Management of temozolomide toxicity by nurse practitioners in neuro-oncology

To investigate the toxicity of temozolomide (TMZ) in patients with brain tumors and appropriate nursing interventions.

Explorative analysis of prospective data.

A TMZ clinic led by a nurse practitioner (NP).

Group A (n = 71) received a standard dose of TMZ daily for five days 200 mg/m2 every four weeks; group B (n = 19) received a dose-intense schedule of TMZ daily for 21 days 75 mg/m2 every four weeks.

Toxicities were scored according to National Cancer Institute Common Terminology Criteria, and results in the two groups were compared.

Thrombopenia, neutropenia, and lymphopenia; nausea and vomiting; and NP interventions.

Of observed toxicities during six cycles, grade 3-4 thrombopenia was seen most frequently in group A. Neutropenia and subsequent interventions occurred more frequently in group A than in group B. Subsequent interventions consisted of dose delays and reductions. When patients were treated for a longer duration of time with TMZ, grade 3-4 lymphopenia occurred significantly more often in group B, necessitating Pneumocystis carinii pneumonia prophylaxis.

Degree of toxicity using a 5-day 200 mg/m2 or 21-day 75 mg/m2 schedule every four weeks was similar to that found in other studies.

Through awareness of toxicity in relation to knowledge of brain tumors, NPs can become more effective in active management of TMZ toxicity.