Saturday, 13 February 2016

Keppra and Temozolomide

Hi Everyone!

I'm new to this blog. I've read many posts and this is a great help to me, as I'm a beginner in the drug coctail treatment.

Our story briefly:
1) My father, 55, was diagnosed with an unknown brain tumor in October 2015 (the biggest dimension 43 mm). Craniotomy was carried out 3 days after the diagnosis. Preliminary histopathology - astrocytoma III, final result - glioblastoma IV.
2) First MRI after the surgery in December, right before chemoradiation, showed still a big tumour. According to the oncologist - radical recurrence. According to another neurosurgeon (we consulted the MR image in another hospital) - first craniotomy improperly done (!!). I'm not sure who's right... the other neurosurgeon, specialized in gliomas, was very convincing.
3) We decided for another surgery (by another surgeon). The resection must have been deeper as afterwards my dad's sight is worse (he sees everything darker, has problems with reading, seeing details etc., however he's getting better, it's been 6.5 weeks since the surgery).
4) Now chemoradiation. First cycle of Temodal during radiation for 42 days on a daily basis.
5) Tumour unmethylated, IDH1 negative. Other genetical tests of a frozen sample in progress.

We are at the very beginning of the drug&supplements treatment. It's very difficult to collect all the prescribed drugs. We're located in Poland. Started like that:
Temodal (150 mg/day);
Depakine (valproic acid) 2x500mg/day- prescribed by the neurosurgeon to prevent seizures;
Keppra (will start tomorrow, 2x500 mg/day)- added in order to sensitize the tumour for TMZ (prescribed by our GP on request, she agreed);
Dexamethasone (2 mg/day);
Proton pump inhibitor (1x/day) - drug called IPP20 in Poland;
"Pheonix tears" with high THC and CBD (rectal application) - 2 ml/day
Curcumin (up to 3000mg/day)
Vitamin C (1000 mg/day)
Sugar-free diet and radical reduction of meat. Working on reduction of gluten.

I have one question and would be grateful if anyone could advise sth:
What would be the best scheme of taking Keppra to sensitize the tumour for TMZ. Does it matter, if the first doze (500mg) is taken with Temodal on an empty stomach or he can take it later, after his daily radiation (with a meal afterwards)?
Should we add Prozac and Disulfiram, apart from Keppra, for a better chance of TMZ working?



  1. During the six weeks of radiochemotherapy, I would focus on sensitizing the tumor to radiation as the main priority. Some ideas on how to do this can be found here:

    keeping in mind much of this evidence comes from mouse studies. One of the most impressive mouse studies I've seen was a study applying ketogenic diet to radiation treatment (a summary of this study can be found on the linked page above). A sugar-free diet is great, and if a more radical diet (like ketogenic) could be tolerated for six weeks, now would be the time to do it.

    Valproic acid was not shown to be a radiosensitizer in a recent large retrospective study, but that could have been due to doses being too low in many of the patients. A recently published phase 2 trial added 25 mg/kg/day of valproic acid (divided into two daily doses) to radiochemotherapy, with good PFS and surprisingly good overall survival outcomes for newly diagnosed GBM.

    Keppra is likely more important during the follow-up cycles of monthly TMZ therapy (5/23).

    Disulfiram could potentially synergize with radiation, provided enough gets into the tumor.

    I would be hesitant about vitamin C during radiation - there was a mouse study showing that vitamin C (ascorbate) injected into mice countered the efficacy of radiation.

    Melatonin might be a better choice as a radioprotectant.

    Good luck!

  2. Whatever Stephen says.. always :-) If adding disulfiram I believe copper should be considered too as it may enhance it. Also curious about rectal administration of CBD, rather than under the tongue. Is this equally effective for glioblastoma? (If you know..)


  3. Thank you for your tips!

    Annie, although it's generally recommended to use THC/CBD sublingually, there is some evidence in Poland that also rectal administration works well for GBM (personally I know 2 cases of using suppositories with THC and getting clear MRIs consequently. To be precise, one of them used THC per rectum and was ingesting CBD).