Systemic Anti-Cancer Therapy Regimen Library
Part 2: temozolomide following chemoradiation (CNS GBM - temozolomide chemoradiation followed by temozolomide)
Treatment Overview
Usually 6 cycles, may be increased up to 12 cycles at clinician discretion.
If cycle 1 temozolomide dose of 150 mg/m2 is well tolerated, dose may be increased to 200 mg/m2 from cycle 2.
Cycle 1 - 28 days - temozolomide 150mg/m2
Cycles 2 to 6 - 28 days - temozolomide 200 mg/m2 (may be used if cycle 1 dose of 150 mg/m2 was well tolerated)
Cycle details
Cycle 1 - 28 days - temozolomide 150mg/m2
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration | 1 to 5 | |
| temozolomide | 150 mg/m² Once daily | oral administration | 1 to 5 | |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| docusate sodium + sennoside B | 2 Tablet(s) | oral administration | 1 |
Cycles 2 to 6 - 28 days - temozolomide 200 mg/m2 (may be used if cycle 1 dose of 150 mg/m2 was well tolerated)
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration | 1 to 5 | |
| temozolomide | 200 mg/m² | oral administration | 1 to 5 | |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| docusate sodium + sennoside B | 2 Tablet(s) | oral administration | 1 |
Full details
Cycle 1 - 28 days - temozolomide 150mg/m2
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 150 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| domperidone | 10 mg Three times daily | oral administration |
Instructions:
When required for nausea and/or vomiting. The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics. |
|
| docusate sodium + sennoside B | 2 Tablet(s) | oral administration |
Instructions:
At night when required for constipation. Each tablet contains docusate sodium 50 mg + sennoside B 8 mg. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 150 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 150 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 150 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 150 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
Cycles 2 to 6 - 28 days - temozolomide 200 mg/m2 (may be used if cycle 1 dose of 150 mg/m2 was well tolerated)
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 200 mg/m² | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| domperidone | 10 mg Three times daily | oral administration |
Instructions:
When required for nausea and/or vomiting. The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics. |
|
| docusate sodium + sennoside B | 2 Tablet(s) | oral administration |
Instructions:
At night when required for constipation. Each tablet contains docusate sodium 50 mg + sennoside B 8 mg. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 200 mg/m² | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 200 mg/m² | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 200 mg/m² | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and 8 to 12 hours after chemotherapy. |
|
| temozolomide | 200 mg/m² | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Constipation risk: | laxatives are usually prescribed |
| Emetogenicity: | Medium to high |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis may be considered |
Emetogenicity: Routine antiemetic premedication may not be required for continuous dosing of oral anti-cancer medicines with MEDIUM to HIGH emetic risk; an individualised approach is appropriate.
PJP prophylaxis: May need to be continued after temozolomide chemoradiation until recovery from cytopenias.
References
No references
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.