The CUSP9 treatment protocol for recurrent glioblastoma
It's now show some activity in patients with this type of cancer https://academic.oup.com/neuro-oncology/article-abstract/19/suppl_6/vi90/4591063
From this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226667/ they state:
''The drugs are generally well-tolerated.
Weekly evaluations with complete blood count are essential given the potential for unforeseen drug-drug interactions in a regimen as complex as this. The initial four drugs and doses are Aprepitant 80 mg once daily, Auranofin 3 mg once daily, Celecoxib 200 mg once daily, Disulfiram 250 mg once daily. These can be started on day one. After seven days Artesunate 50 mg once daily, Captopril 50 mg once daily, Itraconazole 200 mg once daily, Ritonavir 400 mg once daily, and Sertraline 100 mg once daily are started. On the three week check [day 21] drugs are brought to the full doses, given below. These are used in addition to continuous low dose Temozolomide:
Aprepitant 80 mg twice daily.
Artesunate 50 mg twice daily.
Auranofin 3 mg twice daily.
Captopril 50 mg twice daily.
Celecoxib 400 mg twice daily
Disulfiram 250 mg twice daily.
Itraconazole 200 mg twice daily.
Ritonavir 400 mg twice daily.
Sertraline 100 mg twice daily.
No other medicine, herbal preparation, over-the-counter medicine or nutritional supplement are allowed, to minimise the risk of drug-drug interaction.
i). Diarrhea can be treated with Loperamide 2 mg ii bid. This dose can be increased or decreased as needed.
ii). Anxiety or poor sleep should be treated with Lorazepam 1 mg or 2 mg at hour of sleep. This can be increased or decreased as needed. Half this dose can be used several times during the day should daytime anxiety become a problem.
iii). If seizures occur Levetiracetam 1 gram twice daily can be used, with down titration if side effects are encountered.
iv). Headache treatment with low-dose Hydromorphone is allowed.
Strictest avoidance of any source of ethanol, even in such sources as wine vinegar or casseroles and grapefruit juice avoidance will be the only two dietary restrictions. Coffee consumption is allowed but caution advised, as caffeine effects can be magnified by drugs like Disulfiram.
A number of the drugs are expected to act together to reduce glioblastoma related edema and thereby reduce or eliminate the need for Dexamethasone use in the course of treatment.''