Temodar (Temozolomide), Bevacizumab, Lithium and Radiation for High Grade Glioma

Treatment of high grade glioma (HGG) with anti-angiogenic therapy results in clinical
improvement and prolonged progression-free survival (PFS). However, mant patients experience
diffuse recurrence and treatment failure. This is a phase II trial testing the feasibility
of adding lithium carbonate, previously shown to have anti-invasive properties in HGG, to
bevacizumab and chemoradiation following surgical resection of HGG.

Inclusion Criteria:

- Newly diagnosed high grade glioma (WHO Grade III and IV)

- Brain magnetic resonance imaging (MRI) scan with gadolinium contrast

- Patient must have normal organ and marrow function as defined below:

- Absolute neutrophil count >= 1,500/mm^3;

- Platelet count >=100,000/mm^3;

- Hemoglobin >= 10g/dL;

- Blood urea nitrogen and serum creatinine both =< 1.5 times upper limit of normal
(ULN);

- Total bilirubin both =< 1.5 times ULN;

- SGOT and SGPT both =< 3 times ULN;

- Alkaline phosphatase =< 2 times ULN.

- >=18 years of age;

- Karnofsky Performance Score >= 70;

- Life expectancy >= 8 weeks;

- Negative serum or urine beta-hCG pregnancy test at screening for patients of child
bearing potential;

- Men and women with reproductive potential must agree to use an acceptable method of
birth control (surgical, hormonal or double barrier, ie, condom and diaphragm) during
treatment and for 6 months after completion of treatment;

- Patient or their legal proxy must provide written informed consent prior to
registration on study;

- Residual measurable disease.

Exclusion Criteria:

- Current, recent (within 4 weeks of the first infusion of this study), or planned
participation in an experimental drug study;

- Prior radiation therapy to the brain;

- Prior treatment with Chemotherapy or Targeted agent

- Previous (within last 5 years) or current malignancies at other sites except for
adequately treated basal cell or squamous cell skin cancer in situ carcinoma of the
cervix;

- (Uncontrolled High blood pressure >150/100

- Common Terminology Criteria Adverse Event 3.0 >= Grade 2 congestive heart failure
(CHF);

- History of myocardial infarction within 6 months;

- History of stroke within 6 months;

- Clinically significant peripheral vascular disease;

- Evidence of bleeding diathesis or coagulopathy;

- Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to the first dose of bevacizumab or anticipation of need for major surgical
procedure during the course of the study;

- Minor surgical procedures, fine needle aspirations or core biopsies within 7 days
prior to study enrollment;

- Urine protein/Creatinine ratio >= 2.0 at screening;

- Serious, non-healing wound, ulcer, or bone fracture;

- Inability to comply with study and/or follow-up procedures;

- Glioma showing active intratumoral bleeding;

- Patients on enzyme-inducing anti-epileptic drugs;

- Known Positive HIV-1, hepatitis B surface antigen, or hepatitis C antibody;

- Medications like nonsteroidal antiinflammatory drugs, antipsychotics, iodides, and
angiotensin-converting enzyme inhibitor, If they are receiving them, they must have
been discontinued for 7 days prior to initiating lithium;

- Any previous cytotoxic drug therapies, excluding corticosteroids and temozolomide
concurrent with radiation therapy;

- Any known genetic cancer-susceptibility syndromes;

- Acute infection: any active viral, bacterial, or fungal infection that requires
specific therapy.

- Active uncontrolled infection - examples include sexually transmitted disease,
herpes, scrofula, malaria, etc.;

- Fever > 101.5 degrees Fahrenheit;

- Unstable or severe intercurrent medical conditions such as unstable angina,
uncontrolled arrythmias, Crohn's disease, ulcerative colitis, psoriasis, etc.;

- Implantation of Gliadel wafers at surgery;

- Patients with organ allografts; and

- Allergies to reagents used in this study.