【成份】Temozolomide
【适应症】
本品用于治疗 :新诊断的多形性胶质母细胞瘤，开始先与放疗联合治疗，随后作为辅助治疗 ；常规治疗后复发或进展的多形性胶质母细胞瘤或间变性星形细胞瘤。 
【用量】 
新诊断的多形性胶质母细胞瘤的成人患者：
同步放化疗期：口服本品，75 mg/m2/日，共42天，同时接受放疗。随后接受6个周期的本品辅助治疗。根据患者耐受程度可暂停用药，但无需降低剂量。
辅助治疗期：同步放化疗期结束后4周，进行6个周期的本品单药辅助治疗。起始剂量 ：150 mg/m2/日，共5天，然后停药23天。一周期为28天。从第2周期开始，根据前1周期不良反应，剂量可增至200 mg/m2/日，或减至100 mg/m2。
常规治疗后复发或进展的多形性胶质母细胞瘤或间变性星形细胞瘤患者：
成人患者：以前曾接受过化疗者的起始剂量是150 mg/m2/日，共5天。 成人 没有接受过其他化疗者的起始剂量为200 mg/m2/日，均连用5天，28天为一个周期。治疗可继续到病变出现进展，最多为2年。
儿童患者：
在以前接受过化疗3岁或以上的患儿，每28天周期中本品口服起始剂量是 150 mg/m2/日，共5天。如果没有出现毒性，下个周期的剂量增至200 mg/m2/日.治疗可继续到病变出现进展，最多为2年。
全部患者：

应空腹（进餐钱至少一小时）服用本品。服用本品前后可使用止吐药。如果服药后出现呕吐，当天不能服用第2剂。
不能打开或咀嚼本品，应用一杯水整粒吞服。如果胶囊有破损，应避免皮肤或粘膜与胶囊内粉状内容物接触。 
【FDA妊娠分级】
 D级: 有明确证据显示，药物对人类胎儿有危害性，但尽管如此，孕妇用药后绝对有益（例如用该药物来挽救孕妇的生命，或治疗用其他较安全的药物无效的严重疾病）。 
【禁忌】
 对本药或达卡巴嗪过敏、妊娠期、严重骨髓抑制的患者禁用。 
【注意事项】
对 于接受42-49天合并治疗者需要预防卡氏肺囊虫性肺炎发生。男性患者在治疗过程及治疗结束后6个月之内应避孕，在接受该治疗之前应冰冻保存精子。严重肝 功能异常或肾功能异常者慎用。本药不应用于哺乳期妇女。目前尚无3岁以下多形性胶质母细胞瘤患儿使用该药的临床经验。 
【儿童用药】
 尚无3岁以下多形性胶质母细胞瘤患儿使用该药的临床经验；对于3岁以上胶质瘤儿童患者，使用该药的临床经验有限。
【老年患者用药】 
与年轻患者相比，老年患者（>70岁）中性粒细胞减少及血小板减少的可能性较大。
【孕妇及哺乳期妇女用药】
对 妊娠期妇女使用该药尚未进行研究。在用大鼠和兔所进行的临床前研究中，给药150 mg/m2曾有致畸和/或胎儿毒性的报道。因此替莫唑胺不应常规用于妊娠期妇女，如果妊娠期内必须使用该药，应将可能对胎儿造成的潜在风险告知病人。对于 可能怀孕的妇女，应劝阻其在接受替莫唑胺治疗或在终止替莫唑胺治疗后6个月内怀孕。
替莫唑胺是否可经母乳分泌尚不可知，因此替莫唑胺胶囊不应用于哺乳期妇女。
【不良反应】
 轻 中度胃肠道功能紊乱，具有自限性，或标准止吐药易于控制。骨髓抑制（一般在开始几个周期的第21-28天），通常在1-2周内迅速恢复。其他不良反应包 括：口腔念珠菌病、感染，血象异常，体重降低，焦虑、抑郁、情绪不稳定、失眠、头痛、惊厥、头晕等神经系统症状，视力障碍，听力损害、耳鸣，下肢浮肿、出 血、深静脉血栓形成，咳嗽、呼吸困难，脱发、皮肤干燥，肌无力，尿失禁，疲乏、发热、疼痛、过敏反应、放射损伤、味觉异常，SGPT升高。 
【药物相互作用】
 同时服用丙戊酸，替莫唑胺清除率轻度降低。与其他可导致骨髓抑制的的药物联合应用时，骨髓抑制可能加重。
【药物过量】
在 患者中已进行了剂量为500，750，1000和1250 mg/m2 (每治疗周期服药5天的总剂量)的临床评价。剂量限制性毒性为血液学毒性，在任一剂量下均有报道，但在较高剂量时较为严重。1患者5天中每天过量服用 2000 mg，所报道的不良事件为全血细胞减少症、发热、多器官衰竭及死亡。在服药超过5天（最长达64天）的患者中所发生的不良事件包括骨髓抑制（伴随或不伴随 感染），某些严重且持久的病例最终死亡。在药物过量事件

