gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Haematotoxicity and its impact on therapy continuation during concomitant, adjuvant and extended temozolomide treatment in malignant glioma

Meeting Abstract

  • H.C. Bock - Department of Neurosurgery, Georg-August-Universität Göttingen
  • A. Gutenberg - Department of Neurosurgery, Georg-August-Universität Göttingen
  • T. Behm - Department of Neurosurgery, Georg-August-Universität Göttingen
  • V. Rohde - Department of Neurosurgery, Georg-August-Universität Göttingen
  • A. Giese - Department of Neurosurgery, Georg-August-Universität Göttingen

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.03.03

DOI: 10.3205/11dgnc116, URN: urn:nbn:de:0183-11dgnc1160

Published: April 28, 2011

© 2011 Bock et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Current treatment standard for malignant glioma is specified by maximal safe resection, radiation therapy and concomitant and adjuvant oral temozolomide chemotherapy. Despite its favourable safety profile dose-related haematotoxic side effects of temozolomide may lead to low haemoglobin, leukocyte or platelet counts resulting in treatment discontinuation or abortion. Early detection of haematotoxic side effects and careful adaption of temozolomide dosage therefore appears important to secure a safe and continuous treatment regimen.

Methods: Clinical and radiographic course, treatment tolerance and haematotoxicity of 214 patients with malignant glioma (58 anaplastic glioma, 154 glioblastoma, 1 plexuscarcinoma, 1 medulloblastoma) treated with temozolomide as first line systemic chemotherapy were monitored by monthly follow-up. In 1752 outpatient follow-up visits 1254 blood counts during temozolomide treatment were documented and analyzed for grade1 to grade 4 haematotoxicity. Temozolomide dosage was reduced or discontinued mainly according to the temozolomide prescribing information and CTCAE 2009. In case of good treatment response and absence of toxicity temozolomide treatment was continued far beyond 6 cycles.

Results: Haematotoxicity grade 3 or 4 was found in 23 patients (10.7%) and led to treatment abortion in 15 patients (7%). In 38 patients (17.7%) grade 1 or 2 haematotoxicity resulted in adapted dose reduction or temporary discontinuation of temozolomide treatment with later on resumption. In 48 patients (22.4%) treatment was continued for 10 cycles and beyond (range 10 to 78 cycles) with a median cycle number of 15 and a grade 3 or 4 haematotoxicity rate of 2%. In this group with extended temozolomide treatment median OAS for anaplastic glioma and glioblastoma was 39 months and 29.5 months respectively.

Conclusions: Continuous monitoring of haematotoxic side effects and aimed dose adaption secures regular scheduling as a basis of effective temozolomide treatment in malignant glioma. Extended temozolomide scheduling of 10 cycles and beyond was found not to increase haematotoxicity in our experience and was correlated with promising survival data.