Hi, all!
I need advise about what to do...
First mri of my husband Vadym is 1 month afret radiotherapy with chemo.
Ans about this mri there are different opinions of NO.
First opinion is there are radiation gliosis and we have to start our first cours of TMZ. ( neurosurgeons).
Second opinion is tumor is growing and we have to start avastin 5 mg/kg per day, and after 4 injections we have to repead mri ( experianced NO).
We have no analisys of tumor ( methylation).
We were going to make first cours of tmz and after go to Germany for immunotherapy and so on.
May i ask about opinions about our situation?
Tania.
I need advise about what to do...
First mri of my husband Vadym is 1 month afret radiotherapy with chemo.
Ans about this mri there are different opinions of NO.
First opinion is there are radiation gliosis and we have to start our first cours of TMZ. ( neurosurgeons).
Second opinion is tumor is growing and we have to start avastin 5 mg/kg per day, and after 4 injections we have to repead mri ( experianced NO).
We have no analisys of tumor ( methylation).
We were going to make first cours of tmz and after go to Germany for immunotherapy and so on.
May i ask about opinions about our situation?
Tania.
And if we do temozolomide course now, when we can start Avastin after that in case tmz doesnt work?
ReplyDeleteThe dose of TMZ during radiotherapy (75mg/m2/day) is only half the daily dose that's used during the 5/23 schedule (150-200 mg/m2/day). My inclination would be to give chemotherapy a fair chance before concluding it has failed, esp. for younger patients with unknown or methylated MGMT status, like your husband.
ReplyDeleteAvastin could probably be started at any point if TMZ seems to not be working, although depending on the extent of residual tumor, vaccines/immunotherapy might be a better option here. How much tumor was left after his first surgery? Immunotherapy plus Avastin would also be an option.
I noticed the NO is suggesting a lower dose of Avastin (5 mg/kg), and there is some evidence that suggests this dose (half the normal dose of 10 mg/kg) is as effective as the higher dose with less toxicity.
Apart from the question of eligibility for clinical trials that don't allow prior Avastin, my hesitancy about upfront use of Avastin comes from the fact that though Avastin can do wonders in the short-term, staying on Avastin long enough for the tumor to develop resistance often leads to a quick decline thereafter.
There are situations where immediate use of Avastin would be indicated, for example patients with uncontrollable cerebral edema, or weakened patients who would not likely be able to tolerate further therapy at recurrence (may as well get the benefit from Avastin now if there won't be a second chance in those cases). Newly published information also shows tapering and discontinuation of Avastin once tumor control is achieved is also a viable option.
Short answer: TMZ should be given a fair chance before concluding it has failed, whether Avastin is used now or later.
Steven, thank you very much for this answer! It is my opinion too....Espessially, mri was done 1 month after radiation. Unifontis wants mri after 3 month after radiotherapy and before they recommend tmz. But, Vadym has really serious edema, he had convulsions, and he is now weakened.
ReplyDeleteResected around 80 % of tumor.
This is similar to what my husband experienced. One month post Chemo/radiation MRI showed what the oncologist hoped was pseudoprogession. Two months later next MRI showed that the questionable area had grown and it was deemed tumour progression by the oncologist and neurosurgeon. The radio oncologist disagreed with the neurosurgeon and the oncologist and said because it was within the radiation field and the appearance (something like soap bubbles appearance) that he though it was just a strong reaction to the radiation (pseudo progression). My husband started Avastin 7.5mg/k per f/night. The radio oncologist was correct it was pseudo progression and to date just over 2years later there still hasn't been any progression. However my husband had severe cerebral edema and the Avastin was able to successfully control that. Is the area of concern within the radiation field?
ReplyDeleteLinda, thank you veru much! Did your husband take TMZ during avastin?
ReplyDeleteAlan did a few months of TMZ 5/28 schedule then switched over to daily TMZ
DeleteLinda-
DeleteMy sis has recently been recommended to switch to daily tmz from the 5/23 that she's been on for around 16 months. How has it been for Alan? Does he handle it better then the 5/23 and how have the MRIs been? She handled it pretty well besides GI issues, losing some weight and her absolute lymphocytes continue to fall since been on it. Gonna post some more detailed questions to group but saw your post so fig I d ask u directly. Thanks for any info.
Kylie,
DeleteAlan's tumour is unmethylated so is less likely to respond to tmz. He had no problems on the daily dosage and didn't need to take any anti nausea medication. Alan's last MRI showed some progression.
Thanks! She's partially methylated. Hoping Alan's next MRI is stable or shrinking.
DeleteYes, it is a radiation field.
ReplyDeleteA FET-PET scan can make the distinction between pseudoprogression after radiochemotherapy versus real Progression. If pseudoprogression is confirmed, then TMZ is really worth to continue.
ReplyDeleteSVG, thank you very much for this post!
ReplyDeleteYou're right, of course. I had not thought about pet!
My sis has had a area of concern enhancing on MRI since end of rad/chemo phase over year and half ago. When it first appeared at first MRI at end of rad/chemo we got diff opinions (Dana Farber, Duke, Ucla) but most said stick w tmz 5/23 sched to wait and c as could b pseudo Prog. Well year and half later the enhancement has remained stable. We got a PET at one year mark (from start of maintenance tmz) and showed no active cancer cells. And did another PET two months later but since still enhancing and not 100% accurate they decided to do a biopsy to b sure. Just got results and shows some low grade cancer cells. So, recommends daily Temodar for six months w every 2 months MRIs. We did have one Neuro surgeon that initially recommended surgery to c if Temodar had worked and c what was enhancing back in beg after rad/chemo but went w maintenance chemo. No one had mentioned going right to avastin. Just fig I d let u know our experience. She was dx Dec 2014.
DeleteShe has been on 5/23 sched of tmz since rad/chemo ended (around 16 months I believe) and is going straight to daily now. Not sure if made that clear b4 that she did tmz the whole time w MRIs every two months.
Delete