FOR BRAIN TUMOR PATIENTS
2000 MGH Brain Tumor Center
booklet is intended to give brain tumor patients and
their families a better understanding of chemotherapy
treatments. This information can give the patient more
control over the disease and its treatment. Topics which
are covered include:
of therapies for gliomas
are three standard types of treatment for patients with
high-grade gliomas: surgery, radiation therapy, and
chemo-therapy. Clinical research centers such as the
MGH Brain Tumor Center also offer investigational treatments.
high-grade gliomas have a tendency to grow rapidly,
treatment must be started as soon after surgery as is
feasible. Generally, this means that patients should
be undergoing either radiation therapy or chemotherapy
within 2 to 4 weeks after surgery.
radiation and chemotherapy are helpful in controlling
high-grade gliomas, at present it is not possible to
cure most of these tumors. The two major reasons for
this are that: 1) tumor cells infiltrate into surrounding
brain and thus cannot be completely removed by the surgeon,
and 2) that most types of glioma cells are somewhat
resistant to radiation and chemotherapy.
the goals of brain tumor treatments are to:
remove as many tumor cells as possible (with surgery)
kill as many of the cells left behind after surgery
as possible (with radiation and chemotherapy)
put remaining tumor cells into a nondividing, quiescent
state for as long as possible (with radiation and
these treatments, the growth of high-grade gliomas can
usually be controlled for a period of time. However,
the tumor cells may start to grow again. Patients receive
aggressive initial treatment in order to delay this
regrowth as long as possible. Careful surveillance with
serial MRI or CT scans is a crucial part of medical
care, because tumor regrowth requires alteration of
current treatment, or, for patients in the observation
phase, restarting treatment.
and radiation therapy
first step in therapy is maximal reasonable removal
of tumor tissue. There is great variability in the amount
of tumor that can be safely removed from the brain of
a patient. The variability is based mainly on the location
of the tumor. An MRI scan is usually obtained within
3 days after tumor removal. This "post-op"
MRI serves as a baseline for future comparison.
therapy is an important part of the treatment of high-grade
gliomas. In typical situations, patients begin radiation
treatments within 2 to 4 weeks after tumor resection.
Treatments are given daily, Monday through Friday, for
4 to 6 weeks. Each treatment takes only a few minutes.
An MRI is usually obtained about 2 to 4 weeks after
the end of radiation therapy in order to judge the effect
of treatment. Most of the time this scan will show no
change from the post-operative MRI, which is good. Some
shrinkage is even better. Growth during radiation therapy
is an unwanted sign of an aggressive tumor.
is helpful in controlling high-grade gliomas. As noted
above, the goal of chemotherapy is to kill as many of
the tumor cells as possible, and to put remaining tumor
cells into a nondividing, sleeping state for as long
as possible. Most chemotherapy agents are designed to
attack tumor cells in a way that impairs their ability
to divide and give rise to additional tumor cells. Some
newer drugs under investigation attempt to attack other
aspects of tumors, such as formation of new blood vessels.
different chemotherapy drugs are available. Neuro-oncologists
are skilled at tailoring treatments for individual patients.
For most tumors radiation is given prior to chemotherapy,
however, chemotherapy may be administered prior to radiation
therapy for patients whose tumors contain a component
for patients with glioblastoma multiforme occasionally
raises an important question as to timing. Specifically,
although chemotherapy is beneficial, it is not known
whether the timing of administration after radiation
is important, particularly for older patients. Some
centers in the United States now save chemotherapy until
there is evidence that the tumor is growing after radiation
therapy in these older patients. This may mean that
months could elapse between the end of radiation treatment
and the beginning of chemotherapy, allowing the patient
to recover strength. Other specialists prefer to give
chemotherapy immediately after radiation therapy and
to give different chemotherapy when the tumor starts
to grow again. This decision has to made on a patient-by-patient
addition to standard chemotherapy, major research centers
conduct studies of new drugs. It is usually advisable
to enter a research study if possible, both for reasons
of potential personal benefit as well as for the benefit
of others in the future. Neuro-oncologists and nurses
will provide detailed information about clinical trials.
MGH Brain Tumor Center conducts studies of many new
agents. Most of these studies are performed by groups
of research hospitals in the United States, and some
others are set up in conjunction with pharmaceutical
companies. The MGH Brain Tumor Center is a founding
member of the National Cancer Institute (NCI) sponsored
cooperative clinical trials group called New Approaches
to Brain Tumor Therapy (NABTT).
terminology used in chemotherapy trials can be confusing.
