Temozolomide: Brands, Price & Uses in Bangladesh

Temozolomide is an oral alkylating chemotherapy agent used in the treatment of certain brain tumors. Its established, FDA-approved indications are:

• Newly diagnosed glioblastoma multiforme (GBM): Temozolomide is given together with radiotherapy (concomitant phase), followed by up to 6 cycles of Temozolomide alone (maintenance phase).
• Refractory anaplastic astrocytoma: Temozolomide is indicated in adult patients whose disease has progressed on a regimen containing a nitrosourea and procarbazine.

Temozolomide is also used off-label, under specialist oncology supervision, in some other central nervous system tumors (for example, recurrent or progressive low-grade gliomas, and brain metastases from melanoma) and in metastatic melanoma, based on clinical judgment and guideline support rather than formal approval. Temozolomide must always be prescribed and monitored by a physician experienced in cancer chemotherapy.

Temozolomide dosing is calculated by body surface area (mg/m²) and individualized according to indication, blood counts, and tolerability. Temozolomide should be taken consistently — either always on an empty stomach or always with a light meal — preferably at least one hour before food, with a full glass of water. Antiemetic premedication is recommended, particularly on the first treatment day.

Dose adjustment, delay, or discontinuation of Temozolomide is required based on neutrophil count, platelet count, and non-hematologic toxicity, as determined by the treating physician. See Contraindications and Precautions and Warnings for stopping points and monitoring requirements.

Very common side effects of Temozolomide include nausea, vomiting, constipation, fatigue, headache, alopecia (hair loss), and loss of appetite.

Common side effects include diarrhea, rash, fever, dizziness, memory impairment, and mild-to-moderate myelosuppression (low blood counts).

Serious side effects requiring urgent medical attention

• Severe or prolonged myelosuppression (very low white cells, platelets, or red cells), which can be unpredictable and severe with Temozolomide — see Precautions and Warnings.
• Signs of liver injury (yellowing of skin or eyes, dark urine, severe fatigue, abdominal pain) — hepatotoxicity associated with Temozolomide has been fatal in rare cases.
• Signs of infection or pneumonia, including Pneumocystis jirovecii pneumonia (PCP), especially during the phase when Temozolomide is combined with radiotherapy.
• Severe allergic reaction (difficulty breathing, swelling of the face or throat, severe rash).

Secondary cancers, including myelodysplastic syndrome and acute myeloid leukemia, have been reported after Temozolomide-based treatment, generally after prolonged use combined with other chemotherapy or radiotherapy.