Sunday, 10 June 2018

To go or not to go beyond the 6 chemo cycle mark?(3 cycles TMZ + 3 cycles TMZ+Lomustine)

Hi folks,

My mother is a glioblastoma patient who was diagnosed in Sep 2017(IDH1 -ve, methylated). She had a complete resection and has completed her radiation. Following the radiation, we did 3 cycles of temozolomide and the following two cycles were Lomustine(CCNU)+Temozolomide, since I stumbled upon a research that the combination of the two results in a significant improvement in life expectancy for methylated cancers.

However, since this research had 6 cycles of lomustine+temozolimde after the radiotherapy, I wish to ask if I should go beyond the total 6 cycle mark for my mom to do a total of 9 cycles of chemotherapy? Has somebody gone through a situation like mine and gone beyond six cycles of chemo with lomustine and temozolomide in their protocol? Does more chemo always mean better survival? I've heard from my fellow caregivers that an increase consumption of CCNU+TMZ has a risk of liver failiure and pneumonitis, how true is that? If it is, is there anything that we can do to reduce the risk and still do this combination for a total of 9 cycles to get the benefit this protocol gives?

Some context: My mom's last MRI 2 months back showed no growth, her health stays decent, she tolerates the chemo well and her platelet/WBC/Hb/RBC stay around 100k+, 2.5k-3k, 12 and 3.7-4 respectively even during the CCNU+Temozolomide combination.

My mom also takes these supplements: Curcumin(4-5 g/day), Boswellia(4000 mg/day), Keppra(1000 mg/day), Quercetin(3000 mg per day), Resveratrol(400 mg/day) Bromelain(700 mg/Day), Celebrex(600 mg/day), Green Tea(400 mg/day), Ashwagandha(500 mg/day), Metformin 1500 mg day, Doxycycline/Mebendezole, Fish Oil(3-4g/day) and is on a ketogenic diet

I would love to hear from you guys!


  1. Just as in the phase 3 "Stupp" clinical trial of temozolomide + radiation versus radiation alone (2005), the choice of 6 chemotherapy cycles seems rather arbitrary.

    There have been clinical studies showing that more cycles (up to 12) can have a progression-free and/or overall survival benefit, especially for patients with methylated MGMT status.

    For patients who don't benefit from chemo, more (or any) cycles could be detrimental.

    Although the risk of any adverse side effects increase with increased cumulative dose, the most likely adverse side effects from TMZ + CCNU are hematological toxicities (thrombocytopenia, leukopenia, neutropenia).

    If her blood counts hold up (platelets, lymphocytes, neutrophils) and nothing else is out of the ordinary (no elevated liver enzymes etc.) then considering more than three cycles of TMZ+CCNU seems reasonable to me, especially if MRI scans are showing the chemo is helping.

  2. Thank you so much for these inputs Stephen! Will consider having the additional cycles for my mom, in that case.