中，应进行血液学评价。必要时应采取支持性措施。
【药理作用】
替莫唑胺为咪唑并四 嗪类具有抗肿瘤活性的烷化剂。在体循环生理pH状态下，迅速转化为活性产物MTIC（3-甲基-(三嗪-1-)咪唑-4-甲酰胺）。MTIC的细胞毒作用 主要表现为DNA分子上鸟嘌呤第6位氧原子上的烷基化以及第7位氮原子的烷基化。通过甲基化加成物的错配修复，发挥细胞毒作用。
【药代动力学】
临 床前数据提示本品能迅速通过血脑屏障，进入脑脊液。成年患者口服本品后，被迅速吸收，最早在服药后20分钟就可达到血药峰浓度（平均时间为0.5-1.5 小时）。血浆清除率、分布容积和半衰期都与剂量无关。本品的蛋白结合率低 (10-20%)，因此估计不会与蛋白结合率高的药物发生相互作用。口服14C-本品后7天内粪便内排泄的14C为0.8%，表明药物是完全吸收的。口服 后，24小时尿内的原形药占剂量的5%-10%左右，其余是以AIC（4-氨基-5-咪唑-盐酸羧酰胺）形式或其他极性代谢物排泄到尿中。
本品药代动力学的群体分析表明本品血浆清除率与年龄、肾功能或吸烟无关。
儿科患者的AUC比成人患者高，但是儿童和成人每周期的最大耐受剂量(MTD) 都是1000mg/m2。  

Temodal

Active Substance: temozolomide 
Common Name: temozolomide 
ATC Code: L01AX03
Marketing Authorisation Holder: Merck Sharp & Dohme Ltd.
Active Substance: temozolomide 
Status: Authorised
Authorisation Date: 1999-01-26
Therapeutic Area: Glioblastoma Glioma
Pharmacotherapeutic Group: Antineoplastic agents

Therapeutic Indication

Temodal hard capsules is indicated for the treatment of:

adult patients with newly diagnosed glioblastoma multiforme concomitantly with radiotherapy and subsequently as monotherapy treatment;children from the age of three years, adolescents and adult patients with malignant glioma, such as glioblastoma multiforme or anaplastic astrocytoma, showing recurrence or progression after standard therapy.

What is Temodal?

Temodal is a medicine that contains the active substance temozolomide. It is available as capsules (5 mg, 20 mg, 100 mg, 140 mg, 180 mg and 250 mg) and as a powder to be made up into a solution for infusion (drip into a vein).

What is Temodal used for?

Temodal is an anticancer medicine. It is used to treat malignant glioma (brain tumours) in the following groups of patients:

adults with newly diagnosed glioblastoma multiforme (an aggressive type of brain tumour). Temodal is used first with radiotherapy and then on its own;adults and children three years of age and over with malignant glioma such as glioblastoma multiforme or anaplastic astrocytoma, when the tumour has returned or got worse after standard treatment. Temodal is used on its own in these patients.

The medicine can only be obtained with a prescription.

How is Temodal used?

Treatment with Temodal should be prescribed by a doctor with experience in the treatment of brain tumours.

The dose of Temodal depends on body surface area (calculated using the patient’s height and weight) and ranges from 75 to 200 mg per square metre, once a day. The dose and the number of doses depend on the type of tumour being treated, whether the patient has been treated before, whether Temodal is being used alone or with radiotherapy, and how the patient responds to treatment. Temodal capsules should be taken whole without food. If the solution for infusion is used, it should be given over a period of 90 minutes. Patients may also need to take medicines to prevent vomiting before taking Temodal.

For full details, see the summary of product characteristics (also part of the EPAR).

How does Temodal work?

The active substance in Temodal, temozolomide, belongs to a group of anticancer medicines called alkylating agents. In the body, temozolomide is converted to another compound called MTIC. MTIC binds to the DNA of cells while they are reproducing, which stops cell division. As a result, the cancer cells cannot divide, slowing down the growth of tumours.

How has Temodal been studied?

Temodal capsules have been studied in four main studies.

The first study compared the effectiveness of Temodal and radiotherapy with that of radiotherapy on its own in 573 patients with newly diagnosed glioblastoma multiforme.

The other three main studies involved patients with malignant glioma that had come back or got worse after previous treatment. Two of these studies involved patients with glioblastoma multiforme: one looked at the effects of Temodal in 138 patients and the other compared Temodal with procarbazine (another anticancer medicine) in 225 patients. The final study looked at the safety and effectiveness of Temodal in the treatment of 162 patients with anaplastic astrocytoma who were in their first relapse.

The main measures of effectiveness were how long the patients survived or the length of time before the patient’s cancer started to get worse.

A further two studies were carried out in a total of 35 patients with brain tumours to show that the capsules and solution for infusion produce the same levels of temozolomide in the blood.

What benefit has Temodal shown during the studies?

In the study of newly diagnosed glioblastoma multiforme, patients survived for an average of 14.6 months when they received Temodal and radiotherapy, compared with 12.1 months with radiotherapy alone.

In the comparative study of glioblastoma multiforme that had come back or got worse after previous treatment, it took an average of 2.9 months until the cancer got worse in patients taking Temodal, compared with 1.9 months in the patients taking procarbazine. In anaplastic astrocytoma, it took an average of 5.4 months for the cancer to get worse in patients taking Temodal.

What is the risk associated with Temodal?

The most common side effects with Temodal (seen in more than 1 patient in 10) are nausea (feeling sick), vomiting, constipation, loss of appetite, alopecia (hair loss), headache, fatigue (tiredness), convulsions (fits), rash, neutropenia or lymphopenia (low white-blood-cell counts), and thrombocytopenia (low blood platelet counts). Patients receiving the solution for infusion may also have injection-site reactions, such as pain, irritation, itching, warmth, swelling and redness, as well as bruising. For the full list of all side effects reported with Temodal, see the package leaflet.

Temodal must not be used in people who are hypersensitive (allergic) to temozolomide, any of the other ingredients or dacarbazine (another anticancer medicine). Temodal must not be used in patients with severe myelosuppression (a condition in which the bone marrow cannot make enough blood cells).

Why has Temodal been approved?

The CHMP decided that Temodal’s benefits are greater than its risks and recommended that it be given marketing authorisation.

Other information about Temodal

The European Commission granted a marketing authorisation valid throughout the European Union for Temodal on 26 January 1999.

For more information about treatment with Temodal, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

Source: European Medicines Agency