Dose-dense temozolomide for recurrent high-grade gliomas: a single-center retrospective study

Catherine R Garcia, Stacey A Slone, Rachael M Morgan, Lindsey Gruber, Sameera S Kumar, Donita D Lightner, John L Villano

Research output: Contribution to journalArticlepeer-review


There are limited treatment modalities after high-grade gliomas recurrence. MGMT depletion modulated by dose-dense temozolomide (ddTMZ) remains a debated therapy for initial TMZ responders. Patients were selected retrospectively from our practice with diagnosis of high-grade gliomas (WHO grade III or IV), and were followed since the start of ddTMZ until death or change of therapy. Twenty-one patients were reviewed, with a median age of 47 (25-61) years and a median of 5.8 (1.5-38.8) cycles of ddTMZ. The majority were males (71.4%). Sixty-six percent received 21 on/28 off ddTMZ schedule, 28.6% daily, and 1 patient received a 7 days on/7 days off schedule. IDH mutation status was available for 18 (85.7%) patients, with 7 (33.3%) IDH mutant and 11 (52.5%) IDH wild type. MGMT methylation was assessed in 6 (28.6%) of the patients, being MGMT methylated in 3 (14.3%) patients, and non-methylated in 3 (14.3%) patients. The majority of patients (57.1%) were receiving ddTMZ in addition to other forms of therapy, including either bevacizumab (38.1%) or tumor-treating fields (TTFields) (19.1%). Overall ddTMZ was well tolerated, with few adverse events reported. The estimated median overall survival after ddTMZ start was 11 months. Median progression-free survival (PFS) was 6 months. Outcomes did not vary between patients receiving ddTMZ alone or those using TTFields or bevacizumab as concomitant therapy, but there was a trend to longer survival with the use of concomitant TTFields. Our results demonstrate benefit of ddTMZ after previous treatment with standard TMZ dosing with no apparent increase in treatment-related toxicities. In summary, ddTMZ should be considered in TMZ responsive patients and warrants further investigation.

Original languageEnglish
Pages (from-to)136
JournalMedical Oncology and Tumor Pharmacotherapy
Issue number10
StatePublished - Aug 28 2018


  • Adult
  • Antineoplastic Agents, Alkylating/administration & dosage
  • Brain Neoplasms/diagnosis
  • Dose-Response Relationship, Drug
  • Female
  • Glioma/diagnosis
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Grading/methods
  • Neoplasm Recurrence, Local/diagnosis
  • Retrospective Studies
  • Survival Rate/trends
  • Temozolomide/administration & dosage


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