Malignant glioma, ie, anaplastic astrocytoma and glioblastoma, is the most 
common type of primary malignant brain tumor in the People's Republic of China, 
and is particularly aggressive. The median survival of patients with newly 
diagnosed glioblastoma is only 12-14 months despite advanced therapeutic 
strategies. Treatment of malignant glioma consists mainly of surgical resection 
followed by adjuvant radiation and chemotherapy. Temozolomide (TMZ), a 
second-generation oral alkylating agent, is playing an increasingly important 
role in the treatment of malignant glioma in Chinese patients. Since the 
publication of a study by Stupp et al in 2005, which used a protocol of 
conventional fractionated irradiation with concomitant TMZ followed by standard 
TMZ for six cycles, many clinical studies in the People's Republic of China have 
demonstrated that such a treatment strategy has significantly improved efficacy 
with limited side effects for newly diagnosed glioblastoma after surgery as 
compared with strategies that do not contain TMZ. However, as a relatively new 
agent, the history and development of TMZ for malignant glioma is not well 
documented in Chinese patients. Multicenter, randomized controlled trials 
including appropriately sized patient populations investigating multiple aspects 
of TMZ therapy and related combination therapies are warranted in patients with 
malignant glioma. This review provides an update on the efficacy, mechanism of 
action, adverse reactions, and clinical role of TMZ in the treatment of 
malignant glioma in Chinese patients.