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Brain Metastases Respond to Temozolomide Plus Radiotherapy
A DGReview of :"Phase II Randomized Trial of Temozolomide and Concurrent Radiotherapy in Patients With Brain Metastases."
Journal of Clinical Oncology (JCO)
09/09/2002
By Anne MacLennan
Temozolomide is safe and when combined with radiotherapy significantly improves response rate in patients with previously untreated brain metastases, doctors in Greece have found.
Dr. D. Antonadou and colleagues from the Metaxas Cancer Hospital, Piraeus examined the efficacy, tolerability and safety of this drug administered concurrently with radiotherapy.
Researchers randomised 52 patients with brain metastases from solid tumours to oral temozolomide (75 mg/m2/day) concurrent with radiotherapy for four weeks or radiotherapy alone. Patients on the combined treatment continued temozolomide therapy (200 mg/m2/day) for five days every 28 days for an additional six cycles.
Radiologic response and neurologic symptom evaluation were the primary end points.
In patients on temozolomide and radiotherapy versus radiotherapy alone, the objective response rate was significantly improved. Of 24 patients who were evaluable for response in the temozolomide group, 23 (96 percent) responded. This group included nine patients (38 percent) with a complete response and 14 (58 percent) with a partial response.
With radiotherapy alone, 14 (67 percent) of 21 assessable patients responded, including seven (33 percent) complete responses and seven (33 percent) partial responses.
In the group on the combined therapy, there was marked neurologic improvement.
Moreover, the proportion of patients needing corticosteroids two months post treatment was lower (67 percent) in the temozolomide than in the radiotherapy alone group (91 percent).
The authors found daily temozolomide concurrent with radiotherapy was generally well tolerated although nausea and vomiting were significantly increased in this as compared with the radiotherapy group.
Haematologic toxicity was predictable and reversible.
These authors suggest a larger randomised trial is now warranted to verify these results.
J Clin Oncol 2002 Sep 1;20(17):3644-50
"Phase II Randomized Trial of Temozolomide and Concurrent Radiotherapy in Patients With Brain Metastases."
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