The DOI matches its Crossref record; 33 of the 35 references it cites were found in a registry or an index.
Multicenter phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse
Open accessAbstract
Background Recurrent glioblastoma multiforme (GBM) is resistant to most therapeutic endeavors, with low response rates and survival rarely exceeding six months. There are no clearly established chemotherapeutic regimens and the aim of treatment is palliation with improvement in the quality of life.Patients and methods We report an open-label, uncontrolled, multicenter phase II trial of temozolomide in 138 patients (intent-to-treat [ITT] population) with glioblastoma multiforme at first relapse and a Karnofsky performance status (KPS) > or = 70. One hundred twenty-eight patients were histologically confirmed with GBM or gliosarcoma (GS) by independent central review. Chemotherapy-naïve patients were treated with temozolomide 200 mg/m2/day orally for the first five days of a 28-day cycle. Patients previously treated with nitrosourea-containing adjuvant chemotherapy received 150 mg/m2/day for the first five days of a 28-day cycle. In the absence of grade 3 or 4 toxicity, patients on the 150 mg/m2 dose schedule were eligible for a 200 mg/m2 dose on the next cycle.Results The primary endpoint was six-month progression-free survival assessed with strict radiological and clinical criteria. Secondary endpoints included radiological response and Health-related Quality of Life (HQL). Progression-free survival at six months was 18% (95% confidence interval (CI): 11%-26%) for the eligible-histology population. Median progression-free survival and median overall survival were 2.1 months and 5.4 months, respectively. The six-month survival rate was 46%. The objective response rate (complete response and partial response) determined by independent central review of gadolinium-enhanced magnetic resonance imaging (MRI) scans was 8% for both the ITT and eligible-histology populations, with an additional 43% and 45% of patients, respectively, having stable disease (SD). Objectively assessed response and maintenance of a progression-free status were both associated with HQL benefits (characterized by improvements over baseline in HQL domains). Temozolomide had an acceptable safety profile, with only 9% of therapy cycles requiring a dose reduction due to thrombocytopenia. There was no evidence of cumulative hematologic toxicity.Conclusions Temozolomide demonstrated modest clinical efficacy, with an acceptable safety profile and measurable improvement in quality of life in patients with recurrent GBM. The use of this drug should be explored further in an adjuvant setting and in combination with other agents.
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“and the average historical TTP is 9.5 ± 1.6 weeks.”
From Alternating electric fields arrest cell proliferation in animal tumor models and human brain tumors (2007) · cites this paper as [26]
In the citing paper
“The average historical PFS6 based on the above studies is 15.3 ± 3.8%”
From Alternating electric fields arrest cell proliferation in animal tumor models and human brain tumors (2007) · cites this paper as [26]
In the citing paper
“OS averaged 29.3 ± 6 weeks (see SI Table 2).”
From Alternating electric fields arrest cell proliferation in animal tumor models and human brain tumors (2007) · cites this paper as [26]
In the citing paper
“Efficacy analysis was performed for 10 recurrent GBM patients by comparing TTP, PFS6, and OS in recurrent GBM patients treated with the NovoTTF-100A device with the TTP, PFS6, and OS of recurrent GBM patients in a literature based historical control group (10, 25–28).”
From Alternating electric fields arrest cell proliferation in animal tumor models and human brain tumors (2007) · cites this paper as [26]
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Cost–effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme
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Laser Ablation of Recurrent Malignant Gliomas
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“TMZ has been approved for use in recurrent HGGs as well and provides improvement in quality of life in these patients.(34) In patients with recurrent HGGs, O6-methylguanine methyltransferase promoter methylation remains a prognostic marker for improved outcome after TMZ treatment.”
BackgroundAzathioprine antagonizes aberrantly elevated lipid metabolism and induces apoptosis in glioblastoma
Nam, H. J., Kim, Y. E., Moon, B.-S., Kim, H. Y., Jung, D., Choi, S., Jang, J. W., Nam, D., & Cho, H. (2021) · iScience · doi:10.1016/j.isci.2021.102238 · Cited by 24
Systemic Temozolomide Combined with Loco-regional Mitoxantrone in Treating Recurrent Glioblastoma
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“The drug is active; nevertheless, in most cases responses are short-lived and generally the overall survival of glioma patients remains unaffected [5,7,13].”
BackgroundResultNew approaches for temozolomide therapy: Use in newly diagnosed glioma
Stupp, R., & Newlands, E. (2001) · Seminars in Oncology · doi:10.1016/s0093-7754(01)90067-3 · Cited by 23
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Self-citationTowards personalized therapy for patients with glioblastoma
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Health-related quality of life and symptom research in glioblastoma multiforme patients
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Chemotherapy in pediatric brain tumor and the challenge of the blood–brain barrier
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Efficacy of temozolomide for recurrent embryonal brain tumors in children
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“The efficacy of temozolomide has been evaluated in patients with relapsed malignant glioma [2, 17].”
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“The 6-month PFS for TMZ-treated patients was 18%, and the 6-month OS was 46% [51].”
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Temozolomide and Radiotherapy as First-Line Treatment of High-Grade Gliomas
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Recent therapeutic advances and insights of recurrent glioblastoma multiforme
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“Several clinical trials tried to evaluate the efficacy of TMZ in recurrent GBM with both standard 5-day schedule (24-30) and dose-dense schedule and showed varied results”
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“Grade III -- IV thrombocytopenia is the dose-limiting toxicity of this regimen and occurs in 7 -- 17% of patients, while grade III -- IV neutropenia occurs with lower frequency [34,36,40-42].”
BackgroundMethodTemozolomide Chemotherapy in Patients with Recurrent Malignant Gliomas
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“Leukopenia 3 (12) 1 (4) 0 0 Thrombocytopenia 0 0 0 0 Nausea/vomiting 7 (28) 0 0 0 Hepatic 2 (8) 1 (4) 0 0 Table 3.”
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Maintenance of fertility following treatment with temozolomide for a high grade astrocytoma
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“It has demonstrated efficacy as first-line therapy for patients with glioblastoma multiforme (GBM) and when given concomitantly and adjuvantly with radiotherapy in newly diagnosed GBM [4,5].”
BackgroundInfluentialErukainure, O. L., Ashraf, N., Naqvi, A. S., Zaruwa, M. Z., Muhammad, A. I., Odusote, A. D., & Elemo, G. N. (2018) · Frontiers in Pharmacology · doi:10.3389/fphar.2018.00251 · Cited by 17
“…multiforme (GBM) is a malignant primary brain tumor common amongst the young kids with range of age < 13 years, characterized by high rates of proliferation, metastasis, and resistance to chemotherapy protocols (Brada et al., 2001; Puli et al., 2006; MarkiewiczŻukowska et al., 2013).”
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New chemotherapy options for the treatment of malignant gliomas
Soffietti, R., Rudà, R., & Trevisan, E. (2007) · Anti-Cancer Drugs · doi:10.1097/cad.0b013e32801476fd · Cited by 17
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“No complete response to temozolomide has been observed in previous studies [14, 15], so patients that begin treatment with residual disease, after only biopsy or partial resection, were expected to still have residual disease at 8 months.”
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Distribution of cancer stem cells in two human brain gliomas
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New developments in the treatment of malignant gliomas
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A Case of Relapsing Glioblastoma Multiforme Responding to Vinorelbine
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Chemotherapy of anaplastic oligodendroglial tumours
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“Temozolomide has been shown to be effective in treating patients with recurrent and newly diagnosed glioblastomas and anaplastic astrocytomas [61-65].”
BackgroundEveraert, E. G., Neyns, B., Joosens, E. J., Strauven, T., Branle, F., & Menten, J. J. (2004) · Journal of Neuro-Oncology · doi:10.1023/b:neon.0000040809.97943.c0 · Cited by 14
“5%) was lower as compared to previous reports (29–68%) [18,19,21].”
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“Similar results were reported in previous studies.(4,8,9)”
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Management of Epilepsy in Oncological Patients
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“In their design, other parameters were evaluated (radiological progression or clinical improvement) that were different from improvement in seizure frequency, a secondary aspect in many cases.(84,85) The usage of temozolomide in low-grade tumors, with a greater survival but a priori less chemosensitive, has been obser…”
BackgroundShah, G., Silver, J. S., Rosenfeld, S. S., Gavrilovic, I. T., Abrey, L. E., & Lassman, A. B. (2007) · Journal of Neuro-Oncology · doi:10.1007/s11060-007-9408-1 · Cited by 14
Surgery, radiotherapy and temozolomide in treating high-grade gliomas
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“Because of its favourable pharmacokinetic and pharmacodynamic properties and improved tolerability, TMZ is has been the subject of several trial for its use as chemotherapeutic agent in newlydiagnosed GBM (12-16).”
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“Brada reported that incidences of grade 3–4 hematological and grade 3–4 non-hematological toxicity in the temozolomide monotherapy for glioblastoma were the same as 25%.(13) Chua reported a higher incidences of grade 3–4 hematological toxicity (36.”
BackgroundMartín, M. G., Bruna, J., Clopes, Fort, Gil, & Martinez, M. (2009) · Cancer Management and Research · doi:10.2147/cmr.s5598 · Cited by 13
Phase II study of two-weekly temozolomide in patients with high-grade gliomas
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Temozolomide Salvage Chemotherapy for Recurrent Anaplastic Oligodendroglioma and Oligo-Astrocytoma
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“In comparison with historical data of phase II clinical trials in patients with recurrent glioblastoma treated with TMZ standard dose (TMZ 5/28) [22–24], we observed a higher PFS-6 (range of PFS-6, 18–24 % vs.”
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“The response rate of glioblastoma (GBM) or AA to the standard TMZ protocol of 5 days in a 28-day cycle is 7–30% [1,2,7,8].”
BackgroundDrivers Underlying Metastasis and Relapse in Medulloblastoma and Targeting Strategies
Holmberg, K. O., Borgenvik, A., Zhao, M., Giraud, G., & Swartling, F. J. (2024) · Cancers · doi:10.3390/cancers16091752 · Cited by 13
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“Bevacizumab (± Irinotecan) 17 (28) PCV 13 (21) Re-operation 12 (20) Gamma knife radiosurgery 8 (13) ACNU/CDDP 7 (12) Re-radiation 3 (5) Metronomic temozolomide 3 (5) Temozolomide re-trial 2 (3) Irinotecan only 1 (1.”
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“Recent studies in relapsing patients with malignant glioma confirmed these findings with 6-month survival rates of 46 and 75%, respectively [7, 50].”
BackgroundComplete Response of Multiple Melanoma Brain Metastases after Treatment with Temozolomide
Dvořák, J., Melichar, B., Žižka, J., Hadzi-Nikolov, D., & Petera, J. (2004) · Oncology Research and Treatment · doi:10.1159/000076908 · Cited by 12
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Distinct spatial N‐glycan profiles reveal glioblastoma‐specific signatures
Angerstein, A. O., Young, L. E. A., Thanasupawat, T., Vriend, J. P., Grimsley, G., Lun, X., Senger, D. L., Sinha, N., Beiko, J., Pitz, M. W., et al. (2025) · The Journal of Pathology · doi:10.1002/path.6401 · Cited by 11
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Perillyl alcohol as a treatment for cancer: A systematic review
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Yang, D., Bu, X., Zhou, Z.-L., Yan, Z., Ma, C., Qu, M., Zhao, Y.-W., Kong, L., Wang, Y.-W., & Luo, J.-C. (2018) · Journal of Cancer Research and Therapeutics · doi:10.4103/jcrt.jcrt_844_17 · Cited by 11
Norden, A. D., Drappatz, J., & Wen, P. Y. (2010) · Blue books of neurology · doi:10.1016/b978-0-7506-7516-1.00005-0 · Cited by 12
Tanaka, S. A., Akimoto, J., Kobayashi, I., Oka, H., & Ujiié, H. (2008) · Oncology Reports · doi:10.3892/or.20.1.165 · Cited by 9
“TMZ is an oral medication with much fewer side effects than conventional anticancer agents and is thought to be extremely useful during maintenance therapy for glioma and recurrence (36,37).”
BackgroundChanging boundaries in the treatment of malignant gliomas
Brandes, A. A., Basso, U., & Pasetto, L. M. (2001) · Expert Review of Anticancer Therapy · doi:10.1586/14737140.1.3.357 · Cited by 10
Insights into pharmacotherapy of malignant glioma in adults
Salvati, M., D’Elia, A., Formichella, A. I., & Frati, A. (2009) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656560903146910 · Cited by 9
“TMZ was initially administered in a 5-day repeated scheme and demonstrated modest activity as a single agent against recurrent GBM after standard surgical and radiotherapy treatment, with response rates of 5% and progression-free survival at 6 months (PFS6) of 21% [10-11].”
