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Home > CNS GBM Adjuvant - lomustine and temozolomide chemoradiation

CNS GBM Adjuvant - lomustine and temozolomide chemoradiation

Treatment Overview

Commence regimen in relation to radiation therapy as per institutional policy.

Cycle 1 - 42 days

Cycle length:
42

First cycle concurrent with radiation therapy.

Cycles 2 to 6 - 42 days

Cycle length:
42

temozolomide: From cycle 2, increase dose stepwise to 120 mg/m², 150 mg/m², and 200 mg/m² if radiation therapy completed, and the white cell count was greater than 2.5 x 109/L, and platelet count was greater than 100 x 109/L in the nadir of the preceding cycle, see Additional details temozolomide dose schedule.  

Cycle details

Cycle 1 - 42 days

Medication Dose Route Days Max Duration
ondansetron 8 mg Twice daily oral administration 1 to 6
lomustine * 100 mg/m² oral administration 1
temozolomide * 100 mg/m² Once daily oral administration 2 to 6
domperidone 10 mg Three times daily oral administration 1
docusate sodium + sennoside B 2 Tablet(s) oral administration 1

First cycle concurrent with radiation therapy.

Cycles 2 to 6 - 42 days

Medication Dose Route Days Max Duration
ondansetron 8 mg Twice daily oral administration 1 to 6
lomustine * 100 mg/m² oral administration 1
temozolomide * [Dose - see details] Once daily oral administration 2 to 6
domperidone 10 mg Three times daily oral administration 1
docusate sodium + sennoside B 2 Tablet(s) oral administration 1

temozolomide: From cycle 2, increase dose stepwise to 120 mg/m², 150 mg/m², and 200 mg/m² if radiation therapy completed, and the white cell count was greater than 2.5 x 109/L, and platelet count was greater than 100 x 109/L in the nadir of the preceding cycle, see Additional details temozolomide dose schedule.  

Full details

Cycle 1 - 42 days

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg Twice daily oral administration
Instructions:

ONE hour prior to chemotherapy and if required 8 to 12 hours after chemotherapy.
lomustine * 100 mg/m² oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Round dose to closest multiple of 10 mg or 40 mg capsules.
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 if required 8 to 12 hours after chemotherapy.
temozolomide * 100 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 if required 8 to 12 hours after chemotherapy.
temozolomide * 100 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 if required 8 to 12 hours after chemotherapy.
temozolomide * 100 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 if required 8 to 12 hours after chemotherapy.
temozolomide * 100 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: 6

Medication Dose Route Max duration Details
ondansetron 8 mg Twice daily oral administration
Instructions:

ONE hour prior to chemotherapy and if required 8 to 12 hours after chemotherapy.
temozolomide * 100 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 - 42 days

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg Twice daily oral administration
Instructions:

ONE hour prior to chemotherapy and if required 8 to 12 hours after chemotherapy.
lomustine * 100 mg/m² oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Round dose to closest multiple of 10 mg or 40 mg capsules.
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 if required.
temozolomide * [Dose - see details] Once daily oral administration
Instructions:

Dose depends on the nadir during the preceding cycle, see temozolomide dose schedule in Additional details below.

  • 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.
Additional details:

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 if required.
temozolomide * [Dose - see details] Once daily oral administration
Instructions:

Dose depends on the nadir during the preceding cycle, see temozolomide dose schedule in Additional details below.

  • 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.
Additional details:

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 if required.
temozolomide * [Dose - see details] Once daily oral administration
Instructions:

Dose depends on the nadir during the preceding cycle, see temozolomide dose schedule in Additional details below.

  • 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.
Additional details:

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 if required.
temozolomide * [Dose - see details] Once daily oral administration
Instructions:

Dose depends on the nadir during the preceding cycle, see temozolomide dose schedule in Additional details below.

  • 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.
Additional details:

Day: 6

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 if required.
temozolomide * [Dose - see details] Once daily oral administration
Instructions:

Dose depends on the nadir during the preceding cycle, see temozolomide dose schedule in Additional details below.

  • 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.
Additional details:

Additional details

Section 1: temozolomide dose schedule

For cycle 2 onwards, temozolomide dose is based on the nadir during the first 25 days of the preceding cycle.

  • If white cell count (WCC) greater than 2.5 x 109/L AND platelets greater than 100 x 109/L and radiation therapy completed increase by one dose level;
  • If WCC less than 1.5 x 109/L OR platelets less than 50 x 109/L reduce by one dose level (or discontinue if already on lowest level);
  • If WCC less than 1 x 109/L OR platelets less than 25 x 109/L reduce by two dose levels.
temozolomide dose level Dose 
-2 50 mg/m2
-175 mg/m2
Starting dose100 mg/m2 
+1120 mg/m2
+2150 mg/m2
+3200 mg/m2

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:

  • day 1, lomustine: MEDIUM to HIGH.
  • days 2 to 6, temozolomide, cycle 1 and doses over 75 mg/m2/day: MEDIUM to HIGH—Regular premedication with ondansetron and/or domperidone may initially be required, for temozolomide doses 75 mg or less (MINIMAL to LOW emetogenicity) regular antiemetic premedication is not usually required; an individualised approach is appropriate.

PJP prophylaxis: Recommended during chemoradiation; may need to be continued after chemoradiation until recovery from cytopenias.

References

Herrlinger U, Tzaridis T, Mack F, et al; Neurooncology Working Group of the German Cancer Society. Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA-09): a randomised, open-label, phase 3 trial. Lancet. 2019 Feb 16;393(10172):678-688., PMID: 30782343

Bristol-Myers Squibb (NZ) Limited. CeeNU New Zealand Data Sheet 15 March 2024. https://www.medsafe.govt.nz/profs/datasheet/c/CeeNUcap10mg.pdf (Accessed 5 November 2024)

Douglas Pharmaceuticals Ltd. Temaccord New Zealand Data Sheet 23 September 2010. https://www.medsafe.govt.nz/profs/datasheet/t/temaccordcap.pdf (Accessed 5 November 2024)

* 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.