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Pronunciation
(te moe ZOE loe mide)
Generic Available (U.S.)
No
Index Terms
U.S. Brand Names
Canadian Brand Names
Pharmacologic Category
Use: Labeled Indications
Treatment of newly-diagnosed glioblastoma multiforme (initially in combination with radiotherapy, then as maintenance treatment); treatment of refractory anaplastic astrocytoma
Canadian labeling (not an approved indication in the U.S.): Treatment of recurrent or progressive glioblastoma multiforme
Use: Unlabeled/Investigational
Treatment of recurrent glioblastoma multiforme, low-grade astrocytoma, low-grade oligodendroglioma, anaplastic oligodendroglioma, metastatic CNS lesions, refractory primary CNS lymphoma, advanced or metastatic melanoma, cutaneous T-cell lymphomas (mycosis fungoides [MF] and Sézary syndrome [SS]), advanced neuroendocrine tumors (carcinoid or islet cell), Ewing's sarcoma (recurrent or progressive), soft tissue sarcomas (extremity/retroperitoneal/intra-abdominal or hemangiopericytoma/solitary fibrous tumor), treatment of pediatric neuroblastoma
Pregnancy Risk Factor
D
Pregnancy Considerations
May cause fetal harm when administered to pregnant women. Animal studies, at doses less than used in humans, resulted in numerous birth defects. Testicular toxicity was demonstrated in animal studies using smaller doses than recommended for cancer treatment. There are no adequate and well-controlled studies in pregnant women. Male and female patients should avoid pregnancy while receiving drug.
Lactation
Excretion in breast milk unknown/not recommended
Breast-Feeding Considerations
Due to the potential for serious adverse reactions in the nursing infant, breast-feeding is not recommended.
Contraindications
Hypersensitivity (eg, allergic reaction, anaphylaxis, urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis) to temozolomide or any component of the formulation; hypersensitivity to dacarbazine (both drugs are metabolized to MTIC)
Canadian labeling: Additional contraindications (not in U.S. labeling): Not recommended in patients with severe myelosuppression
Warnings/Precautions
Special handling:
• Hazardous agent: Use appropriate precautions for handling and disposal.
Concerns related to adverse effects:
• Myelosuppression: May occur with use; an increased incidence has been reported in geriatric and female patients. Prolonged pancytopenia resulting in aplastic anemia has been reported; concurrent use of temozolomide with medications associated with aplastic anemia (eg, carbamazepine, co-trimoxazole, phenytoin) may obscure assessment for development of aplastic anemia.
• Pneumonia: Pneumocystis jiroveci pneumonia (PCP) may occur; risk is increased in those receiving steroids or longer dosing regimens; PCP prophylaxis is required in patients receiving radiotherapy in combination with the 42-day temozolomide regimen.
• Secondary malignancies: Rare cases of myelodysplastic syndrome and secondary malignancies, including myeloid leukemia have been reported.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with severe hepatic impairment.
• Renal impairment: Use with caution in patients with severe renal impairment; has not been studied in dialysis patients.
Other warnings/precautions:
• Temozolomide resistance: Increased MGMT (O-6-methylguanine-DNA methyltransferase) activity/levels within tumor tissue is associated with temozolomide resistance. Glioblastoma patients with decreased levels (due to methylated MGMT promoter) may be more likely to benefit from the combination of radiation therapy and temozolomide (Hegi, 2008; Stupp, 2009). Determination of MGMT status may be predictive for response to alkylating agents.
Adverse Reactions
Note: With CNS malignancies, it may be difficult to distinguish between CNS adverse events caused by temozolomide versus the effects of progressive disease.
