A phase Ib/IIa trial of 9 repurposed drugs combined with temozolomide for the treatment of recurrent glioblastoma: CUSP9v3
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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.
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CUSP9v3 can be safely administered in patients with recurrent glioblastoma under careful monitoring, and the most common adverse events were nausea, headache, fatigue, diarrhea, and ataxia.
“concluding that CUSP9v3 can be safely administered in patients with recurrent glioblastoma under careful monitoring, and the most common adverse events identified were nausea, headache, fatigue, diarrhea, and ataxia.22,23”
From Off-label and repurposed use of disulfiram beyond alcohol dependence: A systematic review of clinical and preclinical evidence (2026) · cites this paper as [23]
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- Authors
- Halatsch, M.-E., Kast, R. E., Karpel-Massler, G., Mayer, B., Zolk, O., Schmitz, B., Scheuerle, A., Maier, L., Bullinger, L., Mayer-Steinacker, R., Schmidt, C., Zeiler, K., Elshaer, Z., Panther, P., Schmelzle, B., Hallmen, A., Dwucet, A., Siegelin, M. D., Westhoff, M.-A., Beckers, K., Bouche, G., & Heiland, T.
- Affiliations
- University Hospital Ulm (DE)
- IIAIGC Study Center, Burlington, Vermont, USA
- Department of Neurosurgery, Ulm University Hospital, Ulm, Germany
- Universität Ulm (DE)
- Division of Hematology and Oncology, Department of Internal Medicine, Ulm University Hospital, Ulm, Germany
- Columbia University Irving Medical Center (US)
- Anticancer Fund (BE)
- Corresponding author
- Halatsch, Marc-Eric
- Bullinger, Lars
- ORCID
- Venue
- Neuro-Oncology Advances
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-01-01
- Volume
- 3
- Issue
- 1
- Pages
- vdab075-vdab075
- ISSN
- 2632-2498 (ISSN-L)
- PMC
- PMC8349180
- OpenAlex
- W3175611212
- Cited by
- 74
- References
- 46
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 18 · 2023: 21 · 2022: 10 · 2021: 4
- FWCI
- 7.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Neuro-Oncology Advances (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- MDC Repository (Max-Delbrueck-Center for Molecular Medicine) (acceptedVersion)
- Funders
- Anticancer Fund (A37)
- 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
- recurrent glioblastoma, drug repurposing, aprepitant, auranofin, celecoxib, captopril, disulfiram, itraconazole, minocycline, ritonavir, sertraline, dose-limiting toxicity, treatment resistance, combination therapy safety
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