Chemotherapy for malignant gliomas

Concomitant and adjuvant treatment with Temozolomide, an oral alkylating agent, has significantly improved the survival of patients with newly diagnosed glioblastoma multiforme (study EORTC 26981/22981, NCIC CE3). When given with the appropriate cautiousness including weekly clinical and laboratory controls during the concomitant phase, this therapy is generally well tolerated. The observed toxicity is mainly haematological. Grade III and IV toxicities mainly thrombocytopenia or lymphocytopenia occur in around 5 % of patients. A prophylaxis against pneumocystis carinii pneumonia was mandatory in the EORTC study. Most importantly, the quality of life of the patients was maintained throughout the therapy. This success has boosted the whole field of neurooncology, after a dry spell of more than thirty years for glioblastoma multiforme. Whether this concept will be applicable to other brain tumours and which schedule modifications or combinations with biologicals will improve the effectivity of therapy in brain tumours should be explored in further studies.