Temozolomide is a medication used to treat people with newly diagnosed or persistent brain cancers (such as glioblastoma multiforme and anaplastic astrocytoma). It is a member of the class of drugs known as antineoplastics. Astrocytoma is a very common form of primary brain tumor and is classified as a glioma. They develop in the brain as astrocytes. These cells provide support and protection to the brain’s nerves (neurons) as well as aid in message transmission. Astrocytomas can form in a variety of locations of the brain due to the presence of these cells throughout. Other brain tumors that do not bear the name “astrocytoma” are nonetheless classified as astrocytomas since they develop from astrocytes. For example, some diffuse midline gliomas.
Temozolomide is a prescription medication that comes in injectable powder and oral capsule form. The medical expert will write a prescription for the medication. Your doctor will decide on the dosage, form, and duration of the medication.
It is given as a maintenance therapy after radiotherapy. It is also recommended for the treatment of resistant anaplastic astrocytoma in patients who have had their condition advance while receiving medication therapy that includes procarbazine hydrochloride and nitrosourea.
Based on several clinical trials, it has been observed that patients with high-grade brain tumors who received temozolomide in addition to radiation therapy had a better average rate of survival in comparison to those who only received radiation therapy. Thus, temozolomide is the primary chemotherapeutic drug used globally to treat glioblastoma.
How does Temozolomide works?
Temozolomide is an agent that is alkylating. It works by inhibiting the division of cancer cells, which causes cell death. Although temozolomide is not active directly, it is rapidly transformed into an active metabolite that breaks DNA strands and kills cells.
It can enter the brain by crossing the blood-brain barrier (BBB), unlike a lot of other medications. The blood-brain barrier (BBB) is a cell membrane that prevents potentially hazardous chemicals from entering the brain.
Precautions while using Temozolomide
In order to ensure that this medication is functioning correctly, it is vital that your doctor monitors your progress during routine appointments. It could be necessary to have blood tests to look for side effects.
If either partner uses this medication while trying to conceive or while pregnant, it could result in birth abnormalities. Your doctor may perform tests to ensure that you are not expecting before starting this medication if you are a woman who is capable of becoming pregnant. Throughout your therapy and for at least six months following your last dosage, use a reliable method of birth control. When undergoing treatment and for three months following the last dosage, males who have female partners and are capable of getting pregnant need to use an effective birth control method. Inform your physician as soon as possible if you believe you are pregnant.
Temozolomide can temporarily decrease your blood’s white blood cell count, which raises your risk of infection. Additionally, it may reduce platelet counts, which are essential for healthy blood coagulation.
Dosage of Temozolomide
Take this drug orally with a full glass of water. Please do not chew, crush, or open the capsules. This drug can be taken with or without food. However, you need to proceed in the same manner each time. Taking this medication on an empty stomach may help decrease nausea. Taking this medication at bedtime may also help with nausea. Follow the instructions on your prescription label. Take your medications at regular times. Do not take your medication more frequently than prescribed. Stop taking it only if your doctor advises you to.
The dosage of medicine taken is determined by the potency of the drug. Furthermore, the number of doses you take each day, the time between doses, and the duration of your medication use are determined by the medical condition for which you are using it.
If you have been recently diagnosed with glioblastoma, the standard treatment is radiotherapy for up to 6 weeks, followed by Temozolomide taken orally every day. It should be taken at the same time every day.
This first stage is referred to as the concurrent phase. During this phase, your oncologist will check on you every week. Your overall health will be examined, along with frequent testing such as full blood counts and bone marrow function.
The results will be used to determine whether or not you should continue taking Temozolomide as part of your therapy.
Four weeks following the completion of radiotherapy, you may commence the monotherapy phase of treatment. This entails taking Temozolomide for the initial five days of a 28-day cycle, which can last numerous cycles. During this stage, blood counts will be obtained on the last day of each cycle once.
