Are we done with dose-intense temozolomide in recurrent glioblastoma?

Extract

See the article by Han et al, on pages 1255–1262.

In this month's issue of Neuro-Oncology, Han et al present another sobering result of dose-dense chemotherapy in a series of 40 recurrent glioblastoma patients failing chemo-irradiation with temozolomide (TMZ).¹ In a well-designed trial the investigators avoided patients with pseudoprogression by not excluding patients relapsing within three months from the end of radiotherapy (RT), and also took O⁶-methylguanine-DNA methyltransferase (MGMT) status into consideration. They report a progression-free survival (PFS) at 6 months (PFS-6) of just 10%, with a trend towards improved outcome in MGMT promoter methylated cases (median PFS 12 weeks versus 8 weeks for unmethylated cases, P = .06). Taken together with the first results of the DIREKTOR trial (NCT00941460) presented at ASCO 2014, it seems fair to ask if there is any role left for these dose-dense temozolomide schedules given to glioblastoma patients at progression after combined chemo-irradiation with TMZ.^2,3