Treatment Options for progressive GBM

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Treatment Options for progressive GBM

by tisha55 on Wed Aug 26, 2009 12:00 AM

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My husband and I have been in a fog since his MRI last Thursday.  Expected good clean report since he is on the latest most aggressive therapy for GBM and instead this is not to be and the tumor is in new areas, which are deeper into the brain and crossing over.  So, since he has been on the avastin biweekly, the temodar daily, then 5/23 after surgery and radiation we have limited options as far as clinical trials.  His NO suggests adding Carboplatin to the Avastin and instead of temodar 5/23 going to low dose, daily temodar.  Has anyone done this?  Would you choose this for 6 more months or nothing and take 2-3 months and be off of all of this chemo?  This is what she says he's looking at most likely.

Heritage_Softail Heritage_Softai...
(Inactive)

RE: Treatment Options for progressive GBM

by Heritage_Softail on Wed Aug 26, 2009 12:00 AM

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Tisha,

As for the low dose temodar this option was discussed with my NO early on in my treatment. It is more like 23 days on and 5 days off. The opposite of the normal protocal. I have not started this "clinical trial" as it is on the sideline for now as I am stable currently. As for moving forward that would depend on how well your husband is tolerating the drugs overall. There are several clinical trials in regards to progressive tumors.

http://clinicaltrials.gov/ct2/results?term=Thalidomide+brain

I have posted above the area my NO is involved in with research. I am being seen at MDA. I know the choices are tough but I wish your husband and you the best, God Bless!

Damon

RE: Treatment Options for progressive GBM

by haley on Wed Aug 26, 2009 12:00 AM

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On 8/26/2009 tisha55 wrote:

My husband and I have been in a fog since his MRI last Thursday.  Expected good clean report since he is on the latest most aggressive therapy for GBM and instead this is not to be and the tumor is in new areas, which are deeper into the brain and crossing over.  So, since he has been on the avastin biweekly, the temodar daily, then 5/23 after surgery and radiation we have limited options as far as clinical trials.  His NO suggests adding Carboplatin to the Avastin and instead of temodar 5/23 going to low dose, daily temodar.  Has anyone done this?  Would you choose this for 6 more months or nothing and take 2-3 months and be off of all of this chemo?  This is what she says he's looking at most likely.

My dad was on a trial getting biweekly avastin and temodar 5/23. His last few scans showed increased white areas and after a MRS it was determined that some of this white area is tumor cells and some of it radiation damage. Yesterday his NO basically said that he would stop the temodar because every time he gets this treatment he continues to decline greatly (memory, falling, incontinence, weak) which we agree is not the best quality of life. He can stay on the Avastin because it was approved for treating reoccurance of GBM. His doctor mentioned that there are a few other chemo drugs out there, but none have been proven to be beneficial and would probably have more side effects than the Temodar. So we are wondering as well what to do. We do not want to just give up, but we also want him to have a life. Please let me know what your NO has said about Carboplatin.

 

Thanks,

Haley

RE: Treatment Options for progressive GBM

by madonnav on Wed Aug 26, 2009 12:00 AM

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Tisha;

My husband's July MRI showed progression, growth of one tumor and an additional spot above it.  He now has 4 spots in total.  2 of which were stable in that MRI.  He originally just had a biopsy of one spot, 30 days rad and temador, 4 cycles of Temador then this upset.  The brain tumor team agreed that since there was a new tumor site to use stereotactic radiotherapy for 11 days, everyother week avastin and continue 5/23 temador.  He finished the radiaion - no problems- 3 infusions of avastin and temador.  He will have an MRI next Weds. and meet with the NO before his next avastin infusion on Friday and to go over the MRI results. Needless to say I am sick to my stomach with worry so I know how you are feeling.  Have no idea what next but know that it will have to be something like adding CPT11.  OMG this is awful.  My thoughts and prayers.  I look through the clinical trial site all the time and have made some notes on trials for recurrent GBM- it narrows the search as there are so many for newly diagnosed.  Pittsburgh Medical UPMC has a dendric cell vaccine trial-not excluding recurrences, there is Cliengtide,sorafenib, Imatinib Mesylate, ZD6474, Cliengtide.  So confusing but best to be aware to bring to the Dr. attention.  Please keep me informed and vis versa. 

