5-aminolevulinic acid + carmustine + temozolomide

This is a combination therapy consisting of 5-aminolevulinic acid (5-ALA), carmustine (BCNU), and temozolomide (TMZ) for the treatment of malignant gliomas, particularly glioblastoma. 5-ALA is a naturally occurring amino acid derivative that accumulates in tumor cells and is metabolized to protoporphyrin IX (PpIX), which can be activated by light or radiation to produce reactive oxygen species that kill cancer cells. Carmustine and temozolomide are alkylating agents that damage DNA in cancer cells. The combination leverages complementary mechanisms of action and may overcome resistance through MGMT depletion to enhance cytotoxic activity against malignant glioma cells.