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Temozolomide Improves Response of Brain Metastases to Radiation Therapy: Presented at ASTRO
By Emma Hitt
Special to DG News
NEW ORLEANS, LA -- October 9, 2002 -- In patients with brain metastases undergoing whole brain radiation therapy, use of the oral alkylating agent temozolomide significantly increases the response rate, according to findings of a phase III trial.
Dr. Desonie Antonadou, with the Metaxas Cancer Hospital, in Pireus, Greece presented the findings here October 8 at the 44th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).
Temozolomide is similar to other oral alkylating agents, but it crosses the blood brain barrier, According to Dr. Antonadou. She also pointed out that it is convenient to use and can be given on an outpatient basis.
Her study enrolled 134 patients with brain metastases, 82 percent of them with primary lung cancer. Patients were randomised to receive whole brain radiation 30Gy given in 10 fractions with or without temozolomide 75 mg/mē/day. None had received previous treatment for brain metastases and all had a Karnofsky performance status of 70 or more.
One month after radiotherapy, the temozolomide dose was increased to 200 mg/mē/day from days 1 to 5 every 28 days for six consecutive cycles. Computerised tomography or magnetic resonance imaging was used to evaluate radiographic response.
The response rate was 53.4 percent for those receiving combination therapy compared to 33.3 percent for those on radiotherapy alone (p=0.039). Patients younger than 60 years of age receiving who received the combination treatment had a 76.7 percent response rate compared to 37.0 percent for those on radiotherapy alone (p=0.003). Similarly, among patients with a Karnofsky performance score of 90 to 100, those on temozolomide had a 70.6 percent response rate compared to 32.4 percent in the radiotherapy-only arm (p=0.003).
Neurological response and median survival were similar between the two groups. Median survival was 8.3 months in the group treated with temozolomide and 6.3 months in the group receiving radiotherapy alone.
"Combined treatment of [temozolomide] and [radiotherapy] results in a significantly higher objective response rate of brain metastases," Dr. Antonadou concluded.
She also noted that need for corticosteroid treatment was significantly reduced in the temozolomide group three months after radiation therapy and temozolomide was well tolerated with mild and reversible toxicity.
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