There is a short glossary of these terms at the end
of this booklet. A list of sites on the world wide web
that discuss chemotherapy trials is also provided at
the end of the booklet.
effects of chemotherapy
chemotherapy is intended to target dividing tumor cells,
there are normal cells in the body which are also dividing.
These normal cells can also be temporarily affected
by chemotherapy, thus producing side effects. In addition,
chemotherapy can produce nausea or vomiting by a direct
effect on the vomiting center in the brain. Specific
side effects of chemotherapy are discussed below.
to significant advances in medical science, chemotherapy
is much easier to tolerate today than even a few years
ago. A neuro-oncologist or nurse practitioner will discuss
the potential side effects of chemotherapy prior to
beginning the treatments. After all questions have been
answered, a consent form must be signed.
Low blood counts
bone marrow produces blood cells that circulate in the
arteries, veins and capillaries. There are white blood
cells which fight infection, red blood cells which carry
oxygen, and platelets which prevent bleeding.
blood cell counts and platelet counts drop transiently
after each dose of most types of chemotherapy. The lowest
point (called the nadir) could increase
the risk for serious infection (low white blood cells)
or bleeding (low platelets). Low red blood cell count
(anemia) is not common with most types of chemotherapy.
These changes are measured by performing a CBC (complete
blood count). Most of the time patients do not have
symptoms related to the presence of low blood counts.
CBC is taken within 24 - 48 hours before administration
of chemotherapy; the results will help the doctor and
nurse decide if it is safe to give the chemotherapy.
and their families need to be vigilant about signs of
infection and bleeding while on chemotherapy. Good oral
hygiene and handwashing can help prevent infections.
signs of infection include fever (oral temperature over
100.0 degrees F), chills, sore throat, shortness of
breath, new cough, abdominal pain, and pain or burning
signs of bleeding include easy bruising of the skin,
tiny spots of hemorrhage under the skin (petechia),
nose bleeds, and bleeding of the gums with brushing.
Call the doctor or nurse promptly if any of these signs
occur while on chemotherapy.
of infections in patients with low white blood counts
includes administration of antibiotics by vein in the
hospital, and injections of Neupogen (G-CSF, a white
blood cell growth factor; see the end of the booklet
regarding instruction for administration of Neupogen
at home). Low platelet counts are treated with platelet
Nausea and vomiting
chemotherapy agents can cause nausea and vomiting for
one to several days following treatment. Antinausea
medicines (antiemetics) such as Zofran and Kytril can
reduce or eliminate these symptoms. Antinausea medications
are usually given 30 minutes to one hour prior to administration
of chemotherapy. Patients should keep a small supply
of these medications at home in case symptoms persist.
Specific instructions about recommended use of antinausea
agents will be given for each chemotherapy regimen.
It is usually a good idea to eat light meals around
the day of chemotherapy.
cells which produce sperm in men are frequently destroyed
by chemotherapy. This can cause sterility, and therefore
may make it impossible to father a child. Many men decide
to bank sperm prior to chemotherapy. This should be
discussed with the doctor before starting chemotherapy.
chemotherapy drugs can be harmful to a fetus, and therefore
it is crucial to not become pregnant while receiving
chemotherapy. Women of child-bearing years need to use
a reliable birth control method for the entire time
they are undergoing chemotherapy, including the rest
periods. Men should use a condom when having sexual
relations for 3 days after chemotherapy to protect their
spouses from exposure to the drug.
to the kidneys, liver and other organs is rare. There
are some unique risks with individual drugs, and these
will be reviewed in detail prior to their administration.
Chemotherapy patients should avoid overexposure to sun
light. Wear protective clothing (brimmed hat, shirt
sleeves) and use suntan lotion.
Bodily excretions and menses
receiving chemotherapy, and for 3 days after, careful
attention should be paid to hand washing after urination,
since many chemotherapy drugs are removed from the body
in the urine. If family members help with personal care
of the patient, they should wear latex gloves when handling
urine or vomitus for 3 days after chemotherapy. Clothing
soiled with urine, vomit, or feces should be washed
separately in hot soapy water.
who have menstrual cycles and have not gone through
menopause will probably notice a change in their cycle.
The bleeding may lessen, become spotty or stop completely.
The time between cycles may also change. The menstrual
cycle usually changes after one or two complete cycles
(42 - 84 days) of chemotherapy. Some women whose menstrual
cycles stop undergo menopause, with or without symptoms.
