Experience of using the lyophilized form of temozolomide in patients with malignant gliomas

Aim: to evaluate toxicity of temozolomide when administered orally and intravenously in order to optimize treatment of patients with malignant gliomas. From August 2012 to December 2013 18 patients with malignant gliomas of the brain consistently received oral temozolomide (24 cycles) and intravenously (29 cycles) in the course of adjuvant chemotherapy (ACT) at a dose of 150-200 mg/m2 5 days 28-day cycle. Nausea grade 1-2 was noted by all patients (n = 18) who were treated with temozolomide capsules for all 24 cycles ACT. Grade 1 vomiting was observed in 16 of 18 patients during 18 cycles of 24 ACT. Grade 1 dyspepsia was observed in 10 of 18 patients during 12 cycles of 24 ACT using temozolomide capsules. When temozolomide was administered intravenously, Grade 1 nausea was observed in 2 of 18 patients during the 29 cycles of 4 ACT. All patients involved in the study and treated with temozolomide in two medicinal forms noted better tolerability of intravenous infusion in comparison with oral administration of capsules. Limiting the use of lyophilisate was related to the necessity of finding a patient in a medical facility. However, the low toxicity of intravenously admimistered temozolomide allowed a recommendation of infusions both in a daily hospital or outpatient use. In the course of adjuvant chemotherapy nonhematological risk of unwanted effects is a little higher that results in wider indications for intravenous administration of temozolomide in patients with swallowing disorders of various etiologies and in young children.