Journal of neuro-oncology · 2025
Effects of temozolomide dosing on outcome in glioblastoma.
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Raghu Anuradha, Killar Sofia, Cohen Adam L
Аннотация
PURPOSE: Temozolomide (TMZ) with concomitant radiation is the standard therapy for treating glioblastomas (GBM) and is dosed based on body surface area (BSA) using a goal dose of 75 mg/m2. Neurooncologists have different methods of dosing patients, with some dosing within 5 mg of the calculated dose and others rounding to reduce patient burden. We aimed to determine the effect of rounded doses of TMZ on survival.
METHODS: We conducted a single-center retrospective review of 380 patients with GBM from 2013 to 2024. Relevant data was extracted from electronic medical records. Kaplan-Meier curves and Cox regression models were used to determine survival outcomes.
RESULTS: No significant impact on survival outcomes was observed when distance from the calculated temozolomide dose was analyzed as a continuous variable (p = 0.156), adjusting for MGMT, the extent of resection, radiation fractions, and Karnofsky performance scores (KPS). Even limited to just MGMT-methylated tumors, TMZ dose did not affect survival. BMI had no impact on survival outcomes. Our subgroup analysis revealed that patients with MGMT-methylated tumors, total resection, higher KPS, and ≥ 30 radiation fractions had improved survival (p < 0.01). Dose interruptions were not more likely with doses above 75 mg/m2 (14%) than with doses at or below 75 mg/m2 (9%) (p = 0.22).
CONCLUSION: Rounding temozolomide doses does not significantly impact survival outcomes or risk of treatment interruptions for patients with GBM. These findings may allow neuro-oncologists to prioritize reducing pill burden and treatment costs without compromising patient outcomes.
METHODS: We conducted a single-center retrospective review of 380 patients with GBM from 2013 to 2024. Relevant data was extracted from electronic medical records. Kaplan-Meier curves and Cox regression models were used to determine survival outcomes.
RESULTS: No significant impact on survival outcomes was observed when distance from the calculated temozolomide dose was analyzed as a continuous variable (p = 0.156), adjusting for MGMT, the extent of resection, radiation fractions, and Karnofsky performance scores (KPS). Even limited to just MGMT-methylated tumors, TMZ dose did not affect survival. BMI had no impact on survival outcomes. Our subgroup analysis revealed that patients with MGMT-methylated tumors, total resection, higher KPS, and ≥ 30 radiation fractions had improved survival (p < 0.01). Dose interruptions were not more likely with doses above 75 mg/m2 (14%) than with doses at or below 75 mg/m2 (9%) (p = 0.22).
CONCLUSION: Rounding temozolomide doses does not significantly impact survival outcomes or risk of treatment interruptions for patients with GBM. These findings may allow neuro-oncologists to prioritize reducing pill burden and treatment costs without compromising patient outcomes.