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The Neuro-Oncology Working Group of the German Cancer Society ( Neuroonkologische Arbeitsgemeinshaft , NOA), studied the effect of lomustine (CCNU, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea) and temozolomide together to treat patients with newly diagnosed glioblastoma with a methylated O6-methylguanine DNA methyltransferase (MGMT) promoter (1). This strategy needed testing after the encouraging results of a phase II trial (2), and the synergistic or additive effect between temozolomide and lomustine since nitrosoureas have additional non-alkylating effects on DNA and cell replication (3).

Lomustine and temozolomide for newly diagnosed glioblastoma with methylated MGMT promoter: Lessons from the CeTeG/NOA-09 trial