In Practice

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  Temozolomide should be used with caution in the treatment of pituitary tumours because of the lack of formal controlled trial data. The preferred dosing regimen should be 200 mg/m daily for 5 days every 28 days. The optimal duration of temozolomide treatment remains unclear.
  
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  Rapid tumour shrinkage or hormonal response to temozolomide treatment is usually observed within weeks after treatment initiation in responding patients. As a consequence, the lack of response after three cycles predicts further resistance to this treatment. In contrast, an initial response to temozolomide is not always associated with short- or long-term control.
  
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  MGMT expression, but probably not MGMT promoter methylation, could theoretically represent a predictive factor for response to temozolomide. However, contradictory published results suggest that, at least to date, this parameter should not influence the clinical decision for treatment with temozolomide.