- What is the clinical effectiveness of extended dosing (12 cycles) of adjuvant temozolomide in adult patients with newly diagnosed high grade gliomas?
- What is the cost-effectiveness of extended dosing (12 cycles) of adjuvant temozolomide in adult patients with newly diagnosed high grade gliomas?
- What are the evidence-based guidelines associated with the use of adjuvant temozolomide in adult patients with newly diagnosed high grade gliomas?
Evidence from two randomized controlled trials and one non-randomized controlled trial of adult patients with newly-diagnosed gliomas suggest that compared with the conventional 6-cycle adjuvant temozolomide therapy, the 12-cycle regimen was associated with improved survival outcomes, including overall survival and progression-free survival, although the between-group difference in overall survival was not statistically significant. The use of 12-cycle adjuvant temozolomide therapy was also related to higher risks of Grade 3-4 toxicities compared with the 6-cycle regimen, especially for hematological toxicities. However, the clinical effectiveness of extended dosing of adjuvant temozolomide relative to conventional 6-cycle regimen should be interpreted with caution, due to the compromised quality and the small sample size in some of the included trials. Two evidence-based clinical practice guidelines developed in Spain recommend the use of 12-cycle adjuvant temozolomide therapy after surgery and radiotherapy, for newly-diagnosed glioblastoma in elderly patients ( 65 years) or anaplastic astrocytoma.No relevant economic evaluations were identified from the literature to examine the cost-effectiveness of 12-cycle temozolomide therapy in the population of interest.