Temozolomide and thalidomide in the treatment of glioblastoma multiforme

OBJECTIVE

The aim of this study was to assess efficacy and toxicity of temozolomide given alone or in combination with thalidomide, an anti-angiogenetic drug, in patients with newly diagnosed glioblastoma multiforme (GBM).

PATIENTS AND METHODS

46 patients with histologically proven GBM were eligible for inclusion. Twenty-three patients (15 males and 8 females) received temozolomide on a conventional schedule; 23 patients (12 males and 11 females) received temozolomide on the same schedule and thalidomide was dose-adjusted in each individual patient based on their tolerance.

RESULTS

The median survival time was 12 months for temozolomide and 13 months for temozolomide + thalidomide.

CONCLUSION

The administration of temozolomide in association with thalidomide after radiotherapy (RT) does not offer an advantage over temozolomide alone in adults with newly diagnosed GBM. The two therapeutic strategies produce similar results for survival, but the latter regimen shows a moderate increase in toxicity.

[Evolution and radiologic sequelae of pulmonary tuberculosis]

During the treatment of pulmonary tuberculosis, the radiologist is often asked the following questions: 1) is it really TB?; 2) is there any improvement?; 3) when is the X-ray check-up required?. In our opinion, the radiologist is in a position: 1) to confirm the diagnosis of TB; 2) to give a radiological diagnosis of "abnormality" but without a prognostic opinion; 3) to suggest, case by case, when the X-ray check-up is required. After some month or years, when radiological-clinical sequelae are present, the radiologist is often asked equally difficult questions: 1) is it still TB?; 2) is it still active?; 3) could it have caused the hemoptysis?. Again, in our opinion, the radiologist must bear in mind: 1) the not infrequent possibility of reinfections; 2) that the fine, smooth contour of the cavity, whose shape remains unchanged, does not necessarily signify absence of activity; 3) that, at the present time, other illnesses (bronchitis, bronchiectasis, lung cancer) are more frequently the cause of hemoptysis.

[Radiologic determination of total lung capacity]

The authors studied in 50 healthy subjects the cilindroid and the planimetric method for the radiological measurement of TLC. Both methods proved to be accurate, but the first showed a better relation with the pletismographic measurements; in both methods the individual variability was very limited (5 divided by 6%). In a screening protocol comprising double-projection chest X-ray, the radiological measurement of TLC seems to be very useful to evaluate with simplicity and realiability its values and its variations in time.

[Radiological mass screening in pulmonary cancer. Is it useful in improving the prognosis?]

The diagnostic usefulness and practical possibilities of mass X-ray screening in lung cancer is examined. On the basis of the literature and personal experience, the conclusion is cautiously pessimistic, in agreement with what has recently been stated by Lemoine, Corda and others.

[A roentgenologic study on metoclopramide in the vagotomized rat]

After a brief description of the central pharmacodynamic action of metoclopramide, the results of an investigation in two groups of rats of the same age, sex, and weight are reported. The first group was subjected to vagotomy, whereas the second consisted of normal animals. The experiment consisted of two stages. During the first part of the experiment control roentgenograms were taken at fixed intervals after a barium solution had been introduced into the stomach of the animals (both normal and vagotomized). Later, the experiment was repeated after the intravenous or intramuscular administration of 5 mg of metoclopramide. A positive action of Plasil on the gastro-intestinal motility was confirmed in the normal rat, as was the negative action of the drug in the vagotomized animal. An effective action of the drug on the gastro-intestinal system thus depends on the integrity of the efferent parasympathetic paths; this is probably also related to species differences.