Patients who did not die during the 1-year analysis period were censored and marked by a +. If a patient was alive at the end of treatment, then the end of treatment visit was the date at which they were censored. Otherwise if a patient withdrew, they were censored at the date of the survival status review. If a patient was lost to follow-up then they were censored at the last known visit date. The number of patients at risk at a given timepoint was the number still alive or who had not been censored.
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SUPPLEMENTARY INFORMATION
ACKNOWLEDGEMENTS
We are indebted to the patients who took part in the trial, as well as to the staff at the clinical research sites. We thank Dr Marcel Kamp for his contribution to the review of this manuscript. The research was supported by the National Institute for Health Research (NIHR) infrastructure at Leeds. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
GWCA1208 study group
Catherine McBain6, Brian Haylock7, Paul Mulholland8, Christopher Herbert9, Allan James10, Mohan Hingorani11, Joerg Berrouschot12, Rainer Fietkau13, Jens Panse14
AUTHOR CONTRIBUTIONS
Involved in analysis, interpretation of trial data, contributed to the writing and review of the manuscript: S.M., B.T., D.C. D.C. was responsible for the statistical analysis. Involved in the acquisition of trial data, interpretation of trial data and contributed to the writing and review of the manuscript: S.S., M.S., M.J., L.B. and C.T.
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
This trial was conducted in accordance with International Council for Harmonisation Good Clinical Practice guidelines and ethical principles that have their origin in the Declaration of Helsinki. The research protocol was approved by the relevant Institutional Review Board or Independent Ethics Committee at each site, including: The NRES Committee Yorkshire & The Humber—Leeds East. The Ethics Committee of the State Medical Association of Thuringia in consultation with: The Ethics Committee of Friedrich-Alexander at the University of Erlangen-Nuremberg. The Ethics Committee of the Faculty of Medicine at the University of Duesseldorf. The Ethics Committee of the Faculty of Medicine at the Rheinisch-Westfälischen Technical College, Aachen. All patients provided written informed consent.
DATA AVAILABILITY
The trial protocol is registered on the ClinicalTrials.gov website (Part 1: NCT01812603; Part 2: NCT01812616). Supplemental Materials contain additional information about individual site and patient stopping rules, the safety review team, pharmacokinetic analysis, statistical methods, randomisation, patients excluded from the pharmacokinetic analysis, and Magnetic Resonance Imaging scans. Demographics and baseline characteristics are summarised in Supplemental Table 1. Maximum treatment-emergent adverse event toxicities for patients who experienced a grade 2 or higher treatment-emergent adverse event are summarised in Supplemental Table 2. EORTC-predicted vs. actual overall survival for the randomised element of the trial is summarised in Supplemental Table 3. EORTC-predicted vs. actual overall survival for the open-label element of the trial is summarised in Supplemental Table 4. Pharmacokinetic parameters for temozolomide and 4-amino-5-imidazole-carboxamide from the open-label element of the trial are summarised in Supplemental Table 5. Pharmacokinetic parameters for temozolomide and 4-amino-5-imidazole-carboxamide from the randomised element of the trial are summarised in Supplemental Table 6. The trial schema is supplied in Supplemental Fig. 1.
COMPETING INTERESTS
D.C., S.M. and B.T. are employed by and hold share options in GW. C.T., M.S., M.J., L.B. and S.S. have no conflicts of interest to declare.
FUNDING INFORMATION
The trial was sponsored by GW Research Ltd (GW). Medical writing support was provided to authors by Lesley Taylor, PhD, of Alchemy Medical Writing Ltd., and funded by Greenwich Biosciences, Inc. GW provided funding to the Leeds Hospital Clinical Fellowship program, which supported M.J.’s Fellowship. The Spanish Medical Oncology Society awarded a personal grant to M.J.
FOOTNOTES
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Members of the GWCA1208 study group are listed above Acknowledgements.
CONTRIBUTOR INFORMATION
on behalf of the GWCA1208 study group:
,6 ,7 ,8 ,9 ,10 ,11 ,12 ,13 and 14
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1038/s41416-021-01259-3.
REFERENCES
1.
Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro Oncol. 2016;18(Suppl 5):v1–v75. doi: 10.1093/neuonc/now207. [PubMed] [CrossRef] [Google Scholar]
2.
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N. Engl. J. Med. 2005;352:987–996. doi: 10.1056/NEJMoa043330. [PubMed] [CrossRef] [Google Scholar]
3.
Seystahl K, Wick W, Weller M. Therapeutic options in recurrent glioblastoma—an update. Crit. Rev. Oncol. Hematol. 2016;99:389–408. doi: 10.1016/j.critrevonc.2016.01.018. [PubMed] [CrossRef] [Google Scholar]
4.