Women who are closer to the age of menopause occasionally
do not resume menstruating once chemotherapy stops.
to call the doctor
doctor or nurse should be called in the following situations:
signs of infectionfever, chills, pain on urinating,
unusual headache, stiff neck, sore throat, or abdominal
signs of possible bleedingunusual bruising,
tiny red spots on the skin, severe headache, unusual
abdominal pain, bright red blood from the nose or
severe nausea and vomiting which is not relieved
by the anti-nausea medicine, or if the anti-nausea
medicine is repeatedly vomited and there is a concern
development of a skin rash
development of constipation which is not relieved
by usual methods
decrease in urine output despite drinking usual
amounts of fluids.
are some of the situations about which the doctor or
nurse needs to know. Sometimes it is hard to know whether
to call the doctor about a certain problem. If unsure,
it is better to make the call. This will help to avoid
possible problems. Before beginning treatment the phone
numbers of the doctor and a number at which the doctor
on call can be reached after hours or on weekends will
of PCV chemotherapy regimen
refers to the three chemotherapy drugs which are used
in the regimen: Procarbazine, CCNU, and Vincristine.
is given in "cycles". A cycle is the time
period over which the chemotherapy is be given. It includes
rest periods. The PCV regimen is made up of multiple
six-week long cycles (42 days). Chemotherapy is taken
on day 1, days 8-21, and day 29 of the cycle (see below).
On the other days no chemotherapy is taken. A full course
of treatment usually consists of six cycles of PCV,
lasting 9 months.
entire treatment is performed as an outpatient. Patients
visit their doctor three times during each cycle (day
1, 8, and 29). Each visit includes a physical examination
and analysis of blood count (CBC) results.
of Drug Administration During a Cycle
chemotherapy is administered on certain days of each
cycle. The actual schedule of drug(s) on which days
pills day 1
injection day 8 and day 29
pills days 8 through 21 (every day for 2 weeks)
Information About Each Drug
Take the antinausea medication (for example, Zofran
8 mg pill) 30 to 60 minutes prior to bedtime. Then take
the CCNU immediately before going to bed. (For example:
if usual bed time is at 11 PM, take the anti-nausea
medicine at 10 PM and the CCNU at 11 PM.)
comes in capsule form and is taken by mouth on day 1
of the chemotherapy cycle. The dose is determined by
a formula using height and weight. Several capsules
are needed to make up the full dose.
most common side effect of CCNU is nausea and vomiting.
In order to prevent or minimize this, an antinausea
drug will be prescribed (see above).
causes a drop in number of white blood cells and platelets,
with the lowest point occurring around 4 6 weeks.
chemotherapy agents in the PCV regimen usually do not
cause hair loss. CCNU can cause stiffening of the lungs,
but this is rare at the dose of CCNU used in this regimen.
Other possible side effects of CCNU which are not common,
include sensitive gums, sores in the mouth, and fatigue.
Many years after taking CCNU there is a very small risk
of a second cancer such as leukemia.
Vincristine is given at the hospital by placing a small
needle in a vein which is connected to a bag of saline
by tubing. The vincristine is in a syringe which is
then connected to the tubing and injected by the nurse.
The injection only takes a few minutes.
major side effect of vincristine is to damage nerves
in the hands and feet or in other parts of the body.
This type or nerve injury is usually a reversible after
about six weeks. Typical symptoms of this nerve injury
include tingling or numbness of the fingertips and/or
toes, an achy jaw and constipation. Tingling or numbness
can make it difficult to use buttons or zippers. A diet
high in fiber, with plenty of fresh fruits or fruit
juices and vegetables will help prevent constipation.
Maintaining an active physical program, when possible,
will also help prevent constipation.
and vomiting are so rare with vincristine that anti-nausea
medicine does not need to be taken. Vincristine does
not affect the blood counts.
