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Treatment Name: Temozolomide (Temodar®) + Radiation

Temozolomide (Temodar®) + Radiation is a Chemotherapy Regimen for Brain Cancer

What is Glioblastoma Brain Cancer?
A disease of the glial cells found in the brain. Glioblastoma is a very rare condition but is very aggressive. In most cases, the cause of glioblastoma is not known; however, glioblastoma can also arise from other low-grade brain cancers. Currently, there is no staging system for glioblastoma. Treatment plans for glioblastoma are commonly dependent on age and performance status.

How does temozolomide work?
Temozolomide is designed to kill and slow growth of cancer cells in the brain known as glioblastoma.

Goals of therapy:
Temozolomide is taken to shrink tumors and make them more sensitive to radiation. Temozolomide with radiation is not commonly given with the goal of cure, but can decrease symptoms from glioblastoma brain cancer and prolong life.

Schedule

  • One or more capsules by mouth once daily for 42 days (six weeks) with brain radiation
  • Maintenance dosing: one or more capsules by mouth once daily for Days 1 through 5 of a 28-day cycle, for six cycles

Temozolomide is usually taken at home. Typical duration of therapy with radiation is six weeks.

Click here for common starting doses

Side Effects

In clinical studies, the most commonly reported side effects with temozolomide with radiation are shown here:

Note: Nausea, vomiting, and constipation may be more common in patients older than 65 years

On average, 5% of patients discontinued temozolomide due to unacceptable side effects.

Side effect videos Side Effect Videos
Fatigue Fatigue Nausea and VomitingNausea and VomitingAnemiaAnemiaConstipationConstipation

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment and weekly during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

A small sample of brain tissue may be analyzed to see how the MGMT gene is functioning. The MGMT gene repairs tumor cells. If the MGMT gene is turned off (a process known as methylation), the cancer cell cannot repair itself as effectively thus allowing chemotherapy such as temozolomide to kill the cancer cells more effectively. Patients with a MGMT gene methylation may have a better response to temozolomide than those without the gene abnormality.

How often is imaging needed?
Magnetic resonance imaging (MRI) of the brain may be checked before treatment, 2 to 6 weeks after treatment, every 2 to 4 months during the first 2 to 3 years, then periodically until stable. Other imaging may include: computed tomography (CT) scans and bone scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue temozolomide as planned, or delay or switch therapy.

ChemoExperts Tips

  • Try taking your dose of temozolomide before bedtime to avoid experiencing nausea and vomiting. Make sure you always have medications to help treat nausea with you
  • Temozolomide is available in several different strength capsules. You may have to take capsules containing different strengths of temozolomide at the same time to equal the total dose prescribed. Talk to your doctor or pharmacist if you are ever unsure of which capsules to take or how many to take
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for glioblastoma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Temozolomide (Temodar®) + Radiation, we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Temozolomide (Temodar®) + Radiation. Depending upon your income, they may be able to help cover the cost of:

  • Temozolomide

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Temozolomide (Temodar®) + Radiation and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Temozolomide (Temodar®) + Radiation

Individual Drug Label Information

Temozolomide (Temodar®)

  • Temozolomide is an oral capsule that comes in 5 mg (green capsule), 20 mg (yellow capsule), 100 mg (pink capsule), 140 mg (white/blue capsule), 180 mg (white/orange capsule) and 250 mg (white capsule)
  • Take consistently with food or consistently without food with a large glass of water. Do not alternate between taking it with and without food
  • Best to take at night to help avoid nausea
  • Dose may be changed if certain blood counts get too low
  • Capsules should not be opened or chewed; always swallow whole
  • If you miss a dose or if you vomit up a dose do not make up missed dose, wait until next scheduled dose
  • Store at room temperature in a dry place
  • Interacts with an anti-seizure medication called valproic acid (Depakene®, Stavzor®). Talk to your doctor before taking temozolomide if you take these medications
  • Can cause fetal harm; use during pregnancy should be avoided
General Temozolomide (Temodar) Side Effects
  • May cause low red blood cells, white blood cells, and platelets. Your blood counts will be checked frequently during treatment
  • Nausea and vomiting
  • Temozolomide increases your risk of developing a lung infection called pneumocystis pneumonia also known as PCP or PJP. You may have to take antibiotics such as sulfamethoxazole/trimethoprim (Bactrim®), atovaquone (Mepron®), or dapsone to prevent this from ocurring 
  • Liver injury; liver function tests are regularly checked throughout therapy
  • Hair loss
  • Both diarrhea and constipation have been reported
  • Although rare, temozolomide can increase your risk or developing other cancers such as acute leukemia later in life
  • Click on the temozolomide (Temodar) package insert below for reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue ConstipationConstipationAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma. N Engl J Med. 2005;352:987-996.

2. Supplement to: Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987-996.

Created: December 8, 2015 Updated: January 18, 2016

What is Brain Cancer?

Also known as Central Nervous System Cancer, can be grouped into two main types: benign tumors or malignant (cancerous) tumors. Tumors can be of primary type which start in brain tissue, or secondary meaning that they have spread from somewhere else in the body. Symptoms depend upon what part of the brain the tumor is in and may include headache, vision problems, seizures, nausea & vomiting, or mental status changes. Diagnosis is made using imaging with a CT scan (computed tomography) or MRI (magnetic resonance imaging), then often followed by a surgical biopsy.

There is no standard staging system for primary type brain tumors. Brain tumors are assigned a "Grade" based upon the way the cancer cells look under a microscope. Grades include: I, II, III, and IV. Brain cancer is treated with surgery, chemotherapy, radiation therapy, or a combination of all these. Grading systems are used by doctors to determine which treatments to offer. The effectiveness of the treatment may depend upon the Grade at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Common Starting Doses

Temozolomide 75mg/m2/dose, oral capsule(s) by mouth Once Daily + Radiation Therapy for 42 days (six weeks for induction)

Then, Temozolomide maintenance dose: 150 mg/m2/dose, oral capsule(s) Once Daily for Days 1,2,3,4,5 only, of a 28-day cycle for six cycles (six months)

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium