Temozolomide and its role in the treatment of malignant gliomas

Abstract

Malignant gliomas include glioblastomas, which are most common, anaplastic astrocytomas, anaplastic oligodendrogliomas and anaplastic oligoastrocytomas. According to their biological features, they are a heterogeneous group of tumours and some of them can be considered as rare tumours. Standard therapeutic modalities in the treatment of malignant gliomas are operation, radiotherapy and chemotherapy but, unfortunately, results are still poor and unsatisfactory. There is no complete response or longterm remission. Standard treatment of malignant gliomas is maximal surgical reduction of tumour volume since direct impact on survival has been demonstrated. Radiotherapy is used postoperatively. Since 2005, temozolomide has been registered as a standard drug in the treatment of malignant gliomas. It is an oral alkylating cytostatic drug that results in a statistically significantly better survival when used concomitantly with radiotherapy and thereafter as consolidation therapy in glioblastoma patients. In Croatia, temozolomide is on the Croatian Institute of Health Insurance list of so-called “expensive drugs”. Its use has to be approved by an expert committee on the basis of medical history and oncologist’s written application. If we consider the use of temozolomide in other malignant glial tumours, there are differences between the USA and the European Union countries. According to the Croatian Institute of Health Insurance guidelines, temozolomide can only be used in glioblastoma patients with performance status ECOG 0-1 and normal standard laboratory values. Considering the heterogeneity of malignant gliomas and differences in temozolomide use between countries, the purpose of our presentation is to demonstrate the specificities of its application.