Glioblastoma is a disease for which there were few options available until recently. The past several years brought several new potentially promising treatments and one, Temodar as a single drug, has been FDA approved for this indication. Irinotecan and Avastin is a promising new combination for gliolastoma, which NCCN now recommends. However, Avastin with Temodar is not as well explored and is not NCCN recommended. I was able to find one preliminary report of this combination. It is still in clinical trials. For example, there is a phase II study: Bevacizumab in Combination With Metronomic Temozolomide for Recurrent Malignant Glioma, NCT00501891, in Duke( completed but not published). There is also a phase II trial of the two in combination with radiation.
However, recently another phase II trial was reported, albeit with radiation. Another approach is with metronomic Temodar dosing.
Desjardins et al It found that regimen of combined daily temozolomide and biweekly bevacizumab had some activity and was well tolerated. However, the results obtained in this study were inferior to those observed in studies of bevacizumab monotherapy and of combined irinotecan and bevacizumab therapy. The population was more heterogeneous and was pretreated more heavily than patients in previous studies. Clearly more investigation is needed before Temodar combintions can be used routinely.
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