Temozolomide in early stages of newly diagnosed malignant glioma and neoplastic meningitis.

Temozolomide is a novel, oral, second-generation alkylating agent. Preclinical and phase I/II studies have demonstrated its efficacy against newly diagnosed high-grade glioma and anaplastic astrocytoma. Its antineoplastic effect is accompanied by quality of life benefits in patients with these debilitating tumors. Neoplastic meningitis, a refractory disorder, develops in approximately 3% to 8% of patients with systemic cancers. Traditional approaches to leptomeningeal metastases, such as radiation and intrathecal chemotherapy, have limited success and a high degree of toxicity. Temozolomide offers a number of potential therapeutic advantages in this disorder, including activity against a wide spectrum of human cancers that produce neoplastic meningitis and penetration of the blood-brain barrier. Patients treated with temozolomide benefit from both its systemic and intracranial activity. Recently, intrathecal temozolomide has been shown to increase median survival in athymic rats bearing subarachnoid human malignant glioma xenografts. Its efficacy, convenient dosing, and predictable safety profile make it an ideal agent for future study of these difficult-to-treat central nervous system malignancies.