Temozolomide may potentially be recommended as a second-line treatment for kids or adults with high-grade gliomas. This means that if the tumor has not responded to other routine treatments or if it returns – a condition called recurrence.
What if I miss dosage
If you miss a Temozolomide dose, take it as soon as possible, preferably within 12 hours. If it has been more than 12 hours after your missed dosage, skip it and return to your regular dosing schedule. Do not take two doses exactly at the same time.
Common side effects of Temozolomide
Infection risk
Your blood’s white blood cell count may drop as a result of this treatment. These cells fight infections. An infection may be more likely to strike if your white blood cell count is low. Neutropenia is a low count of white blood cells. A low white blood cell count can make an illness exceedingly dangerous. You may be prescribed antibiotics and other medications by your doctor to take during this treatment. These might decrease your chance of catching an infection.
Bleeding and bruising
There is a chance that this treatment will lower your blood platelet count. The cells known as platelets help in blood clotting. You may bruise or bleed readily if your platelet count is low. You might have bleeding gums, nosebleeds, blood in your stools and urine, rashes, and heavy periods.
Anemia
Your blood’s red blood cell count may drop as a result of this treatment. The body uses red blood cells to carry oxygen. A low red blood cell count is referred to as anemia.
Constipation
Constipation might arise from this treatment. Being constipated is the inability to pass feces as frequently as you usually can. It might get challenging or painful.
Diarrhea
Diarrhea can occur from this medication. Experiencing loose or watery stools or passing more feces than usual are signs of diarrhea. Also possible is cramping in your stomach. Your stoma can be more active than usual if you have one.
Loss of appetite
Your appetite may be affected by this treatment. If you go a day or two without eating much, don’t worry. However, notify your healthcare provider, nurse, or pharmacist if your appetite does not return within a few days or if you are experiencing weight loss. They are able to offer you guidance. You could get food or beverages as supplements. Alternatively, they could advise you to adjust your eating habits or diet.
Sore throat and mouth
Sore mouth and throat after this treatment is likely. Mouth ulcers are another possibility. You may be more susceptible to a throat or mouth infection as a result of this. After meals, at night, and in the morning, brush your teeth or dentures with a gentle toothbrush.
Tiredness
One of the most common side effects of this medication is fatigue. It often gets worse as the treatment draws to a the end and for a few weeks after. Make an effort to schedule your day and pace yourself to allow for downtime. Short walks or other gentle activity can help you feel less exhausted. Avoid operating machinery or driving if you are tired.
Seizures and headache
Headaches could result from this treatment. Inform your physician or nurse if you experience headaches. They can assist you by giving you painkillers. Seizures (fits) could result from this treatment. Inform your physician or nurse right away if you experience any of these symptoms. They might alter how you are treated. It’s crucial that you avoid operating machinery or driving if you experience these repercussions.
Hair loss
You’ll start to lose hair. Or your head can become completely hairless. In addition, other body hair, including eyebrows and eyelashes, may fall off. Usually, hair loss begins following your first or second treatment.
Skin problem
Your skin may be affected by this treatment. It could result in an itchy rash. The area that was treated by radiation therapy may become red or sore, whether it was received recently or in the past. You might ask your physician or nurse about what to anticipate. Try using an unscented moisturizing cream every day if your skin feels dry.
During therapy and for a few months following, your skin may be more susceptible to sunburn and more prone to burning. Use a sunblock with a high SPF (at least 30) if you’re going to be outside in the sun to protect your skin. Put on a helmet and gear to protect yourself.
Hepatitis B reactivation
This medication has the potential to reactivate liver infections such as Hepatitis B. You will discuss this with your physician or nurse, who may also do a Hepatitis B test on you prior to, during, and following treatment.
Other common side effects of Temozolomide
- Muscle or joint pain
- Raised blood sugar levels
- Fluid build-up
- Hearing changes
- Taste changes
- Eyesight issues
- Mood swings
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