MethodConcurrent hyperthermia and re-irradiation for recurrent high-grade gliomas
Heo, J., Kim, S. H., Oh, Y., Chun, M., & Noh, O. K. (2017) · Neoplasma · doi:10.4149/neo_2017_520 · Cited by 9
Joo, J., Chang, J. H., Kim, J. H., Hong, Y.-K., Kim, Y., & Kim, C. (2012) · Journal of Korean Neurosurgical Society · doi:10.3340/jkns.2012.52.2.92 · Cited by 9
“D.(1) Department of Neurosurgery,1 Seoul National University Bundang Hospital, Seongnam, Korea Department of Neurosurgery,2 Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Neurosurgery,3 Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neuro…”
BackgroundCytostatic and cytotoxic drugs
Murphy, F., & Middleton, M. R. (2012) · Side effects of drugs annual · doi:10.1016/b978-0-444-59499-0.00045-3 · Cited by 8
Evaluation of cognitive functions and quality of life
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Li, L., Du, Y., Xiang, D., Chen, L., Shi, Z., Tian, J., & Chen, X. (2018) · Biomedical Optics Express · doi:10.1364/boe.9.003193 · Cited by 8
Garcia-Vega, Y., Salva-Camaño, S., García-Iglesias, E., Cubero-Rego, D., González-Gonzalez, J., & Rivero, I. B. (2015) · Journal of Cancer Research & Therapy · doi:10.14312/2052-4994.2015-20 · Cited by 8
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Recent developments in the molecular characterization and treatment of oligodendroglial tumors
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“Following three preregistration studies which were the largest ever performed in patients with recurrent malignant glioma (Yung et al, 1999, 2000; Brada et al, 2001) it became available in clinical practice.”
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“The early Phase II studies in recurrent GBM defined the standard regimen as 200 mg/m(2) for 5 days every 28 days, with a response rate of 8% and PFS6 of 18%.(36) Temozolomide was granted FDA approval for the treatment of recurrent anaplastic astrocytoma in 1999, and later for recurrent GBM.”
Glioblastoma multiforme: advances in postsurgical management
Mohin, G., Madajewicz, S., Manzione, J. V., & Franceschi, D. (2006) · Community Oncology · doi:10.1016/s1548-5315(11)70921-4 · Cited by 7
Gool, S. V., & Vleeschouwer, S. D. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.12.107 · Cited by 7
Re-evaluation of the cost effectiveness of temozolomide for malignant gliomas in British Columbia
Mabasa, V. H., & Taylor, S. C. M. (2006) · Journal of Oncology Pharmacy Practice · doi:10.1177/1078155206069161 · Cited by 7
Hojan, K. (2016) · Journal of Medical Science · doi:10.20883/jms.2016.91 · Cited by 7
Hassler, M. R., Micksche, M., Stockhammer, G., Pichler, J., Payer, F., Abuja, B., Deinsberger, R., & Marosi, C. (2006) · Wiener klinische Wochenschrift · doi:10.1007/s00508-006-0576-3 · Cited by 7
“This compares favorably with data from other recent studies [20, 26] (Table 3) and might be due to selection of patients with favorable prognostic profiles to this study.”
ResultDai, X., Jiang, W., Wang, W., & Shu-jin, Z. (2010) · Drugs · doi:10.2165/11538040-000000000-00000 · Cited by 7
Effects of palliative treatment with temozolomide in patients with high-grade gliomas.
Ziobro, M., Rolski, J., Grela-Wojewoda, A., Zygulska, A. L., & Niemiec, M. (2008) · PubMed · Cited by 7
Neurocytological Advances in the Treatment of Glioblastoma Multiforme
Fiani, B., Covarrubias, C., Onyedimma, C., & Jarrah, R. M. (2021) · Cureus · doi:10.7759/cureus.16301 · Cited by 6
“The results of this trial were modest yet showed certain quality improvement in the lives of patients and a favorable safety profile [30].”
