Effects of temozolomide in malignant brain tumours

Abstract

I agree with the conclusion drawn by Tracy Batchelor in the April 1 commentary,1Batchelor T Temozolomide for malignant brain tumours.Lancet. 2000; 355: 1115-1215Summary Full Text Full Text PDF PubMed Scopus (26) Google Scholar that patients with high-grade glioma should continue to be enrolled in clinical trials. We are still a long way from an ideal treatment for this deadly disease. However, data from two studies,2Osoba D Brada M Yung WK Prados M Health‐related quality of life in patients treated with temozolomide versus procarbazine for recurrent glioblastoma multiforme.J Clin Oncol. 2000; 18: 1481-1491PubMed Google Scholar, 3Osoba D, Brada M, Yung WKA, Prados M. Health‐related quality of life in patients with anaplastic astrocytoma during treatment with temozolomide. Eur J Cancer (in press).Google Scholar show that treatment with temozolomide offers health-related quality-of-life (HR-QoL) benefits for patients with recurrent glioblastoma multiforme and anaplastic astrocytoma. In a phase III study of patients with glioblastoma temozolomide was associated with HR-QoL improvement in several domains, until disease progression was documented by gadolinium-enhanced magnetic-resonance imaging.2Osoba D Brada M Yung WK Prados M Health‐related quality of life in patients treated with temozolomide versus procarbazine for recurrent glioblastoma multiforme.J Clin Oncol. 2000; 18: 1481-1491PubMed Google Scholar In sharp contrast, therapy with procarbazine was associated with deterioration of HR-QoL scores throughout the treatment. The deterioration during treatment with procarbazine was reported, not only by patients whose disease progressed, but also by patients who were judged to have a partial tumour response. Thus, in recurrent glioblastoma, temozolomide is clearly preferable to procarbazine. In a phase II study of patients with anaplastic astrocytoma treated with temozolomide, improvement in HR-QoL scores was reported until about 4 weeks before documented disease progression.3Osoba D, Brada M, Yung WKA, Prados M. Health‐related quality of life in patients with anaplastic astrocytoma during treatment with temozolomide. Eur J Cancer (in press).Google Scholar These results support the data showing HR-QoL benefits associated with temozolomide treatment for glioblastoms multi-forme from the phase III study. Temozolomide, as monotherapy, may not be the ideal therapy for high-grade glioma, but it is an effective treatment that offers HR-QoL benefits.