Quick Answer
Temonat — temozolomide 20/100/250 mg (Natco Pharma). Oral DNA-alkylating agent — first-line chemotherapy for glioblastoma multiforme (with concurrent radiotherapy then adjuvant), anaplastic astrocytoma, melanoma (off-label/historical). Crosses the blood-brain barrier.
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⚠️ Specialist-supervised cancer therapy — this medication is started, monitored, and stopped by an oncologist or haematologist. Dosing depends on tumour type, stage, body surface area, organ function, and concomitant therapy. Self-treatment is not appropriate; the information below is educational and supports informed conversations with your specialist.
Cumulative myelosuppression (especially thrombocytopenia and lymphopenia). Mandatory weekly FBC. Lymphopenia + concurrent radiotherapy creates infection risk — Pneumocystis jirovecii pneumonia (PCP) prophylaxis (cotrimoxazole or atovaquone) is recommended during the chemoradiation phase.
Frequently Asked Questions
Standard schedule?
Stupp protocol: 75 mg/m²/day during 6 weeks of radiotherapy, then 4-week break, then adjuvant 150-200 mg/m² × 5 days every 28 days for 6 cycles. Newer schedules (extended adjuvant, dose-dense) are used in selected cases.
Take with food?
Empty stomach (1 hour before food or 2 hours after) on the same schedule each day. Antiemetic prophylaxis (5-HT3 antagonist) is standard.
Common side effects?
Nausea/vomiting (controlled by antiemetics), fatigue, lymphopenia, thrombocytopenia, headache, alopecia (with radiotherapy), constipation.
MGMT methylation status?
MGMT promoter methylation predicts greater benefit from temozolomide. Test all newly diagnosed glioblastomas. Methylated tumours have median survival ~22 months on Stupp regimen vs ~12 months unmethylated.
PCP prophylaxis — why?
Prolonged lymphopenia + concurrent radiotherapy creates risk of opportunistic infection, particularly Pneumocystis jirovecii pneumonia. Cotrimoxazole 480 mg three times weekly during the chemoradiation phase is standard.
Pregnancy?
Strongly contraindicated — teratogenic. Effective contraception during and for at least 6 months after for both partners.
Drug interactions?
Few significant. Valproate may modestly affect levels. Antiemetics (granisetron, ondansetron) routinely used.
What if I miss a dose?
Skip the missed dose; resume normal schedule next day. Notify oncology team.
Long-term complications?
Cumulative myelosuppression and small risk of secondary malignancy (myelodysplasia, AML) after years of cumulative therapy.
What about second-line?
On glioblastoma progression, options include bevacizumab, lomustine, re-irradiation, or clinical trials. No standard-of-care second-line — all decisions specialist-led.
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