Low Dose Radiation Therapy for Glioblastoma Multiforme

In vitro and in vivo studies have suggested that low dose fractionated radiation therapy
(LDFRT) may be used to potentiate full dose chemotherapy, decreasing the development of
resistance found with standard doses of radiation and chemotherapy. This is a nonrandomized,
open label, single institution phase II trial with a safety run-in to evaluate the safety and
efficacy of LDFRT plus temozolomide in patients with High Grade Glioma (to only include
Anaplastic Astrocytoma or Glioblastoma Multiforme) previously treated with surgical resection
followed by adjuvant radiation therapy plus temozolomide. The primary objective of the phase
II study is to estimate response rate in patients treated with twice daily fractions of low
dose radiation plus temozolomide chemotherapy.

Inclusion Criteria:

- Patients must have recurrent GBM (Glioblastoma Multiforme)or Anaplastic Astrocytoma.

- The diagnosis of GBM or Anaplastic Astrocytoma.

- Patients must have been previously treated with surgical resection (any extent okay)
and adjuvant radiation therapy plus temozolomide.

- Patients must be at least 12 months from completion of radiation therapy

- At least 2 months from completion of temozolomide (to be consistent with the the
"rechallenge" group from Perry et al. JCO 2010).

- Age >18 years

- ECOG performance status <2 (Karnofsky >60%, see appendix A).

- There must be measurable disease on MRI.

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

- Women must not be pregnant

- Ability to understand and the willingness to sign a written informed consent document

- Temozolomide re-treatment is planned by the treating neuro-oncologist.

- The most recent brain tumor pathology obtained for the patient must be glioblastoma.

Exclusion Criteria:

- Must be able to receive an MRI

- Patients may not be receiving any other investigational cancer treatment agents at the
time of enrollment.

- Patients may not have previously failed treatment with salvage temozolomide.

- Patients may not have previously failed treatment with a VEGF inhibitor.

- Patients may not have previously been treated with >1 course of radiotherapy.

- Patients may not have previously been treated with radiosurgery to the brain.

- Uncontrolled intercurrent illness

- Pregnant and breastfeeding women are excluded. Women of child-bearing potential who
are unwilling or unable to use and acceptable method of birth control to avoid
pregnancy for the entire study period and up to 12 weeks after the study are excluded.
Male subjects must also agree to use effective contraception for the same period as
above.