Use of Temozolomide with Other Cytotoxic Chemotherapy in the Treatment of Patients with Recurrent Brain Metastases from Lung Cancer

Abstract Learning Objectives After completing this course, the reader will be able to: Identify appropriate treatments for patients with brain metastases from lung cancer with a consideration of the response rates of chemotherapy in phase II clinical trials. Describe the mechanism of action and the current clinical applications of temozolomide. Explain why temozolomide may have utility in combination with other cytotoxic chemotherapeutic agents for treating brain metastases from lung cancer. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com The use of chemotherapy for the treatment of brain metastases arising from lung cancer has been limited by poor efficacy and high toxicity. Temozolomide, an orally bioavailable alkylating agent that crosses the blood-brain barrier, has activity against brain metastases from both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) when used as a single agent, but response rates are low. Preclinical experiments and early clinical studies in other malignancies indicate that temozolomide may have additive or synergistic effects when used with other chemotherapeutic agents. We report a case of a patient with SCLC with recurrent brain metastases after treatment with multiple chemotherapeutic regimens and whole-brain radiation therapy (WBRT) who was treated with temozolomide (150 mg/m2 for 5 days in a 28-day cycle) and oral etoposide (50 mg/m2 for 10 days in a 28-day cycle). A second patient with NSCLC and brain metastases who progressed after treatment with chemotherapy and WBRT was treated with temozolomide (150 mg/m2 for 5 days in a 28-day cycle) and gemcitabine (1,000 mg/m2 weekly for 2 weeks in a 3- week cycle). In both patients, the temozolomide regimens were extremely well tolerated and resulted in dramatic and durable responses. The combination of temozolomide with other chemotherapeutic agents represents a promising strategy for treating patients with lung cancer and recurrent brain metastases and merits further study.