>10%:
Cardiovascular: Peripheral edema (11%)
Central nervous system: Fatigue (34% to 61%), headache (23% to 41%), seizure (6% to 23%), hemiparesis (18%), fever (13%), dizziness (5% to 12%), coordination abnormality (11%)
Dermatologic: Alopecia (55%), rash (8% to 13%)
Gastrointestinal: Nausea (49% to 53%; grades 3/4: 1% to 10%), vomiting (29% to 42%; grades 3/4: 2% to 6%), constipation (22% to 33%), anorexia (9% to 27%), diarrhea (10% to 16%)
Hematologic: Lymphopenia (grades 3/4: 55%), thrombocytopenia (grades 3/4: adults: 4% to 19%; children: 25%), neutropenia (grades 3/4: adults: 8% to 14%; children: 20%), leukopenia (grades 3/4: 11%)
Neuromuscular & skeletal: Weakness (7% to 13%)
Miscellaneous: Viral infection (11%)
1% to 10%:
Central nervous system: Amnesia (10%), insomnia (4% to 10%), somnolence (9%), ataxia (8%), paresis (8%), anxiety (7%), memory impairment (7%), depression (6%), confusion (5%)
Dermatologic: Pruritus (5% to 8%), dry skin (5%), radiation injury (2% maintenance phase after radiotherapy), erythema (1%)
Endocrine & metabolic: Hypercorticism (8%), breast pain (females 6%)
Gastrointestinal: Stomatitis (9%), abdominal pain (5% to 9%), dysphagia (7%), taste perversion (5%), weight gain (5%)
Genitourinary: Incontinence (8%), urinary tract infection (8%), urinary frequency (6%)
Hematologic: Anemia (grades 3/4: 4%)
Neuromuscular & skeletal: Paresthesia (9%), back pain (8%), abnormal gait (6%), arthralgia (6%), myalgia (5%)
Ocular: Blurred vision (5% to 8%), diplopia (5%), vision abnormality (visual deficit/vision changes 5%)
Respiratory: Pharyngitis (8%), upper respiratory tract infection (8%), cough (5% to 8%), sinusitis (6%), dyspnea (5%)
Miscellaneous: Allergic reaction (≤3%)
<1%, postmarketing, and/or case reports (limited to important or life-threatening): Agitation, alkaline phosphatase increased, alveolitis, anaphylaxis, apathy, aplastic anemia, cholestasis, emotional lability, erythema multiforme, febrile neutropenia, flu-like syndrome, hallucination, hematoma, hemorrhage, hepatitis, hepatotoxicity, herpes simplex, herpes zoster, hyperbilirubinemia, hyperglycemia, hypokalemia, injection site reactions (erythema, irritation, pain, pruritus, swelling, warmth), interstitial pneumonia/pneumonitis, myelodysplastic syndrome, neuropathy, opportunistic infection (eg, PCP), oral candidiasis, pancytopenia (may be prolonged), peripheral neuropathy, petechiae, pneumonitis, pulmonary fibrosis, secondary malignancies (including myeloid leukemia), Stevens-Johnson syndrome, toxic epidermal necrolysis, transaminases increased, weight loss
Drug Interactions
BCG: Immunosuppressants may diminish the therapeutic effect of BCG. Risk X: Avoid combination
Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Risk C: Monitor therapy
Divalproex: May enhance the adverse/toxic effect of Temozolomide. Divalproex may increase the serum concentration of Temozolomide. Risk C: Monitor therapy
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Risk D: Consider therapy modification
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination
Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination
Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Risk X: Avoid combination
Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Risk C: Monitor therapy
Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Risk C: Monitor therapy
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Vaccinial infections may develop. Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Risk X: Avoid combination
Valproic Acid: May enhance the adverse/toxic effect of Temozolomide. Valproic Acid may increase the serum concentration of Temozolomide. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Food: Food reduces rate and extent of absorption.
Storage
Injection: Store intact vials refrigerated at 2°C to 8°C (36°F to 46°F). Reconstituted vials may be stored for up to 14 hours at room temperature of 25°C (77°F); infusion must be completed within 14 hours of reconstitution.
Capsule: Store at room temperature of 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).
Reconstitution
Bring to room temperature prior to reconstitution. Reconstitute each 100 mg vial with 41 mL sterile water for injection to a final concentration of 2.5 mg/mL. Swirl gently; do not shake. Place dose without further dilution into a 250 mL empty sterile infusion bag. Infusion must be completed within 14 hours of reconstitution. Use appropriate precautions for handling and disposal.
Compatibility
Y-site administration: Compatible: Normal saline
Mechanism of Action
Like dacarbazine, temozolomide (a prodrug) is rapidly and nonenzymatically converted to the active alkylating metabolite MTIC [(methyl-triazene-1-yl)-imidazole-4-carboxamide]. Unlike dacarbazine, however, this conversion is spontaneous, nonenzymatic, and occurs under physiologic conditions in all tissues to which it distributes. The cytotoxic effects of MTIC are manifested through alkylation of DNA at the O6, N7 guanine positions.
