tag:blogger.com,1999:blog-6235733697979948062.post6410930536510479066..comments2024-03-19T00:33:30.191-07:00Comments on our brain tumor cocktails and stories: Treatment questionsStephen Whttp://www.blogger.com/profile/00777652648990108253noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-6235733697979948062.post-38760956701778193212019-04-16T18:26:51.307-07:002019-04-16T18:26:51.307-07:00Hi Christine
We are in a similar boat with AA3 di...Hi Christine<br /><br />We are in a similar boat with AA3 diagnosis and was wondering what can we do post SOC. How has your experience at IOZK been so far?<br /><br />Regards.Surbhihttps://www.blogger.com/profile/15842542441012430678noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-78435545863911066682017-09-03T09:07:40.922-07:002017-09-03T09:07:40.922-07:00Hi Christine,
I hope your husband is responding to...Hi Christine,<br />I hope your husband is responding to treatment.<br />My sister has AA3 and has gone through the standard of care. We're now going through different options on what to do next.<br />Would you like to share your thoughts on vaccines? You can email me vkalle455@gmail.com. Br, JuhaJuhaHhttps://www.blogger.com/profile/10532555954954439072noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-79890703377645325242017-03-06T16:28:50.934-08:002017-03-06T16:28:50.934-08:00Unfortunately the remaining 20% of his tumor is to...Unfortunately the remaining 20% of his tumor is too far into his Insula. They are unable to remove it. The second surgery was needed to make room to alleviate massive swelling causing a midline shift (11mm). <br /><br />The idea of hypermutation scares the crap out of me. I'm personally relieved by your opinion of going with 6 cycles instead of 12 at this point. I'd rather try and save TMZ for the future if needed. Our NO at UW has been trying to pin us down on whether we are going with 6 cycles or 12 and we have been feeling that 6 is best for now.<br /><br />His lymphocyte counts have been good. In the normal range of 20-40%, he consistently hits in the mid 30's.<br /><br />I'm feeling that Keppra needs to stay in his cocktail. After his final cycle of chemo is over, it won't be as necessary for sensitizing his tumor to the TMZ, but it's really helpful to know about the gap junctions. I'm going to let his NO know that we'd like to continue on with it.<br /><br />Thank you SO SO much!Anonymoushttps://www.blogger.com/profile/10613692666228282357noreply@blogger.comtag:blogger.com,1999:blog-6235733697979948062.post-39676108937662866512017-03-06T14:07:07.917-08:002017-03-06T14:07:07.917-08:00Did the second emergency surgery remove the remain...Did the second emergency surgery remove the remaining 20% of tumor? Normally with IDH-mutant gliomas I'd worry about prolonged TMZ cycles leading to hypermutation later on, but I feel this risk would be much less following a gross total resection, although I have no evidence to back this up.<br /><br />How have the 5 cycles of TMZ affected his lymphocyte counts so far?<br /><br />IDH-mutant grade 3 astrocytoma has a median of 4 years until tumor progression following radiation alone, and a longer time when TMZ is added on top of that. Of course tumor resection is a major factor, and median time until recurrence is even longer for gross total resected tumors. My feeling is that you could probably afford (in terms of time) to proceed with vaccine as planned and re-evaluate the need for further cycles of TMZ later. There is no right answer though, as nobody can predict outcomes with any certainty.<br /><br />Keppra (levetiracetam) at anti-seizure doses of 500-1000 mg twice daily reduced MGMT protein expression from baseline in four GBM patients who required a second surgery within a week or two or their original surgeries. This reduction in the level of MGMT protein would be expected to help sensitize tumors to TMZ.<br />(see figure 6 from this study: https://www.ncbi.nlm.nih.gov/pubmed/20525765 )<br /><br />Another therapeutic target for gliomas is gap junctions (communication between glioma cells and healthy astrocytes helps the tumor cells to survive). In vitro, levetiracetam decrease these gap junctions. The concentration used in the study is not too far above the actual achievable plasma levels (whereas the dex concentration isn't very realistic).<br />https://www.ncbi.nlm.nih.gov/labs/articles/27848138/<br /><br />These are two potential side benefits of sticking with Keppra.<br />Stephen Whttps://www.blogger.com/profile/00777652648990108253noreply@blogger.com