tag:blogger.com,1999:blog-6235733697979948062.post2194430170802411951..comments2024-03-19T00:33:30.191-07:00Comments on our brain tumor cocktails and stories: Avastin + Irinotecan?Stephen Whttp://www.blogger.com/profile/00777652648990108253noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-6235733697979948062.post-39002753686004782112018-01-24T19:24:25.145-08:002018-01-24T19:24:25.145-08:00Comparing Avastin (BEV) + lomustine (CCNU) to Avas...Comparing Avastin (BEV) + lomustine (CCNU) to Avastin + irinotecan:<br /><br />Lom-bev caused a significantly higher frequency of thrombocytopenia (11.4% grade 3-4) compared to iri-bev (3.5% grade 3-4). Iri-bev patients had more gastrointestinal toxicity with regard to nausea, vomiting, diarrhea, constipation and stomatitis.<br /><br />The response rate was 37.1% for lom-bev and 30.1% for iri-bev.Stephen Whttps://www.blogger.com/profile/00777652648990108253noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-44111766817580086242018-01-15T20:44:28.012-08:002018-01-15T20:44:28.012-08:00https://www.ncbi.nlm.nih.gov/pubmed/29330749
Toxic...https://www.ncbi.nlm.nih.gov/pubmed/29330749<br />Toxicity and efficacy of lomustine and bevacizumab in recurrent glioblastoma patients.Stephen Whttps://www.blogger.com/profile/00777652648990108253noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-91103245136488418712018-01-15T15:39:31.760-08:002018-01-15T15:39:31.760-08:00That quote refers to the trial population as a who...That quote refers to the trial population as a whole. When you look at the MGMT-methylated subgroup, there is a modest improvement in overall survival when Avastin is added. Median OS 10.35 months versus 12.55 months, hazard ratio = 0.72.<br /><br />Also in the BELOB trial survival at 18 months was approximately 30% with the combination, but only approximately 15% for either drug alone (see figure 2 from the 2014 publication). <br /><br />Has he had recent bloodwork? What are his neutrophil counts? There is some evidence that a high neutrophil count can predict response to Avastin.<br />https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342600/Stephen Whttps://www.blogger.com/profile/00777652648990108253noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-45027681999996897712018-01-15T14:41:05.615-08:002018-01-15T14:41:05.615-08:00"EORTC 26101 provided phase 3 data on the eff..."EORTC 26101 provided phase 3 data on the efficacy of bevacizumab in patients with progressive glioblastoma. Adding bevacizumab to lomustine did not confer a survival advantage over lomustine alone but prolonged progression-free survival somewhat."<br /><br />So, if the patient starts taking Lomustine, then there's no point in continuing to take Avastin?<br />Winning in time to progression is not worth the toxicity, because in Avastin+Lomustine combination overall survival does not improve!<br /><br />The only significant reason why I can choose Avastin and Lomustine is an attempt to add angiotensin system inhibitors (only with low dose Avastin).<br />https://www.ncbi.nlm.nih.gov/pubmed/28631191<br /><br />Semyonhttps://www.blogger.com/profile/13802560978744551839noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-21550424659715054032018-01-15T11:35:40.126-08:002018-01-15T11:35:40.126-08:00I really do not know what to do. Tomorrow I must t...I really do not know what to do. Tomorrow I must to make a decision. Strange to cancel temozolomid so early, immediately after chemoradiotherapy.<br />But the tumor has grown huge for 3 weeks after the operation and has not decreased for the entire course of radiotherapy and temozolomide!<br /><br />Perhaps Lomustine will make temozolomide work? MGMT is methylated.<br /><br />But Mom already took Avastin's first dropper. And we can not combine everything together: Avastin, Lomustine, Temolosomide .. (I have not seen any such test.<br /><br />It is probably better to stop Avastin after the first dropper and try CeTeg protocol?Semyonhttps://www.blogger.com/profile/13802560978744551839noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-7746375796823216122018-01-14T02:03:15.198-08:002018-01-14T02:03:15.198-08:00Thank you for message! good luck to you!
