Skip to main content
Erschienen in: Current Oncology Reports 4/2019

01.04.2019 | Neuro-oncology (Y Umemura, Section Editor)

Evidence-Based Practice: Temozolomide Beyond Glioblastoma

verfasst von: Jason Chua, Elizabeth Nafziger, Denise Leung

Erschienen in: Current Oncology Reports | Ausgabe 4/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Temozolomide is a first-line treatment for newly diagnosed glioblastoma. In this review, we will examine the use of temozolomide in other contexts for treating gliomas, including recurrent glioblastoma, glioblastoma in the elderly, diffuse low- and high-grade gliomas, non-diffuse gliomas, diffuse intrinsic pontine glioma (DIPG), ependymoma, pilocytic astrocytoma, and pleomorphic xanthoastrocytoma.

Recent Findings

Temozolomide improved survival in older patients with glioblastoma, anaplastic gliomas regardless of 1p/19q deletion status, and progressive ependymomas. Temozolomide afforded less toxicity and comparable efficacy to radiation in high-risk low-grade gliomas and to platinum-based chemotherapy in pediatric high-grade gliomas.

Summary

The success of temozolomide in promoting survival has expanded beyond glioblastoma to benefit patients with non-glioblastoma tumors. Identifying practical biomarkers for predicting temozolomide susceptibility, and establishing complementary agents for chemosensitizing tumors to temozolomide, will be key next steps for future success.
Literatur
1.
Zurück zum Zitat • Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J med. 2005;352:987–96. https://doi.org/10.1056/NEJMoa043330 This study demonstrated, both clinically and statistically, significant survival benefit with the addition of temozolomide to radiotherapy for glioblastoma, without significant toxicity. This has now become the standard of care following maximal safe surgical resection.CrossRefPubMed • Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J med. 2005;352:987–96. https://​doi.​org/​10.​1056/​NEJMoa043330 This study demonstrated, both clinically and statistically, significant survival benefit with the addition of temozolomide to radiotherapy for glioblastoma, without significant toxicity. This has now become the standard of care following maximal safe surgical resection.CrossRefPubMed
3.
Zurück zum Zitat Newlands ES, Stevens MF, Wedge SR, Wheelhouse RT, Brock C. Temozolomide: a review of its discovery, chemical properties, pre-clinical development and clinical trials. Cancer Treat Rev. 1997;23:35–61.CrossRef Newlands ES, Stevens MF, Wedge SR, Wheelhouse RT, Brock C. Temozolomide: a review of its discovery, chemical properties, pre-clinical development and clinical trials. Cancer Treat Rev. 1997;23:35–61.CrossRef
4.
Zurück zum Zitat Agarwala SS, Kirkwood JM. Temozolomide, a novel alkylating agent with activity in the central nervous system, may improve the treatment of advanced metastatic melanoma. Oncologist. 2000;5:144–51.CrossRef Agarwala SS, Kirkwood JM. Temozolomide, a novel alkylating agent with activity in the central nervous system, may improve the treatment of advanced metastatic melanoma. Oncologist. 2000;5:144–51.CrossRef
5.
Zurück zum Zitat Brindley CJ, Antoniw P, Newlands ES. Plasma and tissue disposition of mitozolomide in mice. Br J Cancer. 1986;53:91–7.CrossRef Brindley CJ, Antoniw P, Newlands ES. Plasma and tissue disposition of mitozolomide in mice. Br J Cancer. 1986;53:91–7.CrossRef
14.
Zurück zum Zitat • Weller M, Tabatabai G, Kastner B, Felsberg J, Steinbach JP, Wick A, et al. MGMT promoter methylation is a strong prognostic biomarker for benefit from dose-intensified temozolomide rechallenge in progressive glioblastoma: the DIRECTOR trial. Clin Cancer Res. 2015;21:2057–64. https://doi.org/10.1158/1078-0432.Ccr-14-2737 This study aimed to identify how dose-intense regimens of temozolomide may be beneficial in treatment of recurrent glioblastoma. There was no major difference in efficacy between one week on/one week off temozolomide compared with three weeks on/one week off. It did, however, indicate that temozolomide rechallenge should not be considered for patients with an unmethylated MGMT promoter status, although it is a viable option for methylated-MGMT tumors, as the median time to treatment failure, progression-free survival, and overall survival were longer versus unmethylated tumors.CrossRefPubMed • Weller M, Tabatabai G, Kastner B, Felsberg J, Steinbach JP, Wick A, et al. MGMT promoter methylation is a strong prognostic biomarker for benefit from dose-intensified temozolomide rechallenge in progressive glioblastoma: the DIRECTOR trial. Clin Cancer Res. 2015;21:2057–64. https://​doi.