Friday, 26 August 2016

Metrononmic TMZ for newly diag with amplified EGFR

My wife's 2nd 5/23 dose (which was doubled) has hit her hard.  I started looking into the metronomic TMZ option and found this very interesting clinical result for strong PFS and OS if you are EGFR amplified and on the metro dosage.

I'm curious:
1. what's your metro dosage been?
2. how have the side effects been?
3. is there anyone out there that has changed mid-stream from 5/23 to metro and if so, was it a significant help with daily QoL?

Thank you!

1 comment:

  1. I was impressed by this study as well, and have summarized it on Astrocytoma Options, and on page 16-17 of Treatment Options for Glioblastoma and other Gliomas.

    Two caveats I have about that study are that the metronomic dose used was 75mg/m2 which is higher than the standard 50mg/m2 dose used at recurrence and is the same dose used during radiation. This dose tends to be quite hard on lymphocytes over time, and I would not recommend it in combination with immunotherapy.

    Secondly, as this was a retrospective study, not a clinical trial, it's possible that selection bias contributed to the positive outcomes in the metronomic group. For example, if only the fittest patients were deemed healthy enough to withstand the higher dose metronomic schedule continuously. The study does not address why some patients were selected for this schedule rather than the standard schedule.

    Still, if lymphocyte counts are normal , and one is not undergoing immunotherapy, and EGFR is amplified or overexpressed, a metronomic schedule could certainly be a reasonable option, even more so if MGMT status is unmethylated.