Procarbazine is taken at bedtime, as with the CCNU (see
above), with the anti-nausea pill an hour before. Procarbazine
is usually taken as two capsules each night from day
8 through day 21 of each cycle (14 days).
major side effects of procarbazine are fatigue and loss
of appetite, nausea and vomiting, and a decrease in
blood counts. The nausea usually occurs with the first
three doses (days 8-10), and then disappears for the
following 11 days. However, if nausea and vomiting are
persistent, the antinausea medicine may be continued
for the entire 14 days. A prescription for antinausea
medicine (Zofran, Kytril, or compazine) will be provided
along with the prescription for the procarbazine.
are certain foods containing large amounts of tyramine
which should be avoided while taking procarbazine. Headaches,
nausea, an increase in blood pressure, and a rapid pulse
may occur if large amounts of these foods are consumed
while on procarbazine. If a restricted food is eaten
by mistake, the risk of side effects is very low, and
a doctor should be notified only if symptoms develop.
foods to avoid are:
Meats Cream Raisins
Fava beans Sour cream
Game Soy sauce
Licorice Yeast extracts
figs Liver Yogurt
Cheeses Meat extracts
avoid over-the-counter cold medicines while taking
procarbazine (decongestants are the main offenders),
and reduce the amount of coffee consumed. In fact, it
is a good idea to speak with a doctor or nurse prior
to starting any new medication while on procarbazine.
patients develop a rash while taking procarbazine. This
is a form of allergic reaction, and can usually be managed
with antihistamines. Call the doctor or nurse prior
to taking the next dose of procarbazine if a rash appears
while taking procarbazine.
of Temozolomide Chemotherapy Regimen
(Temodar) was approved by the FDA for treatment of anaplastic
astrocytoma in 1999, and this drug is now widely used
for high-grade gliomas. Major advantages of temozolomide
include its low incidence of side-effects, and ease
is usually described as being given in cycles. A cycle
is the time period over which the scheduled chemo-therapy
is be given. It includes rest periods. The temozolomide
regimen consists of multiple four-week cycles (28 days
each). Chemotherapy is taken on the mornings of days
1, 2, 3, 4, and 5. No chemotherapy is taken on days
6 - 28.
visit their doctor once during each cycle (day 1). Each
visit includes a physical examination and analysis of
blood count results (CBC).
of Drug Administration During a Cycle
schedule of temozolomide is:
pills days 1, 2, 3, 4, and 5
period days 6 - 28
Information About Temozolomide
eat nothing after midnight prior to each day of
chemo-therapy. Temozolomide must be taken on an
upon arising in the morning, take Zofran 8mg with
sips of water
take temozolomide 30 minutes after the Zofran
wait one hour and then eat a light breakfast and
take other usual medications
keep a written record of each dose
obtain a CBC on days 1, 21, and 28
comes in capsule form. The dose is calculated using
height and weight. Usually more than one capsule will
be needed to make up the full dose. The capsules may
be of different strengths.
most common side effect of temozolomide is nausea, fatigue,
and constipation. In order to prevent or minimize this
an antinausea drug will be prescribed. Take the antinausea
medication (for example, Zofran 8 mg pill) on an empty
stomach upon arising each day of chemotherapy. Senekot
and Colace are useful to treat constipation.
causes a drop in the white blood count and platelet
counts. This typically reaches a low point about 21
days after starting the chemotherapy pills (day 21).
rarely causes hair loss. Other uncommon, but possible,
side effects of temozolomide include sores in the mouth.
is administered by subcutaneous injection, similar to
an insulin injection, for patients whose white blood
counts fall to very low levels after chemotherapy. Sometimes
it is given prophylactically for several days starting
the day after chemotherapy, other times it is given
to raise white blood counts that have already fallen
into a low range.
vials. There are two strengths: 300 mcg and 480 mcg.
Keep the vials in a brown bag in the refrigerator. Vials
may be stored at room temperature for up to 24 hours
(discard vials that sit at room temperature for more
than 24 hours).
3cc syringe with 5/8th inch, 25 gauge needle attached.
do not shake the vial. If there are frothy bubbles
on the surface of the liquid in the vial, allow
the vial to sit undisturbed for a few minutes
until the bubbles disappear.
use aseptic technique. Clean the top of the vial
with an alcohol wipe, and then wipe a small area
of skin at the site of the injection. Sites include
top of the upper thighs, abdomen, and back of
the upper arm.
take care to avoid accidental needle sticks push
the syringe needle into the vial, turn the vial
upside down, and withdraw the entire volume (1
cc) of liquid into the syringe. Remove the syringe,
point it upright and carefully expel any air.
gently pinch the region of skin just cleaned into
a large fold with the fingers of one hand, and
then stick the needle all the way into the fold
with a quick push.
inject the Neupogen quickly. Remove the needle.