​org/​10.​1158/​1078-0432.​Ccr-14-2737 This study aimed to identify how dose-intense regimens of temozolomide may be beneficial in treatment of recurrent glioblastoma. There was no major difference in efficacy between one week on/one week off temozolomide compared with three weeks on/one week off. It did, however, indicate that temozolomide rechallenge should not be considered for patients with an unmethylated MGMT promoter status, although it is a viable option for methylated-MGMT tumors, as the median time to treatment failure, progression-free survival, and overall survival were longer versus unmethylated tumors.CrossRefPubMed
22.
Zurück zum Zitat • Perry JR, Laperriere N, O'Callaghan CJ, Brandes AA, Menten J, Phillips C, et al. Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma. N Engl J Med. 2017;376:1027–37. https://doi.org/10.1056/NEJMoa1611977 Since previous trials implementing Stupp protocol largely excluded patients > 70 years of age, there were few data about the benefit of temozolomide for older patients with glioblastoma. This study was notable for showing that addition of temozolomide does provide survival benefit in elderly patients, even if overall prognosis is poorer compared to younger patients.CrossRefPubMed • Perry JR, Laperriere N, O'Callaghan CJ, Brandes AA, Menten J, Phillips C, et al. Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma. N Engl J Med. 2017;376:1027–37. https://​doi.​org/​10.​1056/​NEJMoa1611977 Since previous trials implementing Stupp protocol largely excluded patients > 70 years of age, there were few data about the benefit of temozolomide for older patients with glioblastoma. This study was notable for showing that addition of temozolomide does provide survival benefit in elderly patients, even if overall prognosis is poorer compared to younger patients.CrossRefPubMed
23.
Zurück zum Zitat Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016(131):803–20. https://doi.org/10.1007/s00401-016-1545-1. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016(131):803–20. https://​doi.​org/​10.​1007/​s00401-016-1545-1.
28.
Zurück zum Zitat Nabors LB, Portnow J, Ammirati M, Baehring J, Brem H, Butowski N, Fenstermaker RA, Forsyth P, Hattangadi-Gluth J, Holdhoff M, Howard S, Junck L, Kaley T, Kumthekar P, Loeffler JS, Moots PL, Mrugala MM, Nagpal S, Pandey M, Parney I, Peters K, Puduvalli VK, Ragsdale J 3rd, Rockhill J, Rogers L, Rusthoven C, Shonka N, Shrieve DC, Sills AK Jr, Swinnen LJ, Tsien C, Weiss S, Wen PY, Willmarth N, Bergman MA, Engh A. NCCN Clinical Practice Guidelines in Oncology. Central Nervous System Cancers (Version I.2018). Accessed November 1, 2018. Nabors LB, Portnow J, Ammirati M, Baehring J, Brem H, Butowski N, Fenstermaker RA, Forsyth P, Hattangadi-Gluth J, Holdhoff M, Howard S, Junck L, Kaley T, Kumthekar P, Loeffler JS, Moots PL, Mrugala MM, Nagpal S, Pandey M, Parney I, Peters K, Puduvalli VK, Ragsdale J 3rd, Rockhill J, Rogers L, Rusthoven C, Shonka N, Shrieve DC, Sills AK Jr, Swinnen LJ, Tsien C, Weiss S, Wen PY, Willmarth N, Bergman MA, Engh A. NCCN Clinical Practice Guidelines in Oncology. Central Nervous System Cancers (Version I.2018). Accessed November 1, 2018.
30.
