From the Guidelines
Pacientų gydymo informacija atrodo teisinga, nes ji atitinka standartinius glioblastomos gydymo protokolus, įskaitant radioterapiją ir temozolomido chemoterapiją. Pacientas gavo radioterapiją 60Gy bendros dozes (30 frakcijų po 2Gy kiekvienoje) į naviko ložę dešiniame parietaliniame regione, ir baigė pirmąją temozolomido chemoterapijos fazę, trunkančią 42 dienas, su gera tolerancija ir pagerėjusiu savijauta. Planuojama adjuvantinė fazė, kurią sudaro 6 ciklai, trunkantys po 28 dienų, kuomet temozolomidas skiriamas didesne 150-200 mg/m² doze per pirmąsias 5 dienų kiekvieno ciklo, o vėliau seka 23 dienų pertrauka. Šis režimas atitinka standartinius glioblastomos gydymo protokolus, aprašytus 1 ir 1 studijose, kuriose nurodoma, kad radioterapija su konkomitantine ir adjuvantine temozolomido terapija yra efektyvi glioblastomos gydyme. Gydymo prieiga siekia maksimaliai kontroliuoti naviką, leisdamas paciento organizmui atsigauti tarp ciklų ir mažinti kumulatyvinę toksiniškumą. Pacientui numatytas kontrolės vizitas per apie mėnesį, kad įvertintų gydymo efektyvumą ir paciento būklę. Vis dėlto, gydymo planas turėtų būti individualizuotas, atsižvelgiant į paciento specifines charakteristikas, tokias kaip amžius, funkcijų būklė ir naviko tipas, kaip nurodyta 1 ir 1 studijose.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Newly Diagnosed GBM: 75 mg/m 2 for 42 days concomitant with focal radiotherapy followed by initial maintenance dose of 150 mg/m 2 once daily for Days 1 to 5 of a 28-day cycle of temozolomide capsules for 6 cycles. (2.1) Refractory Anaplastic Astrocytoma: Initial dose 150 mg/m 2 once daily for 5 consecutive days per 28-day treatment cycle. (2.1)
Temozolomide treatment regimen: The provided information states that the patient received 42 days of concomitant temozolomide and radiotherapy, followed by 6 cycles of adjuvant temozolomide.
- Concomitant phase: 75 mg/m² of temozolomide for 42 days with radiotherapy, which matches the dosage in the label 2.
- Adjuvant phase: 150-200 mg/m² of temozolomide for 5 days every 28 days for 6 cycles, which also matches the label 2. The patient's treatment regimen appears to be consistent with the recommended dosage and administration for newly diagnosed GBM, as stated in the drug label 2.
From the Research
Patient Treatment Information
The patient has undergone chemotherapy with Temozolomide and has received 30 fractions of radiation therapy with a dose of 2Gy up to a total dose of 60Gy to the tumor site in the right parietal lobe. The patient's condition has improved, and they are scheduled for a follow-up examination in about 1 month. The adjuvant phase of treatment consists of 6 cycles, each lasting 28 days, with a higher dose of Temozolomide (150-200 mg/m²) administered on the first 5 days of each cycle.
Treatment Efficacy and Side Effects
- The effectiveness of Temozolomide in treating glioblastoma has been demonstrated in several studies, including 3, which shows that it can increase the median overall survival to 14-15 months.
- However, the use of Temozolomide is also associated with serious systemic, dose-related side effects, as mentioned in 3.
- Radiation therapy, like the one the patient received, can also enhance the effectiveness of Temozolomide, as shown in 4.
Combination Therapies
- The use of combination therapies, such as Temozolomide with bortezomib, has been shown to be effective in eradicating recurrent glioblastoma cells, as demonstrated in 5.
- Another study, 6, investigated the use of sulfasalazine with Temozolomide and radiation therapy, but found that it did not improve overall survival or progression-free survival.
Diagnostic Tools
- Dynamic contrast-enhanced MR imaging can be used to differentiate true progression from pseudoprogression in patients with glioblastoma, as shown in 7.
- The quantitative pharmacokinetic parameters obtained from this imaging technique, such as K(trans) and ve, can be useful in distinguishing between true progression and pseudoprogression.