Hi Stephen,
Could I check if my interpretation of the G34r mutation of GBM is correct.
Does this mutation mean that only a small part of the tumour is methylated?

Stephen W added the following image from the study Hotspot Mutations in H3F3A
and IDH1 Define Distinct Epigenetic and Biological Subgroups of Glioblastoma

mTOR inhibitors

Does anyone have any knowledge of mTOR inhibitors and availability?

I am looking into them as a target for MYCN amplification due to the
 H3F3A G34r mutation that my daughter has.

We have today had recurrence confirmed in inoperable areas and are trying to decide what may be the best way forward.
There don't seem to be a lot of options with this mutation.

Cocktail Medication Times.

I am finding it tricky to decide the best times to give my 18yr old daughter her Cocktail medications and wonder if anyone could advise?
 The NO has stopped her TMZ saying he thinks she has her first recurrence within the 6 months of  TMZ after radiotherapy. It's in a different area to original tumour and NO thinks it extends to Brain Stem so we are waiting the date of a Perfusion Sequencing MRI Scan. Her GBM is Methylated. original Biopsy said ATRX lost, focal positivity for GFAP. EMA is negative as well as IDH1. Proliferation labelled Ki67 reached 40% focally. I've been told recurrence Biopsy if done would probably have different results.
I am keen therefore to get the maximum benefit from the medications she is on, which are:-
Celebrex 100mg x 2  x twice daily
Itraconazole 100mg x 1 x once a day
Keppra 750mg morning 1000mg evening
Metformin 500mg x 1 x twice daily
Omeprazole 20mg x1 x twice daily
Rantidine 150mg x1 x once a day
Dexamethasone 6mg x twice daily
Melatonin 10mg x 2 bedtime
Docusate 100mg if required for constipation.
Cyclizine 50mg x 1 up to 3 times daily if required for nausea.
PSK 16 1070mg x 3 once daily
Pure Fish Oil 1100mg x 2 once daily
Vitamin D3 x 2 1000unit tabs once daily.
Yesterday she also started Doxycycline 100mg x 1 once a day.
I read that Dexamethasone reduces the effectiveness of Itraconazole and some medications like
Doxycycline need to be taken two hours apart from indigestion remedies.
Any help as to how to optimize the use of these medications, and /or any recommended treatment advice would be greatly appreciated.
I'm aware that she needs to be on more Cocktail medications but these are proving difficult to get at the moment. Not sure if there any that would be of particular benefit to get right now?We are awaiting delivery of Boswellia and are hoping to get a prescription for Low Dose Naltrexone.
Regards
Jo

IDH1/IDH2 status?

I've spent some time on the sister site, AstrocytomaOptions, but I'm still not quite sure of the significance of these two markers.

My wife doesn't appear to have either of these mutations and I'm not sure if that's a good or bad thing, or is it merely a status. Does someone that doesn't have these mutations change their cocktails, and if so, in what meaningful way?

Thoughts?