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胶质瘤的药物治疗——化疗研究进展
Efficacy of temozolomide in the treatment of glioblastoma in the elderly
A systematic review included a total of 5 studies (all assessed by the Newcastle-Ottawa scale) with a total of 979 patients with glioblastoma treated with temozolomide. Four of the studies showed that temozolomide significantly improved the overall survival rate of glioblastoma. In a cohort study, the 2-year survival rate of patients treated with temozolomide increased from 14% to 41% compared with radiation therapy alone. But one study came back negative.
Study results suggest that temozolomide may improve overall survival in older patients with glioblastoma. However, further randomized controlled trials are needed to confirm this finding.
Application of extended dose and conventional dose of temozolomide in new high-grade glioma
Maximal safe surgical resection followed by concurrent chemoradiotherapy and adjuvant chemotherapy with temozolomide is the current standard treatment for de novo high-grade gliomas. However, there is still controversy regarding the optimal number of treatment cycles of adjuvant chemotherapy with temozolomide. A randomized, single-blind, two-arm, parallel controlled trial studied the application of extended dose (12 cycles) and conventional dose (6 cycles) of temozolomide in new high-grade gliomas, aiming to compare the survival benefit of 12 cycles of temozolomide and 6 cycles of temozolomide on new high-grade gliomas.
The trial recruited a total of 100 patients over the age of 18 with newly diagnosed high-grade gliomas. These patients all underwent maximum safe surgical resection and received concurrent chemoradiotherapy after surgery. The patients were randomly divided into two groups at a ratio of 1:1. The experimental group received 12 cycles of adjuvant temozolomide treatment, and the control group received 6 cycles of adjuvant temozolomide treatment. The endpoints of the trial were overall survival (OS) and disease-free survival (DFS).
The median follow-up time was 16.5 months, and the proportions of patients who completed 6 and 12 cycles of temozolomide were 91.3% and 55.1%, respectively.
The results of the study showed that the 12-month, 24-month, and 36-month DFS rates of the 6-cycle group were: 72.1%, 46.2%, and 39.6% respectively, while those of the 12-cycle group were: 57.7%, 34.3%, and 3 0.8%; the 12-month, 24-month, and 36-month OS rates of the 6-cycle group were: 82.6%, 55.5%, and 44.4% respectively, and the 12-cycle group were: 78.8%, 63.5%, and 54.4%.
Therefore, for new high-grade gliomas that have been safely resected to the maximum extent and received concurrent chemoradiotherapy, extending adjuvant chemotherapy with temozolomide from the original 6 cycles will not improve the patient's survival benefit.
Temozolomide metronomic therapy for the treatment of recurrent glioblastoma
A large retrospective study investigated the efficacy and safety of metronomic therapy with temozolomide in patients with recurrent glioblastoma who had received heavy treatment. A total of 120 patients were recruited to receive temozolomide (TMZ) single-agent metronomic therapy. The primary endpoints of the study are overall survival (OS), progression-free survival (PFS) and safety.
The median follow-up was 15.6 months, the median PFS was 2.6 months, and the median overall survival was 5.4 months. The most common grade 3 and 4 hematologic toxicities were lymphopenia (10%) and thrombocytopenia (3%). Grade 3 and 4 nonhematologic toxicities were uncommon.
Study results show that metronomic therapy with temozolomide is well tolerated in the treatment of recurrent glioblastoma, even in patients who have previously received heavy treatment. Patients with MGMT methylation and good ECOG PS scores are more likely to benefit from this rhythmic therapy.
The impact of the time to initiate adjuvant chemoradiotherapy on survival after surgery for glioblastoma multiforme
Maximal safe surgical resection followed by concurrent chemoradiotherapy and adjuvant chemotherapy is the current standard treatment for de novo glioblastoma. However, waiting for a period of time after surgery before adjuvant treatment can be detrimental to the patient's overall survival. And when to start concurrent chemoradiotherapy after surgery is most beneficial to patient survival is still controversial. Reviewing the existing literature, many studies have reported that starting concurrent chemoradiotherapy 4-6 weeks after surgery may be more beneficial to patients' overall survival.
Conclusion
In conclusion, temozolomide may improve the overall survival rate of elderly patients with glioblastoma. However, further randomized controlled trials are needed to confirm this finding. For new high-grade gliomas that have been maximally safely resected and received concurrent chemoradiotherapy, extending adjuvant chemotherapy with temozolomide from the original 6 cycles does not improve the patient's survival benefit. Metronomic therapy with temozolomide is well tolerated in the treatment of relapsed glioblastoma, even in patients who have received previously intensive therapy. Patients with MGMT methylation and good ECOG PS scores are more likely to benefit from this metronomic therapy.
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