gms | German Medical Science

Despite a multidisciplinary approach, the prognosis of malignant gliomas remains poor. In 1999, a new therapeutic option for the treatment of recurrent and progressive malignant gliomas was offered by the oral alkylating agent temozolomide. In this study, we retrospectively analysed our experiences regarding side effects and tolerability over the last 5 years.

Between April 1999 and June 2004, 118 patients were treated with temozolomide. 27 patients are still alive. There were 79 male and 39 female patients with a median age of 54 years (range from 23 to 80 years). In all patients, the Karnofsky Performance Scale was at least 70%. The histology was glioblastoma WHO grade IV in 77 patients, anaplastic glioma WHO grade III in 17 patients and diffuse growing astrocytoma WHO grad II in 24 patients. Temozolomide was given at a dose of 150-200 mg/m² x 5 days in 28 day cycles.

Chemotherapy was performed on an outpatient basis in all cases. A total of 717 cycles of temozolomide were applied with a median of 6 cycles (range from 1 to 17 cycles). Leucopenia WHO grade III or IV was observed in 8% (10 patients) and thrombocytopenia WHO grade III or IV in 10% (12 patients). Dose reduction was required in 14% (17 patients). Relevant nonhematologic complications were not observed. 7% (8 patients) showed an allergic drug rash following a simultaneous treatment with carbamazepine. This led to the termination of the temozolomide therapy in one case.

Temozolomide is a low side effect treatment option for malignant gliomas offering a high quality of life. In addition, simple treatment modalities of this therapy, i.e. oral application, account for a high compliance.