Hello all dear friends. I know that TMZ should be taken on an empty stomach. I know that Rich took TMZ on morning. How about Ben.W?I am really confused and I do not trust my oncologist.
Dear Stephen W maybe you are able to help me on that.
Thanks in advance.
My mom takes it in the afternoon on an empty stomach, one hour before RT. That's the way they did it in this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467382/
ReplyDeleteThe only breakfast she has is a smoothie made with: lemon juice, broccoli, ginger, water and a little bit of stevia.
Thanks dear paul.Yes,you are right. It was strange to me that some people took temodal in the morning. That's why I asked.
DeleteBety, in my opinion, it primarily depends on the radiotherapy schedule. TMZ must be taken on empty stomach (that is written in the leaflet of the drug), at least 1 hour before a meal, and shortly before the RT. I do not know exactly, how shortly before, but possibly providing a peak or maximum concentration in the tissue.
DeleteAs Paul wrote above, they took TMZ in the afternoon, but one hour before RT. In a paper here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908372/ they wrote
Experimental Design
Patients with primary or metastatic brain tumors had a microdialysis catheter placed in peritumoral brain tissue at the time of surgical debulking. CT scan confirmed the catheter location. Patients received a single oral dose of TMZ (150 mg/m2) on the first post-operative day, serial plasma and ICMD samples were collected over 24 hrs, and TMZ concentrations were determined by tandem mass spectrometry.
Results
Nine patients were enrolled. Dialysate and plasma samples were successfully collected from 7 of the 9 patients. The mean TMZ area-under-the-concentration-time-curve (AUC) in plasma and BI were 17.1 and 2.7 μg/ml × hr, with an average BI/plasma AUC ratio of 17.8%. The mean peak TMZ concentration in brain was 0.6 ± 0.3 μg/ml, and the mean time to reach peak level in brain was 2.0 ± 0.8 hrs.
In the paper cited by Paul
"Temozolomide was administered daily 1 hour before radiotherapy or in the morning on days without radiotherapy."
However, please double-check this yourself - we are not doctors...
Also, if you dig in this blog, there are threads and discussions at the same subject.
TMZ should be taken on an empty stomach. First in close connection to the radiotherapy. Later-on during the maintenance chemotherapy, I recommend to take it prior to going to sleep.
ReplyDeleteAgree to Stefan and SVG, TMZ should sensitize the Tumor for radiation, which is why it is taken shortly before the radiation treatment.
ReplyDeleteLater on, best time is probably late in the evening as this reduces/avoids nausea. Our oncologist recommended to take it on a completely empty stomach, 6 hours after dinner. But opinions differ here (an earlier recommendation was 2 hours). According to some studys, there is not a great difference between taking TMZ with or without food, but it is recommended to be consistent.
In general it seems that tmz at night is the base protocol and is to minimize the nausea/etc.
ReplyDeleteIn other oncology fields there has been some good data showing that the body's circadian rhythm impacts chemo effectiveness. So some clinics do 'chronotherapy' where the protocol is setup to try and optimize for division rates or drug efflux pump activity, etc.
There is some preliminary info in gliomas (https://clinicaltrials.gov/ct2/show/NCT02781792 and http://ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.e14035 for instance) but certainly no significant info yet.
But if self experimenting then maybe doing one set at night and then the next month doing it during the morning would be a way to stress the cancer a little differently each time.