Zurück zum Zitat • Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, et al. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033–26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016;17:1521–32. https://doi.org/10.1016/s1470-2045(16)30313-8 This was the first study to randomly assign patients with low-grade glioma and at least one high-risk feature to radiotherapy alone or temozolomide chemotherapy alone. Although there was no improvement in progression-free survival with chemotherapy alone, temozolomide may prevent or delay patients from the side effects of radiation by using a similarly effective therapy. Subgroup analysis suggested that IDH mutant, non-co-deleted tumors treated with radiotherapy had a longer progression-free survival than those treated with temozolomide (such that temozolomide treatment alone might be deleterious).CrossRefPubMedPubMedCentral • Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, et al. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033–26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol. 2016;17:1521–32. https://​doi.​org/​10.​1016/​s1470-2045(16)30313-8 This was the first study to randomly assign patients with low-grade glioma and at least one high-risk feature to radiotherapy alone or temozolomide chemotherapy alone. Although there was no improvement in progression-free survival with chemotherapy alone, temozolomide may prevent or delay patients from the side effects of radiation by using a similarly effective therapy. Subgroup analysis suggested that IDH mutant, non-co-deleted tumors treated with radiotherapy had a longer progression-free survival than those treated with temozolomide (such that temozolomide treatment alone might be deleterious).CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Fisher B, Zhang P, Macdonald D, Chakravarti A, Lesser G, Fox S, et al. ACTR-2. NRG Oncology/RTOG 0424: Long term results of a phase II study of temozolomide-based chemoradiotherapy regimen for high risk low-grade gliomas. Neuro-Oncology. 2018;20. https://doi.org/10.1093/neuonc/noy148.039. Fisher B, Zhang P, Macdonald D, Chakravarti A, Lesser G, Fox S, et al. ACTR-2. NRG Oncology/RTOG 0424: Long term results of a phase II study of temozolomide-based chemoradiotherapy regimen for high risk low-grade gliomas. Neuro-Oncology. 2018;20. https://​doi.​org/​10.​1093/​neuonc/​noy148.​039.
33.
Zurück zum Zitat • Bell EH, Zhang P, Fisher BJ, Macdonald DR, McElroy JP, Lesser GJ, et al. Association of MGMT promoter methylation status with survival outcomes in patients with high-risk glioma treated with radiotherapy and temozolomide: an analysis from the NRG oncology/RTOG 0424 trial. JAMA Oncol. 2018;4:1405–9. https://doi.org/10.1001/jamaoncol.2018.1977 This was the first study to demonstrate MGMT methylation as an independent prognostic factor in low-grade glioma treated with temozolomide and radiotherapy.CrossRefPubMed • Bell EH, Zhang P, Fisher BJ, Macdonald DR, McElroy JP, Lesser GJ, et al. Association of MGMT promoter methylation status with survival outcomes in patients with high-risk glioma treated with radiotherapy and temozolomide: an analysis from the NRG oncology/RTOG 0424 trial. JAMA Oncol. 2018;4:1405–9. https://​doi.​org/​10.​1001/​jamaoncol.​2018.​1977 This was the first study to demonstrate MGMT methylation as an independent prognostic factor in low-grade glioma treated with temozolomide and radiotherapy.CrossRefPubMed
35.
Zurück zum Zitat • Izquierdo C, Alentorn A, Idbaih A, Simo M, Kaloshi G, Ricard D, et al. Long-term impact of temozolomide on 1p/19q-codeleted low-grade glioma growth kinetics. J Neurooncol. 2018;136:533–9. https://doi.org/10.1007/s11060-017-2677-4 This group examined the growth kinetics of co-deleted low-grade gliomas who were treated with upfront temozolomide, finding that most tumors resumed their growth within 3 years of treatment. They argued that volumetric analysis to identify early tumor progression can prevent unnecessary exposure to temozolomide, which could put patients at risk for malignant progression (based on mutational analyses proposed that TMZ exposure can lead to acquisition of a hypermutation, leading to progression). CrossRefPubMed • Izquierdo C, Alentorn A, Idbaih A, Simo M, Kaloshi G, Ricard D, et al. Long-term impact of temozolomide on 1p/19q-codeleted low-grade glioma growth kinetics. J Neurooncol. 2018;136:533–9. https://​doi.​org/​10.​1007/​s11060-017-2677-4 This group examined the growth kinetics of co-deleted low-grade gliomas who were treated with upfront temozolomide, finding that most tumors resumed their growth within 3 years of treatment. They argued that volumetric analysis to identify early tumor progression can prevent unnecessary exposure to temozolomide, which could put patients at risk for malignant progression (based on mutational analyses proposed that TMZ exposure can lead to acquisition of a hypermutation, leading to progression). CrossRefPubMed
