VISTA: Valproic Acid, Irinotecan, and Simvastatin for Recurrent Glioma

Inclusion Criteria: * Diagnosis of glioblastoma or IDH-mutated glioma by WHO 2021 classification * For glioblastoma, at least one prior treatment, which needs to include temozolomide and/or radiation * For IDH-mutated glioma, prior treatment with both radiation and alkylating chemotherapy * Evidence of progression by RANO 2.0 criteria on MRI within last four weeks * At least 1 enhancing measurable lesion Exclusion Criteria: * Use of an enzyme-inducing antiepileptic or other strong inducer of CYP3A4 * Prior treatment with irinotecan * Prior use of valproic acid within 2 months * Anticancer treatment within 4 weeks, 6 weeks if nitrosourea * Active bacterial or fungal infection requiring systemic treatment * Pregnancy * Known mitochondrial disease