Intravenous administration of temozolomide as a useful alternative over oral treatment with temozolomide capsules in patients with gliomas

Excerpt

For the last 10 years, oral anticancer agents have been increasingly administered for the treatment of various types of cancers. Of all the cancer therapies under clinical trial development, 20–25% is expected to be oral. The intravenous (IV)-oral switch and the development of oral anticancer therapies for long-term daily use will most likely continue to evolve. Oral temozolomide (TMZ) is a widely used bioactive alkylating agent that has been approved as the standard treatment for patients with high-grade gliomas (HGG). It provides 100% oral bioavailability and readily crosses the blood–brain barrier. However, patients with gliomas, as well as the elderly and children, often experience swallowing difficulties or dysphagia. These patients may have difficulties in orally ingesting the solid TMZ capsules. Some of these patients may require feeding tubes to help them maintain normal nutrition. In nursing homes or in long-term care settings, the nurses generally crush the capsules and mix them with liquids or other foods so that these patients with dysphagia can easily consume this medicine. However, the Institute for Safe Medication Practices (http://​www.​ismp.​org/​) has listed TMZ as an oral medicine that should not be crushed. This organization has specified that the TMZ capsule is designed for slow release and that opened or damaged capsules require rigorous precautions to avoid inhalation or contact with the skin or mucous membranes. The newly approved IV formulation of TMZ provides patients with an important alternative method of administration and offers flexibility in the dose regimen and a convenient alternative form of packaging. Furthermore, IV formulation of TMZ provides the same pharmaco-dynamics as oral administration if it is infused for 90 min [1]. …