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**Voxtalisib + temozolomide** is an investigational combination therapy being evaluated for the treatment of high-grade gliomas including glioblastoma. Voxtalisib is a small molecule dual inhibitor that targets both pan-class I phosphoinositide 3-kinase (PI3K) and mammalian target of rapamycin (mTOR), thereby blocking signaling pathways frequently activated in glioma and associated with tumor growth and survival. Temozolomide is an oral alkylating agent that induces DNA damage and is a standard chemotherapy for glioblastoma and other high-grade gliomas. The combination aims to enhance antitumor efficacy, with voxtalisib inhibiting key growth pathways and temozolomide providing cytotoxic activity. In phase I clinical trials, the combination was administered orally and demonstrated a favorable safety profile and moderate inhibition of the PI3K/mTOR pathway. Most common side effects included nausea, fatigue, thrombocytopenia, and diarrhea; dose-limiting toxicities included thrombocytopenia, rash, and elevated liver enzymes. Partial response and stable disease were observed in a subset of patients[1][3][5].
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