Chemo for glioblastoma may work better in morning than evening

April 6, 2021

An aggressive type of brain cancer, glioblastoma has no cure. While researchers are investigating potential new therapies via ongoing clinical trials, a new study from Washington University in St. Louis suggests that a minor adjustment to the current standard treatment – giving chemotherapy in the morning rather than the evening – could add a few months to patients’ survival.

The study appears online in the journal Neuro-Oncology Advances, according to a news release from the university.

Average overall survival for all patients in the study was about 15 months after diagnosis. Those receiving the chemotherapy drug temozolomide in the morning had an average overall survival of about 17 months post diagnosis, compared with an average overall survival of about 13½ months for those taking the drug in the evening, a statistically significant difference of about 3½ months.

“We are working hard to develop better treatments for this deadly cancer, but even so, the best we can do right now is prolong survival and try to preserve quality of life for our patients,” said co-senior author and neuro-oncologist Jian L. Campian, MD, PhD, Associate Professor of Medicine at the School of Medicine. “These results are exciting because they suggest we can extend survival simply by giving our standard chemotherapy in the morning.”

In the current study, the researchers also observed that among a subset of patients with what are called MGMT methylated tumors, the improved survival with morning chemotherapy was more pronounced. Patients with this tumor type tend to respond better to temozolomide in general. For the 56 patients with MGMT methylated tumors, average overall survival was about 25½ months for those taking the drug in the morning and about 19½ months for those taking it in the evening, a difference of about six months, which was statistically significant.

In this retrospective study, the researchers analyzed data from 166 patients with glioblastoma who were treated at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine between January 2010 and December 2018. All patients received the standard of care for glioblastoma. They underwent surgery to remove as much of each tumor as possible and then received radiation therapy along with the chemotherapy drug temozolomide.

After the radiation and temozolomide regimen was complete, patients continued taking a maintenance dose of temozolomide – taken as an oral capsule – either in the morning or evening, depending on the preference of their oncologists.

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