The prognosis of patients diagnosed with glioblastoma remains dismal in spite of the current concomitant chemoradiotherapy with temozolomide. In particular, the resistance to temozolomide appears to be the greatest obstacle to the treatment of glioblastoma. In the present study, we evaluated in vitro and in vivo the antitumor effects of combination therapy of cilengitide with belotecan, a camptothecin derivate, to treat experimental glioblastoma. The therapeutic effects of the drugs on the U87MG and U251MG human glioblastoma cell lines were assessed using in vitro cell viability and apoptosis assays. The combination treatment group with cilengitide and belotecan enhanced the cytotoxic effects to the glioblastoma cell lines and increased the apoptosis of the tumor cells compared to monotherapy with either drug alone in vitro. Nude mice with established U87MG glioblastoma were assigned to the following four groups: control, cilengitide, belotecan and combination treatment. The volume of tumors and length of survival were also measured. Animals in the combination therapy group demonstrated a significant reduction of tumor volume and an increase in survival (p < 0.05). Immunohistochemistry revealed a decrease in angiogenesis by cilengitide and an increase in apoptosis by cilengitide and belotecan in vivo. The combination therapy of cilengitide with belotecan presented more cytotoxic effects compared to the monotherapy of either drug in vitro and in vivo. This combination protocol may serve as an alternative treatment option for glioblastoma.Glioblastoma is the most common malignant tumor of the central nervous system. 1 Currently, microsurgery and adjuvant concomitant chemoradiotherapy with temozolomide are the recommended first-line treatment for patients with primary glioblastoma.2 Despite recent advances in the treatment of glioblastoma, the prognosis for patients with newly diagnosed glioblastoma remains dismal; hence, these patients survive for no more than 2 years after diagnosis. Currently, there are no proven effective therapeutic options against temozolomide resistance. Therefore, there is a great interest in finding novel therapeutic agents for overcoming the resistance to temozolomide.Cilengitide (EMD121974), a cyclic Arg-Gly-Asp (RGD)-based peptide, is an antagonist of integrins avb3 and avb5 and has been thought to primarily exert an antiangiogenic effect on malignant glioma cells.3 Moreover, cilengitide may also have a direct effect on attachment, migration, invasion and viability of tumor cells. 4 Recently, cilengitide has become of great interest as a novel therapeutic agent for primary and recurrent glioblastoma. [4][5][6][7] Preliminary reports suggested that cilengitide exhibited a preferential benefit over the current concomitant chemoradiotherapy with temozolomide in patients with O 6 -methyl-guanine DNA methyltransferase (MGMT) promoter methylation. 8 Belotecan showed greater antitumor activity while exhibiting a reduced toxicity profile compared to irinotecan or topotecan in recent clinical tr...