Spence Alexander M, Kiem Hans-Peter, Partap Sonia, Schuetze Scott, Silber John R, Peterson Richard A
Department of Neurology, University of Washington School of Medicine, Room RR650, 1959 NE Pacific Street, Seattle, WA 98195, USA.
J Neurooncol. 2006 Oct;80(1):57-61. doi: 10.1007/s11060-006-9152-y. Epub 2006 Apr 28.
This is a report of a 53 year-old man with a glioblastoma multiforme (GBM) treated with an excessive dose of temozolomide (TMZ).
This is a single case review of all clinically relevant records. O6-methylguanine-DNA methyltransferase activity was determined by a biochemical assay.
Following conventional radiotherapy (RT) without concurrent chemotherapy, the patient received 5,500 mg of TMZ over 2 days. At the standard dose of 200 mg/m2/day his total 5-day dose should have been 1,940 mg. Acutely he had nausea, vomiting and diarrhea for 2 days which cleared. The dominant severe toxicity was pancytopenia between one and four weeks after TMZ which was complicated by secondary infections that were successfully managed. Transient transaminitis occurred but there were no significant pulmonary, renal or other systemic toxicities. His progression free survival was 22 months and overall survival 24 months.
His outcome suggests that TMZ may prove to be a good agent for dose-escalation trials with hematopoietic stem cell rescue.
本文报告一名53岁多形性胶质母细胞瘤（GBM）患者，接受了过量剂量的替莫唑胺（TMZ）治疗。
这是对所有临床相关记录的单病例回顾。通过生化测定法测定O6-甲基鸟嘌呤-DNA甲基转移酶活性。
在未进行同步化疗的情况下接受常规放疗（RT）后，患者在2天内接受了5500毫克的TMZ。按照200毫克/平方米/天的标准剂量，其5天的总剂量应为1940毫克。急性期，他出现了2天的恶心、呕吐和腹泻，症状随后缓解。主要的严重毒性是TMZ治疗后1至4周出现的全血细胞减少，并伴有成功处理的继发感染。出现了短暂的转氨酶升高，但无明显的肺部、肾脏或其他全身毒性。他的无进展生存期为22个月，总生存期为24个月。
他的治疗结果表明，TMZ可能被证明是一种适合在造血干细胞救援的剂量递增试验中的良好药物。