BackgroundResultInfluentialAdekeye, A., Needham, D., & Rahman, R. (2023) · Pharmaceutics · doi:10.3390/pharmaceutics15020599 · Cited by 8
Evolution of care for patients with relapsed glioblastoma
Balañá, C., Villà, S., & Teixidor, P. (2011) · Expert Review of Anticancer Therapy · doi:10.1586/era.11.152 · Cited by 6
The Effect of Sequential Radiochemotherapy in Preirradiated Malignant Gliomas in a Phase II Study
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The Use of Temozolomide for Chemoradiation and Adjuvant Therapy of High-Grade Gliomas
Miller, J. J., & Reardon, D. A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-812100-9.00031-0 · Cited by 5
Advances in the therapy of high-grade glioma at relapse: pegylated liposomal doxorubicin
Hau, P., Dietrich, J., Fabel, K. S., & Bogdahn, U. (2002) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2.5.609 · Cited by 5
Cytotoxic and molecular chemotherapy for high-grade glioma: an emerging strategy for the future
Cavaliere, R., & Newton, H. B. (2006) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.7.6.749 · Cited by 5
“It has been estimated that 6-month progression-free and overall survival were ∼ 19 and 60%, respectively, with a median time to progression and overall survival of 10 weeks and 7 months, respectively [20-22].”
BackgroundThe role of bevacizumab in recurrent glioblastoma: new insights from randomized trials
Franceschi, E., & Brandes, A. A. (2015) · CNS Oncology · doi:10.2217/cns.15.7 · Cited by 5
Yang, P., Zhang, C., Cai, J., You, G., Wang, Y., Qiu, X., Li, S., Wu, C., Yao, K., Li, W., et al. (2016) · Oncotarget · doi:10.18632/oncotarget.11756 · Cited by 4
“However, the effective response of glioblastomas ranged between 5% and 8%.[18, 19] The role of TMZ chemotherapy was undefined [20] until the EORTC 26981 trial was published.”
BackgroundChemotherapy for Glioblastoma: Past, Present, and Future
Giglio, P. (2009) · Springer eBooks · doi:10.1007/978-1-4419-0410-2_10 · Cited by 4
The economics of temozolomide in brain cancer
Crott, R. (2007) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.8.12.1923 · Cited by 4
Supratentorial High-Grade Gliomas
Tarapore, P. E., Banerjee, A., & Gupta, N. M. (2010) · Springer eBooks · doi:10.1007/978-3-642-02874-8_26 · Cited by 4
Metadata
- Authors
- Brada, M., Hoang-Xuan, K., Rampling, R., Dietrich, P.-Y., Dirix, L. Y., Macdonald, D., Heimans, J. J., Zonnenberg, B. A., Bravo-Marques, J. M., Henriksson, R., Stupp, R., Yue, N., Bruner, J., Dugan, M., Rao, S., & Zaknoen, S.
- Affiliations
- Royal Marsden Hospital (GB)
- Beatson West of Scotland Cancer Centre (GB)
- University Hospital of Geneva (CH)
- KU Leuven (BE)
- University Medical Center Utrecht (NL)
- Instituto Português de Oncologia Francisco Gentil (PT)
- University Hospital of Umeå (SE)
- Johns Hopkins University (US)
- The University of Texas MD Anderson Cancer Center (US)
- ORCID
- Venue
- Annals of Oncology
- Publisher
- Elsevier BV
- Published
- 2001-02
- Volume
- 12
- Issue
- 2
- Pages
- 259-266
- ISSN
- 0923-7534 (ISSN-L)
- OpenAlex
- W2125643269
- Cited by
- 372
- References
- 35
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 3 · 2023: 7 · 2022: 3 · 2021: 7 · 2020: 9 · 2019: 4 · 2018: 10 · 2017: 12 · 2016: 15 · 2015: 14 · 2014: 12 · 2013: 11 · 2012: 17
- FWCI
- 10.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of Oncology (publishedVersion)
- PubMed (publishedVersion)
- reroDoc Digital Library (submittedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- University of California, San Francisco
- Topics
- Health Sciences › Medicine › Oncology › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Oncology › Ovarian cancer diagnosis and treatment
- Keywords
- temozolomide, recurrent glioblastoma, first relapse, gliosarcoma, progression-free survival, objective response rate, health-related quality of life, thrombocytopenia, chemotherapy toxicity, dose escalation, palliative care, overall survival, Karnofsky performance status
- MeSH terms
- Temozolomide, Adult, Aged, Brain Neoplasms, Dacarbazine, Female, Glioblastoma, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Quality of Life, Disease-Free Survival, Antineoplastic Agents, Alkylating
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