Pharmacodynamics/Kinetics
Absorption: Oral: Rapid and complete
Distribution: Vd: Parent drug: 0.4 L/kg; penetrates blood brain barrier; CSF levels are ~35% to 39% of plasma levels
Protein binding: 15%
Metabolism: Prodrug, hydrolyzed to the active form, MTIC; MTIC is eventually eliminated as CO2 and 5-aminoimidazole-4-carboxamide (AIC), a natural constituent in urine; CYP isoenzymes play only a minor role in metabolism (of temozolomide and MTIC)
Bioavailability: Oral: 100% (on a mg-per-mg basis, I.V. temozolomide, infused over 90 minutes, is bioequivalent to an oral dose)
Half-life elimination: Mean: Parent drug: 1.8 hours
Time to peak: Oral: Empty stomach: 1 hour; with food (high-fat meal): 2.25 hours
Excretion: Urine (~38%; parent drug 6%); feces <1%
Dosage
Children:
Ewing's sarcoma, recurrent or progressive (unlabeled use): Oral: Refer to adult dosing.
Neuroblastoma, relapsed or refractory (unlabeled use): Oral: 100 mg/m2/dose days 1-5 days every 21 days (in combination with irinotecan) for up to 6 cycles (Bagatell, 2011)
Adults:
Anaplastic astrocytoma (refractory): Oral, I.V.: Initial dose: 150 mg/m2/day for 5 days; repeat every 28 days. Subsequent doses of 100-200 mg/m2/day for 5 days per treatment cycle; based upon hematologic tolerance.
Dosage modification for toxicity:
ANC <1000/mm3 or platelets <50,000/mm3 on day 22 or day 29 (day 1 of next cycle): Postpone therapy until ANC >1500/mm3 and platelets >100,000/mm3; reduce dose by 50 mg/m2/day for subsequent cycle
ANC 1000-1500/mm3 or platelets 50,000-100,000/mm3 on day 22 or day 29 (day 1 of next cycle): Postpone therapy until ANC >1500/mm3 and platelets >100,000/mm3; maintain initial dose
ANC ≥1500/mm3 and platelets ≥100,000/mm3 on day 22 or day 29 (day 1 of next cycle): Increase dose to or maintain dose at 200 mg/m2/day for 5 days for subsequent cycle
Glioblastoma multiforme (newly diagnosed, high-grade glioma): Oral, I.V.:
Concomitant phase: 75 mg/m2/day for 42 days with focal radiotherapy (60Gy administered in 30 fractions). Note: PCP prophylaxis is required during concomitant phase and should continue in patients who develop lymphocytopenia until lymphocyte recovery to ≤ grade 1. Obtain weekly CBC.
Continue at 75 mg/m2/day throughout the 42-day concomitant phase (up to 49 days) as long as ANC ≥1500/mm3, platelet count ≥100,000/mm3, and nonhematologic toxicity ≤ grade 1 (excludes alopecia, nausea/vomiting)
Dosage modification for toxicity:
ANC ≥500/mm3 but <1500/mm3 or platelet count ≥10,000/mm3 but <100,000/mm3 or grade 2 nonhematologic toxicity (excludes alopecia, nausea/vomiting): Interrupt therapy
ANC <500/mm3 or platelet count <10,000/mm3 or grade 3/4 nonhematologic toxicity (excludes alopecia, nausea/vomiting): Discontinue therapy
Maintenance phase (consists of 6 treatment cycles): Begin 4 weeks after concomitant phase completion. Note: Each subsequent cycle is 28 days (consisting of 5 days of drug treatment followed by 23 days without treatment). Draw CBC within 48 hours of day 22; hold next cycle and do weekly CBC until ANC >1500/mm3 and platelet count >100,000/mm3; dosing modification should be based on lowest blood counts and worst nonhematologic toxicity during the previous cycle.
Cycle 1: 150 mg/m2/day for 5 days; repeat every 28 days
Cycles 2-6: May increase to 200 mg/m2/day for 5 days every 28 days (if ANC ≥1500/mm3, platelets ≥100,000/mm3 and nonhematologic toxicities for cycle 1 are ≤ grade 2 [excludes alopecia, nausea/vomiting]); Note: If dose was not escalated at the onset of cycle 2, do not increase for cycles 3-6)
Dosage modification (during maintenance phase) for toxicity:
ANC <1000/mm3, platelet count <50,000/mm3, or grade 3 nonhematologic toxicity (excludes for alopecia, nausea/vomiting) during previous cycle: Decrease dose by 1 dose level (by 50 mg/m2/day for 5 days), unless dose has already been lowered to 100 mg/m2/day, then discontinue therapy.
