48·1 months in the lomustine-temozolomide combination.
Side-effects increased from 32 (51%) of 63 patients in the temozolomide group to 39 (59%) of 66 patients in the lomustine-temozolomide group.
There were no treatment-related deaths.
As is usual with GBM clinical trials, this was a small-scale trial. Funding was provided by the German Federal Ministry of Education and Research.
In the past we have had several articles covering compounds that can make Temozolomide work better – several studies show the diabetes drug Metformin can work synergistically with the drug. A Clinical trial in Phase II currently talks of expecting 5 months extra survival. There’s also research on the benefits of Boswellic acid.
Go to: Metformin and Temozolomide work Synergistically against Glioblastoma
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Reference
- Lomustine-Temozolomide Combination Therapy; The Lancet, Feb 16 2019; Prof. Ulrich Herrlinger et al;