Release the skin fold.
dispose of used materials in a safe manner. All
materials (vials of drug, syringes, alcohol wipes,
etc.) are designed for single use only. Dispose
of syringes in a safe place (for instance, use
an empty coffee can or Chlorox bottle, and then
place inside a regular trash bag for disposal).
help at home
are some important things to do at home during chemo-therapy
treatment. These include:
keep a positive mental attitude
eat a healthy diet, including plenty of fresh fruits,
fruit juices and vegetables to prevent constipation
drink adequate fluids-- at least 2 quarts a day
unless the doctor has recommended a restricted
fluid intake. Juices are preferable to plain water
get some form of exercise-- even a little is better
than none. However, avoid exhaustion
avoid sun exposure. Where a brimmed hat, long sleeves,
and use suntan lotion
be alert to signs of infection or bleeding
use good handwashing after toileting
perform good mouth care and personal care
use anti-nausea medicines as directed. It is easier
to prevent nausea and vomiting than to stop it once
keep all questions and notes in a permanent notebook
may occur in patients with brain tumors. Seizures can
have many different manifestations, but common types
are twitching of the face, arm or leg without complete
loss of consciousness, and total body shaking with complete
loss of consciousness. Following a seizure the patient
may be sleepy or confused and there may be increased
seizures are brief and self-limited. If a seizure lasts
for 2 minutes or less and the patient returns to normal
quickly, make a telephone call to the neuro-oncologist
at the Brain Tumor Center (617-724-8770) for instructions
(for example, to check the blood level of a seizure
medication). If the seizure lasts for more than 3 minutes
or if a second seizure occurs shortly after the first,
it is usually necessary to call for medical help by
dialing 911. Have the doctor at the Emergency Room call
the Brain Tumor Center for advice.
patients with brain tumors, the following activities
should be discussed with a neuro-oncologist: driving,
operating heavy equipment, swimming, any potentially
the event of a seizure, several things are important:
remain calm and call for help
protect the patient from sharp objects or dangerous
situations during the seizure
do not put anything in the patients mouth.
Patients do not suffocate during seizures.
if vomiting occurs, turn the patient up on their
side to minimize the risk of aspiration.
MRI or CT scan is obtained at regular intervals in order
to see how the tumor is responding to chemotherapy.
Scans are usually obtained after every second cycle
(i.e., just prior to the start of cycles 3 and 5, etc.).
If new problems arise, it is sometimes necessary to
have a scan earlier than these scheduled intervals.
of common medications
Decadron (dexamethasone) is very useful to reduce swelling
around the tumor. It also has many side effects, but
these are usually less important than the benefit from
taking Decadron. However, it is always a major goal
find the smallest dose that is helpful. Side effects
include: euphoria, with excessive feeling of well-being
and insomnia; increased appetite, especially for sweets;
weight gain with fat deposition in the cheeks; high
blood sugar, particularly in diabetics; high blood pressure;
muscle weakness in the legs (this affects the ability
to climb stairs and arise from chairs); stomach ulcers
(an acid blocking drug is usually given to combat this);
and increased risk of infection (patients on Decadron
for more than 2 months should ask about prophylactic
Dilantin (phenytoin) is a common medication taken to
prevent seizures. The major side effects of Dilantin
are toxic blood levels (too high), and rash. Dilantin
toxicity causes clumsiness while walking, much like
that of alcohol intoxication. Dilantin rashes are very
common and can be dangerous so that the patient must
switch to a different medication for seizure control.
(Note: changing a seizure medication requires consultation
with a neurologist or neuro-oncologist). Some patients
experience fatigue with Dilantin, but this symptom is
more commonly due to the tumor and its treatment.
Tegretol (carbamazepine) is a common anti-seizure medication.
It may cause a rash, may lower the white blood counts,
and may cause double vision when levels become toxic.
Depakote (valproic acid) is another common anti-seizure
medication. The most frequent side effect is a mild
tremor in the hands. A rash is much rarer than with
Dilantin. This medication is very harmful to the human
fetus and should not be taken by pregnant women.
of the MGH Brain Tumor Center
Tumor Support Group
Brain Tumor Support Group meets in the Brain Tumor Center
on the 1st and 3rd Tuesdays of the month from 12:00-2:00
PM. The group offers an opportunity for patients and
family members to learn about the issues that concern
them most, have support provided, as well as an opportunity
to meet others living with similar experiences. For
more information call (617) 726-7851or (617) 726-1061.
social workers help patients and their family members
find solutions to many problems-- from daily crises
to life's most difficult situations. This is accomplished
through counseling, active problem solving and direct
connection with the network of community and hospital
resources. Insurance pre-approval or physician referral
are not necessary. The Brain Tumor Centers social
worker can be reached directly at (617) 724-5828.
and Occupational Therapy
and occupational therapists assess functional status
and provide treatment aimed at maximizing independence
and functional capacity. Physical therapists prescribe
individualized exercises to address strength, balance,
endurance, and pain, and may recommend adaptive equipment.