If dose reduction <100 mg/m2/day is required or grade 4 nonhematologic toxicity (excludes for alopecia, nausea/vomiting), or if the same grade 3 nonhematologic toxicity occurs after dose reduction: Discontinue therapy
Glioblastoma multiforme (recurrent glioma): Canadian labeling (unlabeled use in the U.S.): 200 mg/m2/day for 5 days every 28 days; if previously treated with chemotherapy, initiate at 150 mg/m2/day for 5 days every 28 days and increase to 200 mg/m2/day for 5 days every 28 days with cycle 2 if no hematologic toxicity (Brada, 2001; Yung, 2000)
Ewing's sarcoma, recurrent or progressive (unlabeled use): Oral: 100 mg/m2/dose days 1-5 every 21 days (in combination with irinotecan) (Casey, 2009)
Melanoma, advanced or metastatic (unlabeled use): Oral: 200 mg/m2/day for 5 days every 28 days (for up to 12 cycles). For subsequent cycles reduce dose to 75% of the original dose for grade 3/4 hematologic toxicity and reduce the dose to 50% of the original dose for grade 3/4 nonhematologic toxicity (Middleton, 2000).
Neuroendocrine tumors, advanced (unlabeled use): Oral: 150 mg/m2/day for 7 days every 14 days in combination with thalidomide (Kulke, 2006)
Primary CNS lymphoma, refractory (unlabeled use): Oral: 150 mg/m2/day for 5 days every 28 days, initially in combination with rituximab, followed by temozolomide monotherapy: 150 mg/m2/day for 5 days every 28 days (Wong, 2004) or 150 mg/m2/day for 7 days every 14 days, initially in combination with rituximab, followed by temozolomide monotherapy: 150 mg/m2/day for 5 days every 28 days (Enting, 2004)
Soft tissue sarcoma (unlabeled use): Oral: 75 mg/m2/day for 6 weeks (Garcia del Muro, 2005)
Elderly: Refer to adult dosing. Note: Patients ≥70 years of age in the anaplastic astrocytoma study had a higher incidence of grade 4 neutropenia and thrombocytopenia in the first cycle of therapy than patients <70 years of age.
Dosage adjustment in renal impairment: Oral:
Clcr ≥36 mL/minute/m2: No effect on temozolomide clearance was demonstrated.
Severe renal impairment (Clcr <36 mL/minute/m2): Use with caution.
Dialysis patients: Use has not been studied
Dosage adjustment in hepatic impairment: Severe hepatic impairment: Use with caution
Dosage: Combination Regimens
Primary CNS Lymphoma: Temozolomide-Rituximab (CNS Lymphoma)
Sarcoma: Irinotecan-Temozolomide (Ewing's Sarcoma)
Administration: Oral
Swallow capsules whole with a glass of water. Absorption is affected by food. Administer consistently either with food or without food (was administered in studies under fasting and nonfasting conditions). May administer on an empty stomach or at bedtime to reduce nausea and vomiting. Standard antiemetics may be administered if needed. Do not repeat dose if vomiting occurs after dose is administered; wait until the next scheduled dose. Do not open or chew capsules; avoid contact with skin if capsules are accidentally opened or damaged.
Administration: I.V.
Infuse over 90 minutes. Flush line before and after administration. May be administered through the same I.V. line as sodium chloride 0.9%; do not administer other medications through the same I.V. line.
Monitoring Parameters
CBC with differential and platelets (prior to each cycle; weekly during glioma concomitant phase treatment; at or within 48 hours of day 22 and weekly until ANC >1500/mm3 for glioma maintenance and astrocytoma treatment)
Dietary Considerations
The incidence of nausea/vomiting is decreased when taken on an empty stomach. Take capsules consistently either with food or without food (absorption is affected by food).
Patient Education
If administered I.V., report immediately any swelling, pain, or burning at infusion site. May cause headache, dizziness, confusion, fatigue, anxiety, insomnia, impaired coordination, nausea, vomiting, loss of appetite, constipation, or diarrhea. Report chest pain or palpitations; acute headache; unusual swelling of legs or feet; visual disturbances; unresolved GI problems; itching or burning on urination or vaginal discharge; acute joint, back, bone, or muscle pain or unusual weakness; difficulty breathing; cough; or signs of respiratory infection.
Oral: Take always with food or always without food; taking at bedtime may reduce nausea or vomiting. Swallow whole with 8 ounces of water. Do not open, crush, or chew capsules; if capsule is accidentally broken, do not inhale powder (wash hands thoroughly if powder gets on skin).
