Concomitant (without adjuvant) temozolomide and radiation to treat glioblastoma: a retrospective study.

Between November 2004 and August 2006 we treated 35 patients with concomitant temozolomide (TMZ) and radiotherapy. Twelve patients had very large or multicentric glioblastoma multiforme with a poor performance status and received TMZ plus radiation doses of 45-50.4 Gy. The median survival of these patients was only 3.8 months. Twenty-three patients would have been eligible for randomisation in the European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada (EORTC/NCIC) trial comparing combined and adjuvant TMZ plus radiation against radiotherapy alone. This group of patients received 60 Gy in 30 fractions plus concomitant TMZ (75 mg/m(2)) but no adjuvant chemotherapy. At a median follow-up of 26 months, five of 23 patients are alive. The median survival time was 17 months (1.43 years; 95% confidence interval 0.96-1.55). Eighteen per cent were alive at 2 years. Toxicity from TMZ was infrequent. This series adds to indirect evidence that the concomitant rather than the adjuvant is the more efficacious part of the EORTC/NCIC schedule for this type of patient. Further trials should include a concomitant chemoradiotherapy regimen as well as concomitant plus adjuvant chemotherapy.

The role of epoetin beta in the treatment of anaemia in patients with gynaecological malignancies.

Cancer-related anaemia has a major detrimental effect on quality of life (QoL) and adversely affects patient outcome, having a negative impact on local tumour control, disease-free survival and overall survival. The incidence of cancer-related anaemia is particularly high among patients with gynaecological cancers, affecting up to 80% of individuals in this patient group. Anaemia may develop as a consequence of the disease itself; however, the myelosuppressive and nephrotoxic effects of the intensive chemotherapy and/or radiotherapy regimens frequently used in the treatment of gynaecological cancer are major causative factors. Although blood transfusions were traditionally used for the management of anaemia in patients with cancer, associated adverse events and inconvenience of use have meant that they are now reserved for patients with severe anaemia who require rapid improvements in haemoglobin (Hb) levels. As a consequence, epoetins, with their ability to provide stable Hb levels over prolonged periods, are now firmly established in the management of cancer-related anaemia. The efficacy of epoetin beta, a recombinant human erythropoietin, has been investigated in patients with gynaecological malignancies and anaemia in several European trials. These studies confirm that epoetin beta increases Hb levels, reduces transfusion requirements and improves QoL, and support the use of epoetin beta as an integral part of the treatment regimen in patients with ovarian or cervical malignancies receiving radio-and/or chemotherapy.