Glioblastoma is a disease for which there were few options available until recently. The past several years brought several new potentially promising. Temozolomide (brand names Temodar and Temodal) is an oral alkylating drug. It is FDA indicated is indicated for the treatment of adult patients with newly diagnosed glioblastoma multiforme concomitantly with radiotherapy and then as maintenance treatment. TEMODAR is indicated for the treatment of adult patients with refractory anaplastic astrocytoma (an aggressive brain tumor, also known as glioblastoma multiforme) for patients who have experienced disease progression on a drug regimen containing nitrosourea and procarbazine.
Prior to this approval, only BCNU was approved for adjuvant therapy but, because of its significant toxicity, it was not widely used.
There is strong support for its use in oligodendoglioma, replacing the older (and less well-tolerated) PCV (Procarbazine-Lomustine-Vincristine) regimen. It is also supported off-label for melanoma.
The use of Temodar for glioblastoma has impacted on the overall prognosis. Data from the Surveillance, Epidemiology, and End Results (SEER) Program was analyzed to compare survival of adult glioblastoma patients diagnosed from 2000-2003 to patients diagnosed from 2005-2008, in order to evaluate pre-temozolomide and post-temozolomide periods. The Kaplan-Meier method and Cox proportional hazards models were used. 6,673 patients with glioblastoma diagnosed from 2000-2003 and 7,259 patients diagnosed from 2005-2008 were identified. Median survival times of all patients diagnosed in the 2000-2003 and 2005-2008 periods were 8.1 and 9.7 months, respectively. Amongst patients treated with surgery and a radiation-containing regimen, median survival was 12.0 months in 2000-2003 and 14.2 months in 2005-2008. In the temozolomide era, median survival times ranged from a high of 31.9 months in patients age 20-29 to a low of 5.6 months in patients age 80 and older. The survival of patients with newly diagnosed glioblastoma improved from 2000-2003 to 2005-2008, likely due to temozolomide use. However, median survival time after glioblastoma diagnosis in the SEER population remains well under one year, largely driven by poor prognosis in elderly patients.
nccn.org, brain cancer, 2012
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