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Stomatitis, dysphagia, and taste perversion.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Fatigue, dizziness, amnesia, and insomnia are common; may cause somnolence, confusion, anxiety, depression
Mental Health: Effects on Psychiatric Treatment
Myelosuppression is common, use caution with clozapine and carbamazepine; nausea is very common, avoid use with SSRIs
Nursing: Physical Assessment/Monitoring
Monitor for CNS effects, gastrointestinal disturbance, myelosuppression, opportunistic infection, vision disturbance, and cough on a regular basis; dosage adjustments may be necessary for toxicity.
Oncology: Emetic Potential
Moderate (30% to 90%)
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, oral:
Temodar®: 5 mg, 20 mg, 100 mg, 140 mg, 180 mg, 250 mg
Injection, powder for reconstitution:
Temodar®: 100 mg [contains polysorbate 80]
Pricing: U.S. (www.drugstore.com)
Capsules (Temodar)
5 mg (5): $54.19
20 mg (5): $210.00
100 mg (5): $947.97
100 mg (5): $947.99
180 mg (14): $4876.26
250 mg (5): $2344.10
Extemporaneously Prepared
Hazardous agent: Use appropriate precautions for handling and disposal.
A 10 mg/mL temozolomide oral suspension may be compounded in a vertical flow hood. Mix the contents of ten 100 mg capsules and 500 mg of povidone K-30 powder in a glass mortar; add 25 mg anhydrous citric acid dissolved in 1.5 mL purified water and mix to a uniform paste; mix while adding 50 mL Ora-Plus® in incremental proportions. Transfer to an amber plastic bottle, rinse mortar 4 times with small portions of either Ora-Sweet® or Ora-Sweet® SF, and add quantity of Ora-Sweet® or Ora-Sweet® SF sufficient to make 100 mL. Store in plastic amber prescription bottles; label "shake well" and "refrigerate"; include the beyond-use date. Stable for 7 days at room temperature or 60 days refrigerated (preferred).
Trissel LA, Yanping Z, and Koontz SE, "Temozolomide Stability in Extemporaneously Compounded Oral Suspension," Int J Pharm Compound, 2006, 10(5):396-9.
References
Agarwala SS, Kirkwood JM, Gore M, et al, “ Temozolomide for the Treatment of Brain metastases Associated With Metastatic Melanoma: A Phase II Study,” J Clin Oncol, 2004, 22(11):2101-7.
Bagatell R, London WB, Wagner LM, et al, “Phase II Study of Irinotecan and Temozolomide in Children With Relapsed or Refractory Neuroblastoma: A Children's Oncology Group Study,” J Clin Oncol, 2011, 29(2):208-13.
Brada M, Hoang-Xuan K, Rampling R, et al, “Multicenter Phase II Trial of Temozolomide in Patients With Glioblastoma Multiforme at First Relapse,” Ann Oncol, 2001, 12(2):259-66.
Casey DA, Wexler LH, Merchant MS, et al, “Irinotecan and Temozolomide for Ewing Sarcoma: The Memorial Sloan-Kettering Experience,” Pediatr Blood Cancer, 2009, 53(6):1029-34.
Enting RH, Demopoulos A, DeAngelis LM, et al, “Salvage Therapy for Primary CNS Lymphoma With a Combination of Rituximab and Temozolomide,” Neurology, 2004, 63(5):901-3.
Garcia del Muro X, Lopez-Pousa A, Martin J, et al, “A Phase II Trial of Temozolomide as a 6-Week, Continuous, Oral Schedule in Patients With Advanced Soft Tissue Sarcoma: A Study by the Spanish Group for Research on Sarcomas,” Cancer, 2005, 104(8):1706-12.
Hegi ME, Diserens AC, Gorlia T, et al, “MGMT Gene Silencing and Benefit From Temozolomide in Glioblastoma,” N Engl J Med, 2005, 352(10):997-1003.
Hegi ME, Liu L, Herman JG, et al, “Correlation of O6-Methylguanine Methyltransferase (MGMT) Promoter Methylation With Clinical Outcomes in Glioblastoma and Clinical Strategies to Modulate MGMT Activity,” J Clin Oncol, 2008, 26(25):4189-99.
Jalali R, Singh P, Menon H, et al, “Unexpected Case of Aplastic Anemia in a Patient With Glioblastoma Multiforme Treated With Temozolomide,” J Neurooncol, 2007, 85(1):105-7.
