Hi all!
I would be happy to hear your advice on metronomic TMZ administration. That has been widely discussed here already but I've got a specific question.
My dad's GBM is MGMT unmethylated (and there is some contrast enhancement after the radiochemotherapy). Our oncologist obviously doesn't have anything else to offer so she proposed cycles of monotherapy with 300 mg TMZ daily in the standard schedule 5/23, i.e. 3x100 mg TMZ capsules daily.
Is there any sense of switching to some "partial" metronomic schedule, i.e. he would take 1 capsule of 100 mg TMZ every day for 15 days. After 15 days we'll run out of TMZ (we've got 1500 mg in 100-mg-capsules for one cycle). The oncologist wouldn't agree to put him on full metronomic schedule as this is not allowed officially...
So to conclude, it would be 15 days on (100 mg daily), 13 days off.
High five from Poland!
Hi Piotr,
ReplyDeleteA 15/13 partial metronomic schedule would not likely give the same benefits as a 28-day schedule, as the point of a metronomic schedule is to put continuous pressure on the tumor or perhaps more importantly, the tumor vasculature. With that fixed amount of TMZ, one could do a 7-day on, 7-day off schedule, although the usual 7-day on, 7-day off schedule that has been tested in trials was with a higher dose (higher than 100mg/day).
There have been some very interesting results with very low dose TMZ in recurrent GBM, which I theorize could be due to effects on immune suppressor cells (?). 20 mg TMZ twice daily was used in this trial, combined with etodolac and propranolol:
http://meetinglibrary.asco.org/content/151704-156
Very interesting results, though I cannot confirm the reliability of this data.
Thank you Stephen!
ReplyDeleteAs far as I know the TMZ dose in the 7-day on, 7-days off schedule was 150 mg/m2. That's exactly what we have prescribed for the 5/23 standard.
I'll try contacting authors of the trial you mentioned. It sounds very interesting, indeed.