Chemotherapy has long been a mainstay for treating metastatic melanoma (that is, melanoma that has spread to other parts of the body). Unfortunately, there isn't a clear consensus among doctors about the most effective use of these drugs, which most likely reflects their low level of activity. Their side effects, however, are well-known and should be understood completely before treatment. This overview is part of a series that will introduce you to the most common chemotherapy drugs used to treat metastatic melanoma.
Note that this information may not cover all possible precautions, interactions, or adverse effects for this drug. If you have any questions about the drugs you are taking, be sure to talk about temozolomide with your healthcare professional.
Temodar, Temodal, TMZ
Temozolomide is an "alkylating agent" that links specific sections of DNA, thus preventing cell division and in turn, killing the cell. It is similar to another chemotherapy drug called dacarbazine in that it is converted to the same chemical (called MTIC) in the body, but differs in that it can cross the blood-brain barrier to better attack brain tumors.
Evidence that Temozolomide is Effective
Temozolomide is only FDA approved to treat brain cancer but it is also used "off label" in patients with melanoma that has metastasized to the brain or nervous system.
In late 2008, Poulam Patel, Ph.D., and colleagues from the University of Nottingham in England presented results from a disappointing phase III trial that compared high doses of temozolomide to dacarbazine in patients with stage IV melanoma. Although temozolomide was shown to have a higher response rate than dacarbazine, it didn’t improve the statistic that really counts: overall survival. However, since temozolimide comes in convenient pill form, some doctors prescribe it for patients who have difficulty with IV infusions or are unable to travel to a healthcare facility for the equally effective dacarbazine injection.
Currently, 18 clinical trials are investigating temozolimide use in patients with metastatic melanoma. These include studies combining temozolimide with other drugs such as thalidomide and interferon-alfa2b. If you or a loved one has metastatic melanoma, be sure to ask your doctor if you are eligible for these trials.
Potential Side Effects
The following serious side effects have occurred in a small percentage of people taking temozolomide. If you experience any of these, seek emergency medical attention immediately:
- skin rash, itching or hives, pain at the injection site, swelling of the face, lips, or tongue (signs of an allergic reaction)
- fever or chills, cough, sore throat, pain or difficulty passing urine (signs of infection due to a decrease in the number of white blood cells)
- bruising, pinpoint red spots on the skin, black, tarry stools, blood in the urine (signs of a decreased number of platelets)
- severe weakness, fainting spells, lightheadedness (signs of a decreased number red blood cells)
The following less serious side effects have also been reported but don’t require immediate attention:
- nausea and vomiting
- changes in vision
- memory problems
- problems with balance, walking
- loss of appetite
Interactions and Cautions
Do not take temozolomide if you have had an allergic reaction to it or dacarbazine in the past. Tell your doctor if you take valproic acid, which is used to treat seizures. Do not take if you are pregnant or breastfeeding.
Melanoma. National Comprehensive Cancer Network. V1.2009. 23 November 2008.
Temozolomide. Drug Information Portal. US National Library of Medicine. 25 November 2008.
Quirbt I, et al. “Temozolomide for the treatment of metastatic melanoma.” Curr Oncol 2007 14(1), 27-33. 30 November 2008.
Patel P, et al. “Extended schedule, escalated dose temozolomide versus dacarbazine in stage IV malignant melanoma: Final results of the randomised phase III study EORTC 18032.” 33rd European Society of Medical Oncology (ESMO) Congress 2008 Abstract LBA8. 1 December 2008.