Carson KA, Grossman SA, Fisher JD, Shaw EG. Prognostic factors for survival in adult patients with recurrent glioma enrolled on new approaches to brain tumour therapy ‘NABTT’ CNS consortium phase I and II clinical trials. J. Clin. Oncol. 2007;25:2601–2606. doi: 10.1200/JCO.2006.08.1661. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
5.
Park JK, Hodges T, Arko L, Shen M, Dello Iacono D, McNabb A, et al. Scale to predict survival after surgery for recurrent glioblastoma multiforme. J. Clin. Oncol. 2010;28:3838–3843. doi: 10.1200/JCO.2010.30.0582. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
6.
Weller M, van den Bent M, Hopkins K, Tonn JC, Stupp R, Falini A, et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol. 2014;15:e395–e403. doi: 10.1016/S1470-2045(14)70011-7. [PubMed] [CrossRef] [Google Scholar]
7.
Mun, E. J., Babiker, H. M., Weinberg, U., Kirson, E. D. & Von Hoff, D.D. Tumor-treating fields: a fourth modality in cancer treatment. Clin. Cancer Res. 24, 266–275 (2018). [PubMed]
8.
Stupp R, Wong ET, Kanner AA, Steinberg D, Engelhard H, Heidecke V, et al. NovoTTF-100A versus physician’s choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality. Eur. J. Cancer. 2012;48:2192–2202. doi: 10.1016/j.ejca.2012.04.011. [PubMed] [CrossRef] [Google Scholar]
9.
Stupp R, Taillibert S, Kanner AA, Kesari S, Steinberg DM, Toms SA, et al. Maintenance therapy with tumor-treating fields plus temozolomide vs. temozolomide alone for glioblastoma: a randomized clinical trial. JAMA. 2015;314:2535–2543. doi: 10.1001/jama.2015.16669. [PubMed] [CrossRef] [Google Scholar]
10.
Tanaka S, Akimoto J, Narita Y, Oka H, Tashiro T. Is the absolute value of O(6)-methylguanine-DNA methyltransferase gene messenger RNA a prognostic factor, and does it predict the results of treatment of glioblastoma with temozolomide? J. Neurosurg. 2014;121:818–826. doi: 10.3171/2014.6.JNS132535. [PubMed] [CrossRef] [Google Scholar]
11.
Hegi ME, Genbrugge E, Gorlia T, Stupp R, Gilbert MR, Chinot OL, et al. MGMT promoter methylation cutoff with safety margin for selecting glioblastoma patients into trials omitting temozolomide. A pooled analysis of four clinical trials. Clin. Cancer Res. 2019;25:1809–1816. doi: 10.1158/1078-0432.CCR-18-3181. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
12.
Herrlinger U, Tzaridis T, Mack F, Steinbach JP, Schlegel U, Sabel M, et al. Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA-09): a randomised, open-label, phase 3 trial. Lancet. 2019;393:678–688. doi: 10.1016/S0140-6736(18)31791-4. [PubMed] [CrossRef] [Google Scholar]
14.
Pertwee RG. Neuropharmacology and therapeutic potential of cannabinoids. Addict. Biol. 2000;5:37–46. doi: 10.1080/13556210071252. [PubMed] [CrossRef] [Google Scholar]
15. Pertwee, R. G. In Cannabinoids (ed. Di Marzo V.) pp 32–83 (Kluwer Academic/Plenum Publishers, New York, USA, 2004).
16.
Mechoulam R, Hanus L. Cannabidiol: an overview of some chemical and pharmacological aspects. Part I Chem. Asp. Chem. Phys. Lipids. 2012;121:35–43. doi: 10.1016/S0009-3084(02)00144-5. [PubMed] [CrossRef] [Google Scholar]
17.
Grotenhermen F. Pharmacology of cannabinoids. Neuro Endocrinol. Lett. 2004;25:14–23. [PubMed] [Google Scholar]
18.
Devinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, Hill C, et al. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 2014;55:791–802. doi: 10.1111/epi.12631. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
19.
Schubart C, Sommer IE, Fusar-Poli P, de Witte L, Kahn RS, Boks MP. Cannabidiol as a potential treatment for psychosis. Eur. Neuropsychopharmacol. 2014;24:51–64. doi: 10.1016/j.euroneuro.2013.11.002. [PubMed] [CrossRef] [Google Scholar]
20.
Espejo-Porras F, Fernández-Ruiz J, Pertwee RG, Mechoulam R, García C. Motor effects of the non-psychotropic phytocannabinoid cannabidiol that are mediated by 5-HT1A receptors. Neuropharmacology. 2013;75:155–163. doi: 10.1016/j.neuropharm.2013.07.024. [PubMed] [CrossRef] [Google Scholar]
21.
Nabissi M, Morelli MB, Santoni M, Santoni G. Triggering of the TRPV2 channel by cannabidiol sensitizes glioblastoma cells to cytotoxic chemotherapeutic agents. Carcinogenesis. 2013;34:48–57. doi: 10.1093/carcin/bgs328. [PubMed] [CrossRef] [Google Scholar]
22.