Did you ...Thank you for message! good luck to you!<br /><br />Did you have a large tumor after chemoradiotherapy? and why was it? could not be removed or grown so quickly after the operation?Semyonhttps://www.blogger.com/profile/13802560978744551839noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-62162179518141252342018-01-13T21:11:27.745-08:002018-01-13T21:11:27.745-08:00After your messages, I persuaded the doctor to use...After your messages, I persuaded the doctor to use the combination Avastin + Lomustine.<br />Mom has already received the first dropper Avastin and now we are waiting for the leukocyte count to start Lomustine.<br /><br />However, in the comments above it is also written that TMZ can still give a result.<br />I am now thinking, maybe after taking Lomustin take 5 days TMZ (as in CeTeg experience) and see the result on MRI in a month? But is it possible to apply TMZ if the mother has already taken Avastin?<br /><br />Can we combine CeTeg and a small dose of Avastin (one dropper in 2 weeks - 6 mg / kg / 2 weeks)? The tumor grew very rapidly after surgery, slightly increased after chemoradiotherapy and it is probably necessary to try this combination?<br /> Semyonhttps://www.blogger.com/profile/13802560978744551839noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-38390718699357968132018-01-13T14:18:36.218-08:002018-01-13T14:18:36.218-08:00Same tumor ... also had no reaction with TMZ+radio...Same tumor ... also had no reaction with TMZ+radio. But my tumor shrunk for the 9 months thereafter with Stupp (TMZ) + additional cycles of TMZ + Methadone + Optune. <br /><br />Thus, I would disconfirm the opinion of your doctor that it has to help until radio is over. <br /><br />Also, normally first MRI after start of radio is at least 6 weeks after radio is over. Otherwise you can not interpret the picture due to the injuries to the tissue following radiotherapy.derjoehttps://www.blogger.com/profile/12602966988277938282noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-54002347735658799442018-01-13T11:16:39.249-08:002018-01-13T11:16:39.249-08:00In our sister experience it didn help Avastin + Ir...In our sister experience it didn help Avastin + IrinotecanAnonymoushttps://www.blogger.com/profile/12582035517064846789noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-43095558687274394202018-01-11T15:19:18.297-08:002018-01-11T15:19:18.297-08:00Bevacizumab + irinotecan was a popular combination...Bevacizumab + irinotecan was a popular combination earlier (several trials reported in the 2008-2010 period), but since the BELOB trial was published in 2014 it has become more common to combine Avastin with lomustine/CCNU in place of irinotecan.<br /><br />Continuing the DCA and chloroquine could help combat resistance to Avastin. I'm not aware of anything specific that would help with irinotecan. <br /><br />In the BRAIN trial https://www.ncbi.nlm.nih.gov/pubmed/19720927<br />BEV + irinotecan gave moderately better progression-free survival outcomes compared to BEV alone, but nearly identical overall survival from recurrence.<br /><br />Did the doctor mention BEV + CCNU/lomustine as being a possibility?Stephen Whttps://www.blogger.com/profile/00777652648990108253noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-68438194515227836372018-01-11T14:01:50.074-08:002018-01-11T14:01:50.074-08:00It's very popular clinical decision in Russia ...It's very popular clinical decision in Russia - to use that combination of drugs. I think one have to use this type of drugs combo only for palliative reasons.Роман Хадиhttps://www.blogger.com/profile/09904727542984108090noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-90589423097143688402018-01-11T13:59:19.273-08:002018-01-11T13:59:19.273-08:00This study was not encouraging. https://www.ncbi.n...This study was not encouraging. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362611/<br /><br />The Mussella Foundation reports good results with Avastin and Optune. Have the doctors discussed that?mstixhttps://www.blogger.com/profile/09086818303147024271noreply@blogger.com