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So we’ll talk about the treatment of malignant gliomas, which include anaplastic oligodendrogliomas and oligoastrocytomas. And again, glioblastoma. The medical literature is very clear, certainly for malignant gliomas in that most neuro-oncologists would recommend initiating temozolomide along with radiation therapy for six weeks. temozolomide is typically dosed daily. During that six week portion of the therapy, there are subsequently then becomes a approximately a three to four week break in which we then, after that initiate what we call adjuvant chemotherapy. That adjuvant chemotherapy includes temozolomide as a single agent. Temozolomide is an alkylating agent that injures the tumor DNA. Inherently, some tumors, approximately 40% of malignant gliomas, make a very important enzyme called methyl guanine methyltransferase. This is an enzyme that actually undoes the injury that temozolomide produces on the tumor cells. And if an individual expresses this enzyme as MGMT, that means that they may be less sensitive to the effects of temozolomide at controlling their tumor. That being stated, individuals that do express temozolomide also should receive temozolomide. The literature is actually very clear in that those individuals that have poor prognostic factors, including those that express MGMT. If receiving radiation, temozolomide followed by temozolomide do considerably better than those individuals that don’t receive temozolomide.
