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The only chemotherapy proven to extend life in glioblastoma, given during and after radiation. It works best when the tumour has switched off a repair gene called MGMT.
Stupp/EORTC 26981-NCIC (2005): adding concurrent and adjuvant temozolomide to radiotherapy raised median OS from 12.1 to 14.6 months and 2-year survival from 10% to 27%. Benefit concentrates in MGMT-promoter-methylated tumours (median OS ~23 months vs ~13 months unmethylated). Also standard with radiotherapy in grade 3 astrocytoma (CATNON) and, with PCV as an alternative, in oligodendroglioma. Oral, well tolerated; lymphopenia and hypermutation at recurrence are the costs.
Prodrug of MTIC; methylates O6-guanine; cytotoxicity depends on unrepaired lesions when MGMT is silenced.
1.Temozolomide slips into a pocket on its target.
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Adults with refractory anaplastic astrocytoma
Accelerated approval on a surrogate endpoint, with a confirmatory trial required.
Adults with refractory anaplastic astrocytoma
Confirmed: the accelerated approval of 1999 converted to traditional approval 5.6 years after it was granted.
| Region | Year | Indication |
|---|---|---|
| US | 1999 | Refractory anaplastic astrocytoma |
| US | 2005 | Newly diagnosed glioblastoma with radiotherapy |
| EU | 1999 | Temodal; malignant glioma (recurrent 1999; newly diagnosed glioblastoma with radiotherapy 2005); 26 Jan 1999 |
Read for the class this product belongs to (other alkylating drugs) unless the answer names the product. Population figures from the cohorts named, not a prediction for one person. Blank where no source gives a recovery figure.
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Confirms irinotecan-temozolomide-dinutuximab as the reference salvage regimen and motivated frontline chemo-immunotherapy trials (ANBL17P1, ANBL1531).
This is what legitimate repurposing looks like: a registered dose-finding trial that reports its toxicities. It says nothing yet about whether mebendazole helps glioblastoma.
Chemo-immunotherapy with dinutuximab became the salvage standard for relapsed neuroblastoma and the regimen to move into first-line induction.
Radiotherapy followed by a year of temozolomide is the standard for grade 3 IDH-mutant astrocytoma; concurrent temozolomide is not needed, and IDH-wild-type tumours behave and are treated like glioblastoma.
Adjuvant temozolomide-cisplatin is used in China for resected mucosal melanoma; elsewhere anti-PD-1 therapy is extrapolated from cutaneous disease, and the two have since been compared directly.
With the Nordic trial, NOA-08 made MGMT testing the way to choose between temozolomide alone and radiotherapy alone for older patients with glioblastoma who are not offered combined treatment.
Query for this drug: (TITLE:"Temozolomide" OR ABSTRACT:"Temozolomide" OR TITLE:"Temodar" OR ABSTRACT:"Temodar") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Temozolomide, not a curated reading list.
Shares Michael Weller, Reverse swing-M, phase 1 study of repurposing mebendazole in recurrent high-grade glioma, CODEL, GBM AGILE.
Shares CheckMate 498, CheckMate 548, A skull ultrasound implant that opens the barrier at every cycle, The blood-brain barrier & brain metastasis.
Shares A skull ultrasound implant that opens the barrier at every cycle, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Transcranial focused ultrasound systems (Exablate Neuro, SonoCloud), The blood-brain barrier & brain metastasis.
Shares 1p/19q codeletion, 1p/19q codeletion, Glioma (KEGG map), Oligodendroglioma, IDH-mutant and 1p/19q-codeleted.