A phase II trial of temozolomide for patients with recurrent or progressive brain metastases

Background: Treatment options for patients with recurrent brain metastases are extremely limited. This study was designed to determine the safety and efficacy of temozolomide in the treatment of recurrent or progressive brain metastases. Patients and methods: Forty-one patients (11 men, 30 women) with a median K PS of 80 were treated with temozolomide 150 mg/m(2)/day (200 mg/m(2)/day if no prior chemotherapy) for 5 days; treatment cycles were repeated every 28 days. Primary tumor types included 22 non-small cell lung, 10 breast, thre e melanoma, two small cell lung, two rectal, one ovarian and one endometria l cancer. Results: There were five episodes of grade 3 thrombocytopenia and one grade 4 leukopenia. Significant non-hematologic toxicity possibly related to tem ozolomide included pneumonitis [2], constipation [1], and elevated liver en zymes [2]. Thirty-four patients were assessed for radiographic response; tw o had a partial response, 15 stable disease and 17 progressed. Both objecti ve responses were seen in patients with non-small cell lung cancer. Overall median survival was 6.6 months. Conclusions: Single agent temozolomide achieved disease control (PR or SD) in 41% of patients with recurrent brain metastases from a variety of primar y malignancies with minimal toxicity. Therefore, temozolomide may be a reas onable treatment option for some patients with recurrent brain metastases.