Long-term treatment with temozolomide in malignant glioma.
Six months of maintenance temozolomide (TMZ) following concurrent TMZ chemotherapy and radiation therapy has become the standard of care in the treatment of glioblastoma. In addition, TMZ has also been used to treat other forms of glioma although less evidence of efficacy exists. TMZ administration longer than 6months is common in clinical practice, but it is unusual for the drug to be administered longer than 1 to 2years. We report five patients who received long-term treatment with TMZ chemotherapy at normal dosing levels. One of these patients was diagnosed with glioblastoma, two with anaplastic astrocytoma, one with gliosarcoma, and one with oligo-astrocytoma. The length of treatment in our group of patients ranged from 45 to 85 cycles of TMZ. Common Terminology Criteria for Adverse Events (CTCAE) developed by The National Cancer Institute was used to classify toxicity. Two patients experienced no toxicity per CTCAE guidelines. One patient experienced grade I thrombocytopenia, one developed grade I leukopenia, and one experienced both grade I thrombocytopenia and grade I nausea, all which resolved with either withholding TMZ for 1month or supportive treatment. Our report provides evidence that long-term TMZ chemotherapy is a therapeutic option when appropriately monitored.
Department of Neurosurgery, University of Kentucky HealthCare, 800 Rose Street, MS101A, Lexington, KY 40536, USA. Electronic address: jonathan.mannas@uky.edu.
Jonathan P
JP
Mannas
Department of Neurology, University of Kentucky HealthCare, Lexington, KY, USA; Department of Pediatrics, University of Kentucky HealthCare, Lexington, KY, USA.
Donita D
DD
Lightner
Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.
Sean R
SR
Defrates
Department of Neurosurgery, University of Kentucky HealthCare, 800 Rose Street, MS101A, Lexington, KY 40536, USA.
Thomas
T
Pittman
Department of Medicine, Division of Oncology, University of Kentucky HealthCare, Lexington, KY, USA.
J Lee
JL
Villano
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D005910:Glioma / Q000188:drug therapy*; D006801:Humans; D060046:Maintenance Chemotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D000077204:Temozolomide
D000970:Antineoplastic Agents; D003606:Dacarbazine; D000077204:Temozolomide
Brain tumors; Malignant gliomas; Temozolomide; Toxicity