36.
Zurück zum Zitat • van den Bent MJ, Baumert B, Erridge SC, Vogelbaum MA, Nowak AK, Sanson M, et al. Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study. Lancet. 2017;390:1645–53. https://doi.org/10.1016/s0140-6736(17)31442-3 Before this trial, there had not been a well-designed study supporting adjuvant temozolomide for grade II and III gliomas. This study demonstrated that the less-chemosensitive 1p/19q non-co-deleted anaplastic gliomas still derived benefit from temozolomide therapy. It showed prolonged overall survival with 12 cycles of adjuvant temozolomide in addition to radiotherapy. The role of concurrent temozolomide therapy is not yet established. CrossRefPubMedPubMedCentral • van den Bent MJ, Baumert B, Erridge SC, Vogelbaum MA, Nowak AK, Sanson M, et al. Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study. Lancet. 2017;390:1645–53. https://​doi.​org/​10.​1016/​s0140-6736(17)31442-3 Before this trial, there had not been a well-designed study supporting adjuvant temozolomide for grade II and III gliomas. This study demonstrated that the less-chemosensitive 1p/19q non-co-deleted anaplastic gliomas still derived benefit from temozolomide therapy. It showed prolonged overall survival with 12 cycles of adjuvant temozolomide in addition to radiotherapy. The role of concurrent temozolomide therapy is not yet established. CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat van Zanten SEM V, Lane A, Heymans MW, Baugh J, Chaney B, Hoffman LM, et al. External validation of the diffuse intrinsic pontine glioma survival prediction model: a collaborative report from the international DIPG registry and the SIOPE DIPG registry. J Neurooncol. 2017;134:231–40. https://doi.org/10.1007/s11060-017-2514-9.CrossRef van Zanten SEM V, Lane A, Heymans MW, Baugh J, Chaney B, Hoffman LM, et al. External validation of the diffuse intrinsic pontine glioma survival prediction model: a collaborative report from the international DIPG registry and the SIOPE DIPG registry. J Neurooncol. 2017;134:231–40. https://​doi.​org/​10.​1007/​s11060-017-2514-9.CrossRef
45.
Zurück zum Zitat • Seidel C, von Bueren AO, Bojko S, Hoffmann M, Pietsch T, Gielen GH, et al. Concurrent radiotherapy with temozolomide vs. concurrent radiotherapy with a cisplatinum-based polychemotherapy regimen: acute toxicity in pediatric high-grade glioma patients. Strahlenther Onkol. 2018:194:215–224. Doi:https://doi.org/10.1007/s00066-017-1218-6. This study identified that cisplatin-based chemotherapy demonstrated increased toxicity (mostly hematologic), with more interruptions of treatment, in comparison with temozolomide in pediatric high-grade gliomas. While the efficacy of chemotherapies for pediatric high-grade glioma are similar (and poor), the authors argued for temozolomide use with radiotherapy because of relatively lower toxicity. • Seidel C, von Bueren AO, Bojko S, Hoffmann M, Pietsch T, Gielen GH, et al. Concurrent radiotherapy with temozolomide vs. concurrent radiotherapy with a cisplatinum-based polychemotherapy regimen: acute toxicity in pediatric high-grade glioma patients. Strahlenther Onkol. 2018:194:215–224. Doi:https://​doi.​org/​10.​1007/​s00066-017-1218-6. This study identified that cisplatin-based chemotherapy demonstrated increased toxicity (mostly hematologic), with more interruptions of treatment, in comparison with temozolomide in pediatric high-grade gliomas. While the efficacy of chemotherapies for pediatric high-grade glioma are similar (and poor), the authors argued for temozolomide use with radiotherapy because of relatively lower toxicity.
46.
