Guidance on the use of temozolomide for the treatment of recurrent malignant glioma (brain cancer)

Temozolomide (Temodal) is an alkylating agent derived from dacarbazine and first synthesised in 1984. It is indicated for the treatment of patients with malignant glioma showing recurrence or progression after standard therapy. It is easier to administer than other chemotherapeutic regimes for this indication and is given orally once a day for 5 days in a 28‑day cycle. It has high bioavailability and crosses the blood‑brain barrier where it is spontaneously hydrolysed to its active form. It is toxic to cancer cells due to inhibition of tumour cell DNA replication.

It exhibits a broad spectrum of anti‑tumour activity in animals and man. Side effects are less than existing regimes and include nausea, vomiting, fatigue and headache. Haematological toxicity is mild and non‑cumulative.

Dosage in chemotherapy‑naïve patients is 200 mg per square metre of patient surface area per day (that is, generally averaging 340 mg per day). In patients previously treated with cytotoxic drugs, the dose is usually reduced by 25%.

The current UK price of this drug is £1,176 per 5‑day cycle for a daily dose of 340 mg for those who have not had prior chemotherapy, and £934 for those who have.