key papersKey paper

Reverse swing-M, phase 1 study of repurposing mebendazole in recurrent high-grade glioma

An Indian phase 1 trial gave a worm medicine to 11 people with recurrent glioblastoma alongside chemotherapy or re-irradiation, found the dose they could tolerate, and saw anaemia and nausea as the most common side effects.

Eleven patients with recurrent glioblastoma were enrolled in an accelerated titration design: arm A1 added mebendazole to re-irradiation with concurrent temozolomide, arm B1 to lomustine and arm C1 to temozolomide alone (Reverse swing-M phase 1 2020). The maximum tolerated dose was not reached in arms A1 and C1, giving a recommended phase 2 dose of 1600 mg three times a day, while with lomustine it was 1600 mg three times a day and the recommended dose 800 mg three times a day; the most common adverse events were anaemia in 9 patients, nausea in 7 and fatigue in 6 (Reverse swing-M phase 1 2020).

Translational studyHas not changed practice yet11 participants

Authors

Patil VM, Bhelekar A, Menon N, et al.

Published

Cancer Medicine, 2020

Full text

doi:10.1002/cam4.3094 PubMed 32400117

Findings

Recommended phase 2 dose 1600 mg three times a day with temozolomide or chemoradiation; 800 mg three times a day with lomustine.
Anaemia 82 percent, nausea 64 percent, fatigue 55 percent.

What it means

This is what legitimate repurposing looks like: a registered dose-finding trial that reports its toxicities. It says nothing yet about whether mebendazole helps glioblastoma.

Caveats