Hassan S, Eldeeb K, Millns PJ, Bennett AJ, Alexander SP, Kendall DA. Cannabidiol enhances microglial phagocytosis via transient receptor potential (TRP) channel activation. Br. J. Pharmacol. 2014;171:2426–2439. doi: 10.1111/bph.12615. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
24.
Kaplan JS, Stella N, Catterall WA, Westenbroek RE. Cannabidiol attenuates seizures and social deficits in a mouse model of Dravet syndrome. Proc. Natl Acad. Sci. USA. 2017;114:11229–11234. doi: 10.1073/pnas.1711351114. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
25.
Laun AS, Song ZH. GPR3 and GPR6, novel molecular targets for cannabidiol. Biochem. Biophys. Res. Commun. 2017;490:17–21. doi: 10.1016/j.bbrc.2017.05.165. [PubMed] [CrossRef] [Google Scholar]
26.
Pertwee RG. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: Δ9-tetrahydrocannabinol, cannabidiol and Δ9-tetrahydrocannabivarin. Br. J. Pharmacol. 2008;153:199–215. doi: 10.1038/sj.bjp.0707442. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
28.
Ellert-Miklaszewska A, Ciechomska I, Kaminsk B. Cannabinoid signaling in glioma cells. Adv. Exp. Med. Biol. 2013;986:209–220. doi: 10.1007/978-94-007-4719-7_11. [PubMed] [CrossRef] [Google Scholar]
29.
Rocha FC, Dos Santos Júnior JG, Stefano SC, da Silveira DX. Systematic review of the literature on clinical and experimental trials on the antitumor effects of cannabinoids in gliomas. J. Neurooncol. 2014;116:11–24. doi: 10.1007/s11060-013-1277-1. [PubMed] [CrossRef] [Google Scholar]
30.
Dimitru CA, Sandalcioglu IE, Karsak M. Cannabinoids in glioblastoma therapy: new applications for old drugs. Front. Mol. Neurosci. 2018;11:159. doi: 10.3389/fnmol.2018.00159. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
31.
Torres S, Lorente M, Rodríguez-Fornés F, Hernández-Tiedra S, Salazar M, García-Taboada E, et al. A combined preclinical therapy of cannabinoids and temozolomide against glioma. Mol. Cancer Ther. 2011;10:90–103. doi: 10.1158/1535-7163.MCT-10-0688. [PubMed] [CrossRef] [Google Scholar]
32.
Guzmán M, Duarte MJ, Blázquez C, Ravina J, Rosa MC, Galve-Roperh I, et al. A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme. Br. J. Cancer. 2006;95:197–203. doi: 10.1038/sj.bjc.6603236. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
33.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97–109. doi: 10.1007/s00401-007-0243-4. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
34.
Lichtman AH, Lux EA, McQuade R, Rossetti S, Sanchez R, Sun W, et al. Results of a double-blind, randomized, placebo-controlled study of nabiximols oromucosal spray as an adjunctive therapy in advanced cancer patients with chronic uncontrolled pain. J. Pain Symptom Manag. 2018;55:179–188. doi: 10.1016/j.jpainsymman.2017.09.001. [PubMed] [CrossRef] [Google Scholar]
35.
Fallon MT, Lux AE, McQuade R, McQuade R, Rossetti S, Sanchez R, et al. Sativex oromucosal spray as adjunctive therapy in advanced cancer patients with chronic pain unalleviated by optimized opioid therapy: two double-blind, randomized, placebo-controlled phase 3 studies. Br. J. Pain. 2017;11:119–133. doi: 10.1177/2049463717710042. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
36.
Ballman KV, Buckner JC, Brown PD, Giannini C, Flynn PJ, LaPlant BR, et al. The relationship between six-month progression-free survival and 12-month overall survival end points for phase II trials in patients with glioblastoma multiforme. Neuro Oncol. 2007;9:29–38. doi: 10.1215/15228517-2006-025. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
37.
Stupp R, Brada M, van den Bent MJ, Tonn JC, Pentheroudakis G, ESMO Guidelines Working Group. High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2014;25(Suppl 3):iii93–iii101. doi: 10.1093/annonc/mdu050. [PubMed] [CrossRef] [Google Scholar]
39.
Norden AD, Lesser GL, Drappatz J, Ligon KL, Hammond SN, Lee EQ, et al. Phase 2 study of dose-intense temozolomide in recurrent glioblastoma. Neuro Oncol. 2013;15:930–935. doi: 10.1093/neuonc/not040. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
40.
Stupp R, Taillibert S, Kanner A, Read W, Steinberg D, Lhermitte B, et al. Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial. JAMA. 2017;318:2306–2316. doi: 10.1001/jama.2017.18718. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
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