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Cochrane Database of Systematic Reviews

Temozolomide for High Grade Glioma

Overview of attention for article published in this source, October 2008
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Temozolomide for High Grade Glioma
Published by
John Wiley & Sons, Ltd, October 2008
DOI 10.1002/14651858.cd007415
Pubmed ID

Hart, Michael G, Grant, Robert, Garside, Ruth, Rogers, Gabriel, Somerville, Margaret, Stein, Ken


High grade glioma (HGG) is an aggressive form of brain tumour the treatment of which usually entails biopsy or resection where possible followed by radiotherapy. Temozolomide is a novel oral chemotherapeutic drug that penetrates into the brain and has a low incidence of adverse effects. To assess whether temozolomide holds any advantage over conventional therapy for HGG in either primary or recurrent disease settings. The following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2007. Medline, EMBASE, Science Citation Index, Physician Data Query and the Meta-Register of Controlled Trials. Reference lists of identified studies were searched. The Journal of Neuro-Oncology was hand searched from 1999 to 2007 including conference abstracts. Neuro-oncologists were contacted regarding ongoing and unpublished trials. Randomised controlled trials (RCTs). Interventions included the use of temozolomide during primary therapy or for recurrent disease. Patients included those of all ages with a proven pathological diagnosis of HGG. Quality assessment and data extraction were undertaken by two review authors. Outcome measures included survival, time to progression, quality of life (QOL) and adverse events. In primary disease two RCTs were identified, enrolling a total of 703 patients, that investigated concomitant and adjuvant temozolomide in Glioblastoma Multiforme (GBM). Temozolomide increased survival (hazard ratio (HR) 0.84, confidence interval (CI) 0.50 to 0.68, p < 0.001) and an increase in time to progression (HR 0.52 CI 0.42 to 0.64 p < 0.0001). This was without having a statistically significant negative effect on QOL and with a low incidence of early adverse events. Grade 3/4 haematological toxicity was found in 5 to14%. The long term effects of temozolomide are still to be assessed. In recurrent GBM a single trial enrolling 225 patients in total found that temozolomide did not increase overall survival but it did increase time to progression (HR 0.68 CI 0.51 to 0.90 p0.008). Severe adverse events were low in this setting. Temozolomide is an effective therapy in GBM for prolonging survival and delaying progression as part of primary therapy without impacting on QoL and with a low incidence of early adverse events. The frequency and severity of late adverse events is unknown. In recurrent GBM it improves time to progression but not overall survival. These findings are from three good quality but non-blinded RCTs of over 900 patients in total.

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Mendeley readers

The data shown below were compiled from readership statistics for 92 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Brazil 3 3%
Turkey 1 1%
Netherlands 1 1%
Nepal 1 1%
Unknown 86 93%

Demographic breakdown

Readers by professional status Count As %
Researcher 19 21%
Student > Master 18 20%
Student > Doctoral Student 11 12%
Student > Ph. D. Student 11 12%
Student > Bachelor 7 8%
Other 22 24%
Unknown 4 4%
Readers by discipline Count As %
Medicine and Dentistry 53 58%
Agricultural and Biological Sciences 10 11%
Chemistry 6 7%
Engineering 2 2%
Nursing and Health Professions 2 2%
Other 10 11%
Unknown 9 10%