Kesari S, Schiff D, Drappatz J, et al, “Phase II Study of Protracted Daily Temozolomide for Low-Grade Gliomas in Adults,” Clin Cancer Res, 2009, 15(1):330-7.
Kulke MH, Stuart K, Enzinger PC, et al, “Phase II Study of Temozolomide and Thalidomide in Patients With Metastatic Neuroendocrine Tumors,” J Clin Oncol, 2006, 24(3):401-6.
Middleton MR, Grob JJ, Aaronson N, et al, “Randomized Phase III Study of Temozolomide Versus Dacarbazine in the Treatment of Patients With Advanced Metastatic Malignant Melanoma,” J Clin Oncol, 2000, 18(1):158-66.
Mikkelsen T, Doyle T, Anderson J, et al, “Temozolomide Single-Agent Chemotherapy for Newly Diagnosed Anaplastic Oligodendroglioma,” J Neurooncol, 2009, 92(1):57-63.
National Comprehensive Cancer Network® (NCCN), “Clinical Practice Guidelines in Oncology™: Central Nervous System Cancers,” Version 2.2011. Available at http://www.nccn.org/professionals/physician_gls/PDF/cns.pdf
National Comprehensive Cancer Network® (NCCN), “Clinical Practice Guidelines in Oncology™: Melanoma,” Version 2.2011. Available at http://www.nccn.org/professionals/physician_gls/PDF/melanoma.pdf
National Comprehensive Cancer Network® (NCCN) “Practice Guidelines in Oncology™: Neuroendocrine Tumors,” Version 2.2010 Available at http://www.nccn.org/professionals/physician_gls/PDF/neuroendocrine.pdf
National Comprehensive Cancer Network® (NCCN), “Clinical Practice Guidelines in Oncology™: Non-Hodgkin's Lymphomas,” Version 2.2011. Available at http://www.nccn.org/professionals/physician_gls/PDF/nhl.pdf
National Comprehensive Cancer Network® (NCCN), “Clinical Practice Guidelines in Oncology™: Soft Tissue Sarcoma,” Version 1.2011. Available at http://www.nccn.org/professionals/physician_gls/PDF/sarcoma.pdf
Stupp R, Dietrich PY, Ostermann Kraljevic S, et al, “Promising Survival for Patients With Newly Diagnosed Glioblastoma Multiforme Treated With Concomitant Radiation Plus Temozolomide Followed by Adjuvant Temozolomide,” J Clin Oncol, 2002, 20(5):1375-82.
Stupp R, Gander M, Leyvraz S, et al, “Current and Future Developments in the Use of Temozolomide for the Treatment of Brain Tumours,” Lancet Oncol, 2001, 2(9):552-60.
Stupp R, Hegi ME, Mason WP, et al, “Effects of Radiotherapy With Concomitant and Adjuvant Temozolomide Versus Radiotherapy Alone on Survival in Glioblastoma in a Randomised Phase III Study: 5-year Analysis of the EORTC-NCIC Trial,” Lancet Oncol, 2009, 10(5):459-66.
Stupp R, Mason WP, van den Bent MJ, et al, “Radiotherapy Plus Concomitant and Adjuvant Temozolomide for Glioblastoma,” N Engl J Med, 2005, 352(10):987-96.
Tani M, Fina M, Alinari L, et al, “Phase II Trial of Temozolomide in Patients With Pretreated Cutaneous T-Cell Lymphoma,” Haematologica, 2005, 90(9):1283-4.
Villano JL, Collins CA, Manasanch EE, et al, “Aplastic Anaemia in Patient With Glioblastoma Multiforme Treated With Temozolomide,” Lancet Oncol, 2006, 7(5):436-8.
Wong ET, Tishler R, Barron L, et al, “Immunochemotherapy With Rituximab and Temozolomide for Central Nervous System Lymphomas,” Cancer, 2004, 101(1):139-45.
Yung WK, Albright RE, Olson J, et al, “A Phase II Study of Temozolomide vs Procarbazine in Patients With Glioblastoma Multiforme at First Relapse,” Br J Cancer, 2000, 83(5):588-93.
Yung WK, Prados MD, Yaya-Tur R, et al, “Multicenter Phase II Trial of Temozolomide in Patients With Anaplastic Astrocytoma or Anaplastic Oligoastrocytoma at First Relapse,” J Clin Oncol, 1999, 17(9):2762-71.
International Brand Names
Lexi-Comp.com
Last full review/revision May 2011
Content last modified May 2011
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