Efficacy and safety of long-term therapy for high-grade glioma with temozolomide: A meta-analysis

Abstract

Further treatments are warranted in preventing recurrence or progression for high-grade glioma (HGG) patients having achieved stable disease with tolerable toxicity after the Stupp regimen (6 cycles of temozolomide). This meta-analysis aims to extensively evaluate the safety, feasibility, and efficacy of long-term therapy with temozolomide (>6 cycles) for these patients. We systematically searched the pubmed, Embase and Chinese Biomedical (CBM) databases using the strategy of combination of free-text words and MeSH terms. The efficacy indicators are hazard ratio (HR) for the pooled analysis of overall survival (OS) and progression free survival (PFS). The safety indicator is risk ratio (RR) for the pooled analysis of adverse effects. Six studies comprising a total number of 396 patients met all inclusion and exclusion criteria were included. No heterogeneity and publication bias were observed across each study. It was found that patients could obtain benefits from long-term administration of temozolomide both in OS (HR 2.39, 95% CI 1.82–3.14) and PFS (HR 2.12, 95% CI 1.56–2.89). In addition, the results showed that the patients receiving long-term administration of temozolomide did not experience additional toxicity over that of the Stupp regimen (6 cycles of temozolomide). It could be concluded that it's efficacious and safe for HGG patients to receive long-term therapy with temozolomide. Nevertheless, more randomized controlled trials (RCTs) should be carried out to verify this conclusion.

Impact of four lncRNA polymorphisms (rs2151280, rs7763881, rs1136410, and rs3787016) on glioma risk and prognosis: A case‐control study

“…In China, 1 016 000 people were diagnosed with brain and CNS cancer . Despite advances in surgical resection, chemotherapy, and radiotherapy, the prognosis of patients with glioma remains unfavorable, even with 15 months median survival in high‐grade glioma . Therefore, a better understanding of tumor characteristics and biology and further refinement of tumor classification and patient stratification are necessary for individualized treatment.…”

“…3 Despite advances in surgical resection, chemotherapy, and radiotherapy, the prognosis of patients with glioma remains unfavorable, even with 15 months median survival in highgrade glioma. 4,5 Therefore, a better understanding of tumor characteristics and biology and further refinement of tumor classification and patient stratification are necessary for individualized treatment. Genetic syndromes, familial aggregation, telomere maintenance, and genetic polymorphisms are reported to be related to the susceptibility and prognosis of glioma.…”

Current Trends in Glioblastoma Treatment

“…In common practice, some medical centers have attempted to prolong TMZ administration for 12-18 months. Some evidence suggests that long-term therapy with TMZ in selected patients is superior to Stupp regimen [71][72][73], but there is no definitive data to prove this.…”

Nasal Drug Delivery of Anticancer Drugs for the Treatment of Glioblastoma: Preclinical and Clinical Trials

“…TMZ is in fact a prodrug, which is spontaneously hydrolyzed into physiological pH to its alkylating metabolite 3-methyl-(triazen-1-yl)-imidazole-4-carboxamide (MTIC) [11]. TMZ is administered orally and leads to fewer side effects when compared with other chemotherapeutic agents administered parenterally [12]. Notwithstanding, its clinical effectiveness remains limited, since tumors rapidly develop resistance to the treatment [13].…”