Hi
I hope all good and i want to ask you some questions
My mother will finish Radiation and TMZ ( 42 days) on 29/10 she still have 2
radiation sessions ,she is taking 120 mg of Temodal daily and doctor
tell us he will give her month free without Chemo then will doubled TMZ
to 240 mg
Her MGMT is Methylated and i am asking doctor for Combination Lomustine
& Temodal but he said this is not official and i cant doing it
I am planing to give here Combination without doctor supervision , is it safe to give her the combination?
Also i want to ask when can i give here the combination ? in this free month? Or when she start Chemo 240 mg after 1 month
Her PLT before 3 days 231000
Thanks in advance
Her 120 mg and 240 mg dose of TMZ most likely corresponds to 75 mg/m2 and 150 mg/m2, with her body surface are probably being around 1.6 m2.
ReplyDeleteIn the CeTeG trial, (see my review and comments here - https://btcocktails.blogspot.com/2017/11/sno-summary-episode-1-ceteg-trial-ccnu.html )
the dose of lomustine given on day 1 of the 6 weeks cycle was 100 mg/m2 and then TMZ at a dose of 100 mg/m2 on days 2-6.
That would amount to about 160 mg of TMZ on each of the five days if your mother's body surface is 1.6 m2.
In the trial there was an allowance to increase the TMZ dose up to 200 mg/m2 in subsequent cycles if the 100 mg/m2 dose was well tolerated.
One problem in doing this without doctor co-operation is that the lomustine + TMZ cycles are 6 weeks long, while TMZ alone cycles are 4 weeks long. If the doctor wasn't aware she was also taking lomustine and going on a 6 week (rather than 4 week) cycle, the blood monitoring would be thrown off-kilter. The relationship with her oncologist would also likely deteriorate if he found out you were trying to do this without his knowledge. This would be far from ideal.
In my summary of the trial (see link above) I mentioned that the combination chemotherapy doubled the rate of lower grade hematological toxicity. This regimen is harder on the blood than TMZ alone, and probably better tolerated by younger fit patients than the elderly. We still don't fully understand why overall survival was improved with combination chemo, while progression-free survival wasn't different. There might have been increased pseudoprogression leading to shorter apparent PFS in the combination treatment group, but that is just a theory and hasn't been demonstrated.
Is it possible to look for another doctor who would be willing to supervise the combination regimen? It would be difficult to pull this off safely without doctor co-operation.
In the blog archives, see all discussions of combination lomustine + TMZ here:
https://btcocktails.blogspot.com/search/label/temozolomide_plus_CCNU%2Flomustine
So as you say i cant give her lomustione without doctor supervision , I want to ask if there is any benefit if i give her give her Lomustine when she start TMZ 240 mg for 5 days on month .
ReplyDeleteFor example on the first day of week Lomustine 160 mg,then after one or two days Temodal 240 mg..
Could it be less toxicity and useful?
What you are asking about (lomustine 160 mg, followed by TMZ in following days) is basically the same thing they did in the CeTeG trial. Lomustine generally requires a longer recovery period which is why they use a 6 week cycle rather than a 4 week cycle. Trying to stay on a 4 week cycle while doing lomustine would probably be too toxic, unless you significantly drop the dose, but then you'd be getting away from the clinical data that supports this combination (namely the CeTeG trial with its dosing and schedule). But doing the 6 week cycles as they did in the CeTeG trial would be awkward without the oncologist's knowledge, because he wouldn't be able to monitor her blood appropriately unless he knew she was on a 6 week cycle. I'm not saying it can't be done, just that there is greater risk involved if you try to do it without her doctor's knowledge and support. Because blood testing is done at specific times during chemotherapy cycles and the timing would be different on a 6 week cycle versus a 4 week cycle.
DeleteFinally i found Oncologist in Dubai he will help me to start the cycles after 1 month from now .
DeleteThanks alot for your help