Monday, 22 July 2019

Seeing feedback on proposed treatment plan and drug/ supplement cocktail

Hi Stephen,

I finally have medical data back for my dad and we had our first meeting with his oncology teams yesterday. I have summarized his medical data as well as our treatment plan below.

A couple of notes and questions upfront:
  • I didn't see anything on my dad's medical records about MGMT
  • Would greatly appreciate your feedback on the proposed drug cocktail and supplements 
    • Are we missing anything?/ Dosages?
    • I would like to supplement COC protocol with some additional re-purposed drugs (particularly the first 4 in the table below. Do you have any information on dosage and how others go about getting prescriptions for these?

Many thanks again for your continued help.


Silvia


MEDICAL DATA:
  • Clinical synopsis
    • 64M p/w expressive dyphasia and headache with likely malignant transformation of L) temporal LGG
    • 2018 June generalised seizure diagnosed with left temporal mass likely LGG
      • Monitored as outpatient
      • Started on keppra and phenytoin for seizure control (self ceased keppra in January due to rash)
      • Last seizure in April
    • July 2019 clinical synopsis
      • Presented with headaches and expressive dyphasia 
      • Treatment
        • Stereotactic left temporal craniotomy and debulking of glioma (3 July)
        • Good postoperative course
        • Discharged 11 July
        • Medications

  • Histopathology results
    • Final Diagnosis: Left insula lesion: Glioblastoma. Features in keeping with IDH wild type (WHO grade IV)
    • GFAP positive
    • IDH-1 R132H negative (not mutated)
    • ATRX positive (not mutated)
    • P53 positive
    • P16 CDKN2A negative
    • Topoisomerase - approximately 20%

  • Post operative MRI
    • Small focus of residual enhancing tumour at the posterosuperior resection margin. Extensive oedema with midline shift measuring 9mm to the right and left uncal herniation has slightly improved

  • Recommending SOC treatment
    • Radiation / chemo to begin in ~3 weeks (~12 August)
      • Combined radiation & TMZ
        • Confirming targeted cavity and margin, not whole brain
        • Starting with 3 week course as patient is over 60
        • If patient is fit will recommend more aggressive 6 week treatment (TBD)
      • Followed by TMZ maintenance schedule 

OUR CURRENT PLAN
  • Commence SOC protocol as prescribed by medical team in ~3 weeks
  • Complement with 
    • (1) Ketogenic Diet
      • Strict 4:1 ratio, targeting Glucose / Ketone Index of 1:2 or lower (ideally 1:1 at 3mmol/ L each)
      • Calorie restricted ~900kcal/ day
      • Intermittent fasting (work towards target 2 - 8pm eating window)
      • Supplemented with Exogenous ketones (Caprilic acid and BHB salts during fasting window and can also be consumed during eating window) 
    • (2) Repurposed drugs cocktail per Care Oncology Clinic (submitted info, waiting for treatment plan)
    • (3) Supplements

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