Treating malignant glioma in Chinese patients: update on temozolomide

Figures & data

Table 1 Overview of different chemotherapeutic agents and cost of treatment for a patient with malignant glioma*

Variable	Nitrosoureas			VM-26	ACNU + VM-26	TMZ (Chinese)		TMZ (Western)	Bevacizumab
	ACNU	BCNU	MeCCNU			Temadar®	Diyi®
Mode of action	DNA chloroethylation			Topoisomerase II inhibitor	Combined actions	DNA methylation			Angiogenesis inhibitor
BBB penetration	+	+	+	+	+	++	++	++	−
Oral or intravenous	Intravenous	Intravenous	Oral	Intravenous	Intravenous	Oral	Oral	Oral	Intravenous
Cost ($)^	61/25 mg	21/125 mg	3/50 mg	23/50 mg	61/25 mg + 23/50 mg	41/20 mg 143/100 mg	52/50 mg	35/20 mg 102/100 mg	853/100 mg
Dose (mg/m^2/day)	90	100	150	60	90+60	75† 150–200‡	75† 150–200‡	75† 150–200‡	5–10 mg/kg
Total ($)/6 cycles	2,182	369	3,060	8,316	10,498	25,444	17,050	19,130	15,327–30,629

Notes:

* Data refer to acquisition cost only and were calculated for a patient with a 1.72 m² body surface area

^ price per unit drug is taken from the price list of the local hospital, according to the current exchange rate, 1$ being equal to 6.10 ¥;

† concomitant with irradiation regimen

‡ adjuvant to irradiation regimen.

Abbreviations: BBB, blood-brain barrier; ACNU, nimustine; BCNU, carmustine; MeCCNU, semustine; VM-26, teniposide; TMZ, temozolomide.

Figure 1 Comparison between Chinese and worldwide literature on use of temozolomide in high grade glioma. (A) Studies published in Chinese databases and PubMed from 2010 to 2012. (B) Patients enrolled in studies identified in Chinese databases and PubMed from 2010 to 2012. *The online PubMed database (http://www.ncbi.nlm.nih.gov) was considered representative of countries other than the People’s Republic of China; the China Knowledge Resource Integrated Database and Chinese Medical Association Digital Periodicals were considered representative of the People’s Republic of China. The databases were searched using the search terms “glioma”, “glioblastoma”, and “temozolomide” from January 2010 to October 2012. In the event that one study was the subject of several publications, the publication with the largest sample size was used. Inclusion criteria were: clinical study of temozolomide in high grade glioma and retrospective or prospective study design. Chinese studies were excluded from data obtained from the PubMed database. Forty papers including 3,470 patients were identified in PubMed and 34 papers including 1,966 patients were identified in the Chinese databases.

Table 2 Therapeutic activity of temozolomide for high grade glioma in Western and Chinese patients

References	Cases (n)	Research subjects	Methods and results (RR, OR, or HR, 95% CI)	Database
Yin et al^Citation41 (2003–2012)	993	Elderly with GBM (>65 years)	TMZ versus RT  Increased OS (HR 0.86, CI 0.74–1.00)	PubMed, EMBASE, Cochrane
Hart et al^Citation42 (1999–2007)	683	High-grade	TMZ plus RT versus RT  Increased OS (HR 0.58, CI 0.50–0.68)  Increased PFS: (HR 0.56, CI 0.48–0.67)	CENTRAL, Medline, EMBASE, SCI, PDQ, Meta-Register of Controlled Trials
	225	Recurrent high-grade	TMZ plus RT versus RT alone  Increased OS (HR 0.87, CI 0.65–1.16)  Increased PFS (HR 0.68, CI 0.51–0.90)
Liang et al^Citation43 (2007–2010)	241	High-grade	TMZ plus RT versus RT  Increased OS (RR 1.87, CI 1.47–2.38)	*CNKI, SinoMed, VIP databases
Wang et al^Citation44 (2007–2008)	438	High-grade	TMZ versus other alkylating agents  Increased PR (OR 3.70, CI 2.37–5.79)	CNKI, SinoMed, VIP databases

Note:

* CNKI, SinoMed, and VIP database are Chinese databases.

Abbreviations: HR, hazard ratio; OR, odds ratio; RR, relative risk; CI, confidence interval; OS, overall survival; PR, partial response; PFS, progression-free survival; TMZ, temozolomide; GBM, glioblastoma; RT, radiation therapy; EMBASE, Excerpta Medica Database; SCI, Science Citation Index; PDQ, Physician Data Query; CENTRAL, Cochrane Central Register of Controlled Trials; CNKI, Chinese National Knowledge Infrastructure; VIP, Very Important Person.

YinAAZhangLHChengJXRadiotherapy plus concurrent or sequential temozolomide for glioblastoma in the elderly: a meta-analysisPLoS One20138e7424224086323

 PubMed Web of Science ®Google Scholar

HartMGGrantRGarsideRTemozolomide for high grade gliomaCochrane Database Syst Rev20084CD00741518843749

 PubMed Web of Science ®Google Scholar

LiangHDongSLEffectiveness and safety of postoperative radiotherapy plus temozolomide for treating brain malignant glioma in China: a meta-analysisModern Oncology20101823452348 Chinese

 Google Scholar

WangYWYinCLZhangZYMeta-analysis of temozolomide for high grade gliomasJ Shandong University2012508083 Chinese

 Google Scholar