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Long-term treatment with temozolomide in malignant glioma.

Al's Comment:

  It never made sense to me to stop Temodar at 6 months. The reason they always give is that is the length of time used in the trial was 6 months so they use that. However, that 6 months was chosen to allow the trial to conclude quickly.  They never tested varying lengths of treatment against each other.   The other argument to end treatment early was increased chance of side effects. This article shows in a small group, that it is relatively safe to continue for an extended period of time.  There is also the risk of developing a secondary cancer - but that risk is smaller than the original tumor growing back and killing you.

Posted on: 10/02/2013

J Clin Neurosci. 2013 Sep 21. pii: S0967-5868(13)00320-2. doi: 10.1016/j.jocn.2013.03.039. [Epub ahead of print]
Long-term treatment with temozolomide in malignant glioma.
Mannas JP, Lightner DD, Defrates SR, Pittman T, Lee Villano J.
Department of Neurosurgery, University of Kentucky HealthCare, 800 Rose Street, MS101A, Lexington, KY 40536, USA. Electronic address:
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.
Copyright © 2013 Elsevier Ltd. All rights reserved.
 PMID: 24063865 [PubMed - as supplied by publisher] 
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