Compliance of temozolamide with concurrent radiotherapy as an adjuvant in patients with high grade glioma – a retrospective study
DOI:
https://doi.org/10.15584/ejcem.2023.1.9Keywords:
glioblastoma multiformae, high grade gliomas, radiotherapy, temozolamideAbstract
Introduction and aim. High grade glioma is the most aggressive form of primary brain tumour with a median survival of one year. Maximal safe resection followed by temozolamide-based concurrent chemoradiation and adjuvant chemotherapy is the standard of care. To assess the compliance of temozolamide in patients of high-grade glioma who underwent concurrent chemoradiation followed by adjuvant chemotherapy.
Material and methods. 30 patients of high grade glioma diagnosed and treated in our Oncology department during the period of March 2016 to March 2018 were analyzed retrospectively. Cases included in this study were patients with biopsy proven high grade glioma who underwent maximal safe surgery, temozolamide-based concurrent chemoradiation, followed by adjuvant chemotherapy with temozolamide. Data regarding age, gender, histopathology, extent of surgery, performance status, radiotherapy dose, chemotherapy cycles and treatment toxicity profiles were recorded.
Results. Treatment was generally well tolerated with most patients experiencing grade 1 and 2 toxicities, which were managed with supportive care. Grade 3 toxicities were noted as follows: anaemia (6.7%, n=2), neutropenia (16.7%, n=5) and thrombocytopenia (16.7%, n=5). Treatment with TMZ was discontinued in 6.7% (n=2) of individuals due to myelosupression. No grade 4 hematological toxicities were observed in the study group.
Conclusion. The compliance of temozolamide in high grade gliomas is high with less treatment interruptions and manageable side effect profile.
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References
Walker MD, Strike TA, Sheline GE. An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys. 1979;5(10):1725-1731. doi: 10.1016/0360-3016(79)90553-4.
Walker MD, Alexander E Jr, Hunt WE, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg. 1978;49(3):333-343. doi: 10.3171/jns.1978.49.3.0333.
Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987-996. doi: 10.1056/NEJMoa043330.
Erpolat OP, Akmansu M, Goksel F, Bora H, Yaman E, Büyükberber S. Outcome of newly diagnosed glioblastoma patients treated by radiotherapy plus concomitant and adjuvant temozolomide: a long-term analysis. Tumori. 2009;95(2):191-197. doi: 10.1177/030089160909500210.
Denny BJ, Wheelhouse RT, Stevens MFG, Tsang LLH, Slack JA. NMR and molecular modeling investigation of the mechanism of activation of the antitumor drug temozolomide and its interaction with DNA. Biochemistry. 1994;33(31):9045-9051.
Cai S, Xu Y, Cooper RJ, et al. Mitochondrial targeting of human o6-methylguanine DNA methyltransferase protects against cell killing by chemotherapeutic alkylating agents. Cancer Res. 2005;65:3319-3327. doi: 10.1158/0008-5472.CAN-04-3335.
Stevens MF, Hickman JA, Langdon SP, et al. Antitumor activity and pharmacokinetics in mice of 8-carbamoyl-3-methyl-imidazo[5,1-d]-1,2,3,5-tetrazin-4(3H)-one (CCRG 81045; M & B 39831), a novel drug with potential as an alternative to dacarbazine. Cancer Res. 1987;47(22):5846-5852.
Denis L, Tolcher A, Figueroa J, et al. Protracted daily administration of Temozolomide is feasible: A phase I pharmacokinetic-pharmacodynamic study. Proc Am Soc Clin Oncol. 2000;19:202a.
Wurm R, Roeschel L, Scheffler D, et al. Phase I-II study with continuous dose-escalated 21-day schedule temozolomide in recurrent high-grade glioma. Proc Am Soc Clin Oncol. 2000;19:164a.
Raymond E, Vera K, Djafari L, et al. Safety profile and activity of high-dose temozolomide given daily x 3 every 2 weeks in patients with primary tumors. Proc Am Soc Clin Oncol. 2002;21:78a.
Wedge SR, Porteous JK, Glaser MG, Marcus K, Newlands ES. In vitro evaluation of temozolomide combined with X-irradiation. Anticancer Drugs. 1997;8(1):92-97. doi: 10.1097/00001813-199701000-00013 .
van Rijn J, Heimans JJ, van den Berg J, van der Valk P, Slotman BJ. Survival of human glioma cells treated with various combination of temozolomide and X-rays. Int J Radiat Oncol Biol Phys. 2000;47(3):779-784. doi: 10.1016/s0360-3016(99)00539-8.
Brada M, Hoang-Xuan K, Rampling R, et al. Multicenter phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse. Ann Oncol. 2001;12(2):259-266. doi: 10.1023/a:1008382516636.
Yung WK, Prados MD, Yaya-Tur R, et al. Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. Temodal Brain Tumor Group. J Clin Oncol. 1999;17(9):2762-2771. doi: 10.1200/JCO.1999.17.9.2762.
Yung WK, Albright RE, Olson J, et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer. 2000;83(5):588-593. doi: 10.1054/bjoc.2000.1316.
Stupp R, Dietrich PY, Ostermann Kraljevic S, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol. 2002;20(5):1375-1382. doi: 10.1200/JCO.2002.20.5.1375.
Athanassiou H, Synodinou M, Maragoudakis E, et al. Randomized phase II study of temozolomide and radiotherapy compared with radiotherapy alone in newly diagnosed glioblastoma multiforme. J Clin Oncol. 2005;23(10):2372-2387. doi: 10.1200/JCO.2005.00.331.
Combs SE, Gutwein S, Schulz-Ertner D, et al. Temozolomide combined with irradiation as postoperative treatment of primary glioblastoma multiforme. Phase I/II study. Strahlenther Onkol. 2005;181(6):372-377. doi: 10.1007/s00066-005-1359-x.
Combs SE, Wagner J, Bischof M, et al. Radiochemotherapy in patients with primary glioblastoma comparing two temozolomide dose regimens. Int J Radiat Oncol Biol Phys. 2008;71(4):999-1005. doi: 10.1016/j.ijrobp.2007.11.064.
Armstrong TS, Cao Y, Vera E. et al. Pharmaco epidemiology of myelotoxicity (TOX) with temozolomide 8TEM) in malignant glioma patients. J Clin Oncol. 2008;26(15):513.
Hawkins R, Grunberg S. Chemotherapy-induced nausea and vomiting: challenges and opportunities for improved patient outcomes. Clin J On¬col Nurs. 2009;13:54-64. doi: 10.1188/09.CJON.54-64.
Middleton J, Lennan E. Effectively managing chemotherapy-induced nausea and vomiting. Br J Nurs. 2011;20(17):7-15. doi: 10.12968/bjon.2011.20.Sup10.S7.
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