I'm posting on behalf of my sister with some questions about her treatment plan.
First, some background history:
2009: Initial diagnosis with full resection and biopsy diagnosed with grade 2 astrocytoma, resulting in watch and wait approach with no radiation / chemo and regular MRIs
2019: 10 yr MRI scan revealed recurrence of tumor in same location; partial resection and biopsy showed very localized portion of tumor had increased proliferation index resulting in grade 3 astrocytoma finding. She completed the IMRT and temodar (TMZ) regimen and has been on TMZ since last summer. She's being treated at Duke's Preston center.
She is IDH1 positive and no 1p/19q co-deletion
Due to COVID-19, her March scan was not conducted by Duke but rather by a local rural center and the scan showed evidence of progression in one area. She has a follow up scan next week at Duke.
Duke is recommending she 1) switch to lumostine (CCNU) or 2) enroll in the STELLAR trial in hopes to be randomized to the CCNU+eflornithine arm.
Questions for the group:
1) If she gets randomized to the lomustine alone arm, is there any real clinical or prognostic value to in staying in the STELLAR trial given that her non-trial treatment option is lumostine anyway and she would have fewer restrictions not in the trial
2) I am recommending she also take papaya leaf extract given the suggestion that it can help with platelet counts which is a known side effect of lumostine. Duke did not want her to take it because it has "antioxidant properties" which doesn't make sense. Does anyone understand this concern?
Thanks for the feedback and the resource of this group!!
Regarding the antioxidant question, this is a common thing for doctors to say about anything known to have antioxidant properties. Ben Williams wrote a long essay on this controversy if you're inclined.
ReplyDeletehttps://virtualtrials.com/pdf/williamssupplements2014.pdf
My opinion is that every "antioxidant" needs to be looked at individually. Some "antioxidants" may actually have other mechanisms that work well with conventional cancer therapies. For example a study where EGCG from green tea (an antioxidant) synergized with TMZ chemotherapy in mouse model.
https://pubmed.ncbi.nlm.nih.gov/21257259/
But yes, it is very common for oncologists everywhere to distrust anything with antioxidant properties during conventional therapies. Whether this is based on evidence or not is another question.