Final results of a phase I dose-escalation, dose-expansion study of adding disulfiram with or without copper to adjuvant temozolomide for newly diagnosed glioblastoma
Abstract
Disulfiram has shown promising activity including proteasome inhibitory properties and synergy with temozolomide in preclinical glioblastoma (GBM) models. In a phase I study for newly diagnosed GBM after chemoradiotherapy, we have previously reported our initial dose-escalation results combining disulfiram with adjuvant temozolomide and established the maximum tolerated dose (MTD) as 500 mg per day. Here we report the final results of the phase I study including an additional dose-expansion cohort of disulfiram with concurrent copper. The phase I study consisted of an initial dose-escalation phase of disulfiram 500-1000 mg daily during adjuvant temozolomide, followed by a dose-expansion phase of disulfiram 500 mg daily with copper 2 mg three times daily. Proteasome inhibition was assessed using fluorometric 20S proteasome assay on peripheral blood cell. A total of 18 patients were enrolled: 7 patients received 500 mg disulfiram, 5 patients received 1000 mg disulfiram, and 6 patients received 500 mg disulfiram with copper. Two dose-limiting toxicities occurred with 1000 mg disulfiram. At disulfiram 500 mg with or without copper, only 1 patient (7%) required dose-reduction during the first month of therapy. Addition of copper to disulfiram did not increase toxicity nor proteasome inhibition. The median progression-free survival was 4.5 months (95% CI 0.8-8.2). The median overall survival (OS) was 14.0 months (95% CI 8.3-19.6), and the 2-year OS was 24%. The MTD of disulfiram at 500 mg daily in combination with adjuvant temozolomide was well tolerated by GBM patients, but 1000 mg daily was not. Toxicity and pharmacodynamic effect of disulfiram were similar with or without concurrent copper. The clinical efficacy appeared to be comparable to historical data. Additional clinical trials to combine disulfiram and copper with chemoradiotherapy or to resensitize recurrent GBM to temozolomide are ongoing.
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Toxicity profiles and pharmacodynamic responses for disulfiram remained comparable whether copper was used concurrently or not.
“Toxicity profiles and pharmacodynamic responses for DIS remained comparable whether copper was used concurrently or not.21”
From Off-label and repurposed use of disulfiram beyond alcohol dependence: A systematic review of clinical and preclinical evidence (2026) · cites this paper as [21]
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- Authors
- Huang, J., Campian, J. L., Gujar, A. D., Tsien, C., Ansstas, G., Tran, D. D., DeWees, T. A., Lockhart, A. C., & Kim, A. H.
- Affiliations
- Washington University in St. Louis (US)
- Corresponding author
- Huang, Jiayi
- ORCID
- Venue
- Journal of Neuro-Oncology
- Published
- 2018-01-27
- Volume
- 138
- Issue
- 1
- Pages
- 105-111
- ISSN
- 0167-594X (ISSN-L)
- 1573-7373
- OpenAlex
- W2786432625
- Cited by
- 52
- References
- 18
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 11 · 2021: 6 · 2020: 5 · 2019: 5 · 2018: 2
- FWCI
- 2.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Neuro-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Alvin J. Siteman Cancer Center
- Topics
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › PARP inhibition in cancer therapy
- Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
- Keywords
- disulfiram, copper, glioblastoma, adjuvant temozolomide, proteasome inhibition, maximum tolerated dose, dose-limiting toxicity, chemoradiotherapy, progression-free survival, overall survival, drug repurposing
- MeSH terms
- Temozolomide, Adjuvants, Immunologic, Adult, Aged, Antineoplastic Agents, Brain Neoplasms, Copper, Disulfiram, Dose-Response Relationship, Drug, Female, Glioblastoma, Humans, Male, Middle Aged, Trace Elements, Cohort Studies, Survival Analysis, Maximum Tolerated Dose, Young Adult
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