How Lymphotoxic Is Dose-Intensified Temozolomide?
Wolfgang Wick, Michael Weller Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany To the Editor: The moderate activity of temozolomide (TMZ) administered at 150 to 200 mg/m2 for 5 days every 4 weeks in chemoresistant cancers has provoked the clinical evaluation of a series of alternative dose-intensified TMZ schedules. In a recent issue of the Journal of Clinical Oncology, Su et al1 reported profound and selective CD4+ lymphopenia in malignant melanoma patients treated with TMZ at 75 mg/m2 for 6 weeks every 8 weeks, alone (n = 17) or in combination with thalidomide (n = 73) or -interferon (n = 7). This lymphopenia evolved in the absence of significant neutropenia or thrombocytopenia and was associated with a high incidence of infection thought to be related to T-cell dysfunction. In contrast, our previous evaluation of a 1-week-on/1-week-off dose-intensified TMZ schedule had shown no such toxicity in 21 patients with
