Refractory anaplastic astrocytoma (WHO grade III) and Glioblastoma multiforme (WHO grade IV) are primary malignant brain tumours with poor prognosis and limited treatment options. Despite considerable genetic heterogeneity, these tumours often have impaired DNA repair systems, rendering them initially sensitive to alkylating agents, although they invariably develop resistance to these agents over time. Temozolomide is an imidazotetrazine prodrug that is stable at acidic pH but undergoes spontaneous nonenzymatic hydrolysis at neutral or slightly basic pH; these properties allow for both oral and intravenous administration. Following initial hydrolysis, further reactions liberate a highly reactive methyl diazonium cation capable of methylating various residues on adenosine and guanine bases leading to DNA lesions and eventual apoptosis. Temozomolide as an adjunct to radiotherapy followed by maintenance dosing remains the standard of care for both Glioblastoma and refractory anaplastic astrocytoma.
Temozolomide was granted FDA approval on August 11, 1999, as an oral capsule and subsequently on February 27, 2009, as an intravenous injection. It is currently marketed under the trademark TEMODAR® by Merck.
Temozolomide is indicated in adult patients for the treatment of newly diagnosed glioblastoma concomitantly with radiotherapy and for use as maintenance treatment thereafter. It is also indicated for the treatment of refractory anaplastic astrocytoma in adult patients or adjuvant therapy for adults with newly diagnosed anaplastic astrocytoma.
UniversitaetsSpital Zurich, Zürich, Switzerland
Universitaetskliniken der Uni Wien - Universitaetsklinikum Wien - AKH uniklinieken, Vienna, Austria
Assistance Publique - Hopitaux de Marseille - Hôpital de La Timone, Marseille, France
Lenox Hill Brain Tumor Center, New York, New York, United States
Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, Beijing, China
Mayo Clinic in Arizona, Scottsdale, Arizona, United States
Mayo Clinic Hospital in Arizona, Phoenix, Arizona, United States
Mayo Clinic in Rochester, Rochester, Minnesota, United States
National Institutes of Health Clinical Center, Bethesda, Maryland, United States
Memorial Sloan Kettering Cancer Center, New York, New York, United States
University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland, United States
Central Maryland Radiation Oncology in Howard County, Columbia, Maryland, United States
Maryland Proton Treatment Center, Baltimore, Maryland, United States
M D Anderson Cancer Center, Houston, Texas, United States
University of Alabama at Birmingham, Birmingham, Alabama, United States
UCLA Neuro-Oncology, Los Angeles, California, United States
Sarah Cannon Research Institute at Health One, Denver, Colorado, United States
Washington University, Saint Louis, Missouri, United States
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