Zurück zum Zitat • Flannery PC, JA DS, Amani V, Venkataraman S, Lemma RT, Prince EW, et al. Preclinical analysis of MTOR complex 1/2 inhibition in diffuse intrinsic pontine glioma. Oncol Rep. 2018;39:455–64. https://doi.org/10.3892/or.2017.6122 AZD2014 is a MTOR complex 1 and 2 inhibitor that was studied in three patient-derived DIPG cell lines. Its use potentiated greatly increased antitumor efficacy, via increased inhibition of cell self-renewal. It also demonstrated a synergistic relationship with dose-dependent radiotherapy, and also with other chemotherapies.CrossRefPubMed • Flannery PC, JA DS, Amani V, Venkataraman S, Lemma RT, Prince EW, et al. Preclinical analysis of MTOR complex 1/2 inhibition in diffuse intrinsic pontine glioma. Oncol Rep. 2018;39:455–64. https://​doi.​org/​10.​3892/​or.​2017.​6122 AZD2014 is a MTOR complex 1 and 2 inhibitor that was studied in three patient-derived DIPG cell lines. Its use potentiated greatly increased antitumor efficacy, via increased inhibition of cell self-renewal. It also demonstrated a synergistic relationship with dose-dependent radiotherapy, and also with other chemotherapies.CrossRefPubMed
54.
Zurück zum Zitat Freyschlag CF, Tuettenberg J, Lohr F, Thome C, Schmieder K, Seiz M. Response to temozolomide in supratentorial multifocal recurrence of malignant ependymoma. Anticancer Res. 2011;31:1023–5.PubMed Freyschlag CF, Tuettenberg J, Lohr F, Thome C, Schmieder K, Seiz M. Response to temozolomide in supratentorial multifocal recurrence of malignant ependymoma. Anticancer Res. 2011;31:1023–5.PubMed
56.
Zurück zum Zitat • Ruda R, Bosa C, Magistrello M, Franchino F, Pellerino A, Fiano V, et al. Temozolomide as salvage treatment for recurrent intracranial ependymomas of the adult: a retrospective study. Neuro Oncol. 2016;18:261–8. https://doi.org/10.1093/neuonc/nov167 Before this study, there were few data to guide the addition of further chemotherapy to recurrent or progressive ependymomas despite initial resection and radiation. Although the efficacy of temozolomide among these select patients was variable, favorable results in chemotherapy-naïve patients suggested a role for temozolomide after failure of first-line treatments. Intriguingly, these benefits occurred independent of MGMT methylation status.CrossRefPubMed • Ruda R, Bosa C, Magistrello M, Franchino F, Pellerino A, Fiano V, et al. Temozolomide as salvage treatment for recurrent intracranial ependymomas of the adult: a retrospective study. Neuro Oncol. 2016;18:261–8. https://​doi.​org/​10.​1093/​neuonc/​nov167 Before this study, there were few data to guide the addition of further chemotherapy to recurrent or progressive ependymomas despite initial resection and radiation. Although the efficacy of temozolomide among these select patients was variable, favorable results in chemotherapy-naïve patients suggested a role for temozolomide after failure of first-line treatments. Intriguingly, these benefits occurred independent of MGMT methylation status.CrossRefPubMed
65.
66.
Metadaten
Titel
Evidence-Based Practice: Temozolomide Beyond Glioblastoma
verfasst von
Jason Chua
Elizabeth Nafziger
Denise Leung
Publikationsdatum
01.04.2019
Verlag
Springer US
Erschienen in
Current Oncology Reports / Ausgabe 4/2019
Print ISSN: 1523-3790
Elektronische ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-019-0783-5

Weitere Artikel der Ausgabe 4/2019

Current Oncology Reports 4/2019 Zur Ausgabe

Genitourinary Cancers (DP Petrylak and JW Kim, Section Editors)

Novel Imaging in Detection of Metastatic Prostate Cancer

Integrative Care (C Lammersfeld, Section Editor)

Cancer Biomarkers for Integrative Oncology

Genitourinary Cancers (DP Petrylak and JW Kim, Section Editors)

Current Status and Future Directions of Immunotherapy in Renal Cell Carcinoma

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

29.05.2024 Larynxkarzinom Nachrichten

Fast ein Viertel der Personen mit mäßig dysplastischen Stimmlippenläsionen entwickelt einen Kehlkopftumor. Solche Personen benötigen daher eine besonders enge ärztliche Überwachung.

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

28.05.2024 Nebenwirkungen der Krebstherapie Nachrichten

Kardiotoxische Nebenwirkungen einer Therapie mit Immuncheckpointhemmern mögen selten sein – wenn sie aber auftreten, wird es für Patienten oft lebensgefährlich. Voruntersuchung und Monitoring sind daher obligat.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.