Occupational therapists give instruction in the use
of assistive devices, adaptive techniques and hand splints
to increase independence in day-to-day tasks. Call (617)
can receive therapy for problems with speech articulation,
language, short term memory, and attention. Steps to
Success is an intensive 6 week group program for patients
with cognitive and language deficits who are returning
to work. Referrals are made at (617) 724-0762.
oncologic psychiatry consultation can be valuable for
patients with problems such as clinical depression or
anxiety. Referrals are made by calling (617) 726-2405.
testing can be useful to determine the nature and severity
of cognitive problems such as memory loss. Testing can
also serve as a valuable baseline for the future. Referrals
can be made at (617) 726-3647.
glossary of terms used in clinical trials
chemotherapy agents are evaluated in carefully designed,
standard format "trials".
I trial. A small trial, typically with 10 to 12 patients,
designed to test the toxicity of various doses of
a new agent.
II trial. Larger trial involving more patients to
assess whether a new agent from the Phase I level
can effectively treat a tumor.
III trial. Very large trial designed to compare how
the new agent, from the Phase II level, compares to
the best currently available agent(s).
trial. Chemotherapy agent is administered after biopsy
or surgery, but prior to irradiation.
trial. Agent is administered immediately after surgery
(salvage) trial. Agent is administered at the time
of tumor progression or recurrence.
scans are used to measure whether the tumor is responding
to the new treatment.
response. All radiographic signs of tumor (on MRI
or CT) have disappeared.
response. The tumor has been reduced in size by 50%
or more, as measured by MRI or CT.
disease. No change in tumor size between two radiographic
disease. Increase in size of tumor between two studies.
wide web sites with information about brain tumors
Brain Tumor Center - http://brain.mgh.harvard.edu/
Brain Tumor Association - http://www.abta.org/
Cancer Society - http://www.cancer.org
Tumor Clinical Trials - http://www.virtualtrials.com
Tumor Foundation of Canada - http://www.btfc.org
Brain Tumor Foundation - http://www.braintumor.org
Cancer Institute - http://email@example.com
Approaches to Brain Tumor Therapy - http://www.nabtt.org
Brain Tumor Society - http://www.nabtt.org
to the physicians of patients on PCV
recommended doses of PCV agents are as follows:
CCNU 110 mg/m2 p.o. on day 1
vincristine 1.4 mg/m2 (maximum dose
of 2 mg) i.v. on days 8 and 29
procarbazine 60 mg/m2/day (maximum
dose of 100 mg/day) p.o. days 8-21
(ondansetron) 8 mg orally is excellent for control of
CCNU-induced nausea. Compazine 10 mg orally for the
first three nights of procarbazine is usually sufficient
to control nausea, although some patients do better
with ondansetron. Prior to initiation of each cycle,
CBC values should be: absolute neutrophil count of 1,500
or greater and platelet count of 100,000. Twenty-five
percent dose reduction of CCNU is commonly required
to avoid prolonged delays between cycles.
should be administered by physicians who are trained
in medical oncology. The doses of drugs in this booklet
are intended as a general guide. The MGH Brain Tumor
Center does not take responsibility for medical decisions
made by physicians outside the Center.
to the physicians of patients on temozolomide
recommended dose of temozolomide is:
150 mg/m2 daily x 5 days (i.e., days
1-5) every 28 days
check CBC on day 21 (nadir) and d28.
grade IV myelosuppression occurs during cycle 1, do
not dose escalate with subsequent cycles
grade IV myelotoxicity does not occur, increase dose
200 mg/m2 daily x 5 days
CBC on day 21 (nadir) and d28 with each cycle.
8 mg orally is excellent for control of temozolomide-induced
nausea, and should be administered prior to all 5 doses.
Prior to institution of therapy, CBC values should be:
absolute neutrophil count of 1,500 or greater and platelet
count of 100,000 or greater. Approximately 10% of patients
are unable to tolerate the 200 mg/m2 dose.
should be administered by physicians who are trained
in medical oncology. The doses of drugs in this booklet
are intended as a general guide. The MGH Brain Tumor
Center does not take responsibility for medical decisions
made by physicians outside the Center.
Brain Tumor Center. By John W. Henson, M.D.