Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 2, pp 337–344 | Cite as

Safety of pioglitazone during and after radiation therapy in patients with brain tumors: a phase I clinical trial

  • Christina K. CramerEmail author
  • Natalie Alphonse-Sullivan
  • Scott Isom
  • Linda J. Metheny-Barlow
  • Tiffany L. Cummings
  • Brandi R. Page
  • Doris R. Brown
  • Arthur W. BlackstockJr.
  • Ann M. Peiffer
  • Roy E. Strowd
  • Stephen Rapp
  • Glenn J. Lesser
  • Edward G. Shaw
  • Michael D. Chan
Original Article – Cancer Research



Radiation-induced cognitive decline (RICD) is a late effect of radiotherapy (RT) occurring in 30–50% of irradiated brain tumor survivors. In preclinical models, pioglitazone prevents RICD but there are little safety data on its use in non-diabetic patients. We conducted a dose-escalation trial to determine the safety of pioglitazone taken during and after brain irradiation.


We enrolled patients > 18 years old with primary or metastatic brain tumors slated to receive at least 10 treatments of RT (≤ 3 Gy per fraction). We evaluated the safety of pioglitazone at 22.5 mg and 45 mg with a dose-escalation phase and dose-expansion phase. Pioglitazone was taken daily during RT and for 6 months after.


18 patients with a mean age of 54 were enrolled between 2010 and 2014. 14 patients had metastatic brain tumors and were treated with whole brain RT. Four patients had primary brain tumors and received partial brain RT and concurrent chemotherapy. No DLTs were identified. In the dose-escalation phase, there were only three instances of grade ≥ 3 toxicity: one instance of neuropathy in a patient receiving 22.5 mg, one instance of fatigue in a patient receiving 22.5 mg and one instance of dizziness in a patient receiving 45 mg. The attribution in each of these cases was considered “possible.” In the dose-expansion phase, nine patients received 45 mg and there was only one grade 3 toxicity (fatigue) possibly attributable to pioglitazone.


Pioglitazone was well tolerated by brain tumor patients undergoing RT. 45 mg is a safe dose to use in future efficacy trials.


Radiation-induced cognitive decline Pioglitazone Neuroprotective 



The authors would like to acknowledge the late Dr. Mike E. Robbins, Ph.D., whose scientific work and advisement were integral to the development of this translational trial.


This study was funded by grant number: P30 CA012197-40.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Data availability

The clinical data used to support the findings of this study are included within the article. The number associated with this protocol is NCT01151670.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Christina K. Cramer
    • 1
    Email author
  • Natalie Alphonse-Sullivan
    • 1
  • Scott Isom
    • 3
  • Linda J. Metheny-Barlow
    • 1
  • Tiffany L. Cummings
    • 4
  • Brandi R. Page
    • 8
  • Doris R. Brown
    • 1
  • Arthur W. BlackstockJr.
    • 1
  • Ann M. Peiffer
    • 7
  • Roy E. Strowd
    • 4
    • 5
  • Stephen Rapp
    • 2
  • Glenn J. Lesser
    • 5
  • Edward G. Shaw
    • 6
  • Michael D. Chan
    • 1
  1. 1.Department of Radiation OncologyWake Forest School of MedicineWinston-SalemUSA
  2. 2.Department of Psychiatry and Behavioral MedicineWake Forest School of MedicineWinston-SalemUSA
  3. 3.Department of Biostatistical SciencesWake Forest School of MedicineWinston-SalemUSA
  4. 4.Department of NeurologyWake Forest School of MedicineWinston-SalemUSA
  5. 5.Department of Internal Medicine (Hematology & Oncology)Wake Forest School of MedicineWinston-SalemUSA
  6. 6.Department of Internal Medicine (Gerontology and Geriatrics)Wake Forest School of MedicineWinston-SalemUSA
  7. 7.Department of PsychologyMars Hill UniversityMars HillUSA
  8. 8.Department of Radiation OncologyJohns Hopkins School of MedicineBaltimoreUSA

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