Sunday, January 20, 2008


My doctor thinks temodar, or temozolomide, a relatively well-tolerated oral chemotherapy agent, is the next way to go. I'm not sure it's effective enough. I'm all for minimizing side-effects, but if that means minimizing the effect also, I'm just not down. First paper I picked up on PubMed is reasonably encouraging:

A phase II trial of temozolomide as a 6-week, continuous, oral schedule in patients with advanced soft tissue sarcoma: a study by the Spanish Group for Research on Sarcomas. The upshot from the abstract is "RESULTS: Among 45 eligible patients in the STS arm, there were 7 partial responses, for an overall response rate of 15.5% (95% confidence interval [95% CI], 5-26%). Responses were seen in 5 of 11 patients who had gynecologic leiomyosarcoma. The median response duration was 12.5 months (range, 3.9-58.0 mos). In 4 patients, response lasted > 1 year, and 2 of those patients remained progression free for > 3 years. The median time to progression was 2.2 months (95% CI, 1.8-2.5 mos), and the median overall survival was 8.1 months (95% CI, 5.6-10.6 mos). Progression-free survival rates at 3 months and 6 months were 39.5% and 26%, respectively. In the GIST arm, no responses were noted."

This is the highest response-rate I've seen for temodar in a study, but the series here, while reasonably sized, was heavily tilted toward uterine leiomyosarcoma, which temodar is an established decent drug for.

This study, from MD Anderson, found a 5 percent response rate in people with non-GIST soft-tissue sarcoma.

Another Phase 2 had about an 8 percent response rate; the responders all had some sort of leiomyosarcoma.

This 1999 European phase 2 is quite discouraging. Just one response (3.3 percent).

What's left to check? Temozolomide is often used with irinotecan. I'll try to find some studies on that soon. It also has potential as a radiosensitizer. The full text of this paper Outpatient chemotherapy plus radiotherapy in sarcomas: improving cancer control with radiosensitizing agents could be very interesting.

More soon.

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