Plerixafor - new drug to cocktail?

Hello!

1. There is one promising report on the treatment of TMZ+Plerixafor (+Lapatinib  pulse dosing) for glioblastoma:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965258/
Plerixafor was administered subcutaneously 1 time per week for 2 years.

2. And one ongoing trial studie at phase II:
https://clinicaltrials.gov/ct2/show/study/NCT01977677?term=AMD3100+glioblastoma&rank=1

Plerixafor was administered via continuous intravenous infusion of 400 micrograms/kg/day starting one week prior to end of RT and continuing for 4 weeks.

Here are published abstratcs:
http://ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.2058
http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.2068

3. There are also several articles about Plerixafor:
https://www.ncbi.nlm.nih.gov/pubmed/27863376
https://www.ncbi.nlm.nih.gov/pubmed/27015814
https://www.ncbi.nlm.nih.gov/pubmed/26023083
https://www.ncbi.nlm.nih.gov/pubmed/25676691
https://www.ncbi.nlm.nih.gov/pubmed/25860928

Stephen wrote that 1 shot of Plerixafor is very expensive, but I am in Delhi (India) and here Plerixafor 24mg/1.2 ml (Celrixafor by Celon Labs) is $ 1000.

What do You think about this medication and what are the tactics of its use more effective?

What do You think about Lapatinib used in the first case, pulse dosing? If it is suitable for all types of glioblastoma? clinical research is also going on:
https://clinicaltrials.gov/show/NCT01591577

Surgery, Avastin or Study Drug Abemaciclib ?

My husband (54yr.) is ~12 months post total surgical resection of GBM unmethylated (got standard treatment of radiation, temodar, and additional 1 mo. of  study drug -IV plerixafor-to enhance radiation effects) Over the past 4 months. MRI is showing increased changes that appear to be evolving treatment changes probably from Plerixafor enhancement of radiation  (+ more swelling) and it appears ther could be a small nodule of  GBM tumor recurrence. His symptoms have also increased (some speech stumbling, small focal seizures, plus a grand mal).  Thus he was put on dexamethasone (steriod 4 mg twice daily (now down to 6mg daily)  and increased Keppra from 2000mg daily to 3000mg daily) .  Next the NO wants to start Avastin (the NO is NOT for surgery).  We are trying to decide on a few options and will get one more MRI  and possibly PET CT to see if tumor recurrence is more definitive.

Choices:
1.  If MIR confirms additional growth, then Surgical removal of tumor first (surgeons recommendation)
2.  Avastin for swelling and to shrink tumor and perhaps add on Optune (NO's recommendation)
3.  2nd opinion of NO at UCSF site suggests Study drug Abemaciclib  due to gene testing of my husband's tumor pathology that shows CDKN2A, CDKN2B.  If we take this route then NO AVASTIN can be used.

Trying to figure out best option for highest functioning and quality of life.

Your Thoughts Appreciated.

Is Vasculogenesis the reason for Tumor growth after Radiation?

Stephen and all -

What's your experience or opinion on anti-vasculogenesis following chemo and radiation therapy?

Research below is claiming that Radiation kills the angiogenesis mechanism and the tumor grows back not due to angiogenesis but due to vasculogenesis after standard therapy. So HIF-1 and SDF need to be inhibited. Plerixafor is one such treatment. More articles available on Google search.

http://www.ncbi.nlm.nih.gov/pubmed/20179352