Donna, wife of Rob, dx 12/08 GBM multifocal

 

RE: Treatment Options for progressive GBM

by gbmwife on Wed Aug 26, 2009 12:00 AM

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My husband is on a trial that is currently enrolling of Azixa for progressive GBM.  He had large biopsy 7/22/08, 6 week rad and low dose Temodar starting 7/29/08, Avastin every 2 weeks starting 7/30/08, progression 7/20/09, Azixa infusion one per week 8/12, 8/19 and 8/26 with Mri 9/2/09 during week off.  He has continued to decline during the trial.

His tumor has crossed to the other side and he is confused not speaking much, etc.  we have increased his dex to 8 mg/day.  He is treated at Cedars-Sinai.  He is tolerating the infusion med just fine.

There are few trials for those that have already been on Avastin.

Take care,  Write with questions.

JMB 

RE: Treatment Options for progressive GBM

by tisha55 on Wed Aug 26, 2009 12:00 AM

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Haley,

Our NO said that the Carboplatin is usually tolerated pretty good.  Biggest side effect she sees is fatigue, but others mentioned on the paper are infusion reaction, decreased blood counts, hearing problems, kidney problems, diarrhea, and nausea.  She told us that this is the chemo they use on kids most of the time and that it has been around several years, so more data is avaiable on it than the ones in the studies.  She feels it would be better to go with one they have more info on for safety reasons at this point.  Adding a third line has worked for several of her patients and if this isn't the one she has a few more she thinks would be worth trying.  She says the Avastin and temodar should still help and figures it would be worth staying on this treatment plan for month and then do another MRI.  Hope that helps.  Tisha

RE: Treatment Options for progressive GBM

by goerge on Thu Aug 27, 2009 12:00 AM

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Here is an option that will if nothing else help you to understand you disease.

One thing that is not to often made known to cancer patients, probably because it is a little bit technical, is that malignant tumors shed antigen and that when this is in excess with antibodies , antigen-antibody complexes are formed, which block further attack and shields the tumor from the immune system both locally and system wide.

There is also not only a suppression of the immune response to the tumor by suppressor T-cells but there is also a mechanism of tolerance called T-Cells and B-cells anergy, where these important players in the immune response become unresponsive. This seems to be somewhat reversible with the removal of the antigen though (Sci. aug21 92).

Beside these problem there is also an immuno-selection process where easily targeted tumor cells are killed off and the surviving tumor cells increasingly produce new undetected lines of descendants.

In a nutshell these seem to be the main problems as to the persistence of diseased state in the face of natural defense mechanisms.

There is however a white blood cell that is capable of eating (phagocytes) antigen-antibody complexes and adcc (antibody dependant cell mediated cytotoxicity). This is where the immune cell locks on to the tail (fc) region of the antibody (shaped like a 3-d Y) that is attached to the cancer cell and chemically destroys it..

This white blood cell is call the eosinophil and because of these attributes and ease of access it is functionally equipped to combat multicellular parasites (helminthes), which present similar strategy requirements to cancer (size [relatively speaking], immunological shielding, and evasion).

Other immunotherapies fail because these therapies attemp to employ via vaccines, and other modes, macrophages, neutrophils, monocytes, and cytotoxic t’s which are equipped to elimiate smaller pathogens, and although these cells are needed in the total response they are by themselves ineffective against targets that are too large and that are immunolgically shielded by antigen antibody complexes.

Because activated eosinophils are associated with the strong and persistent th-2 immune response and because eosinophils are capable of both phagocytsising antigen and antibody complexes (Clinical and Basic Immunology 1977 edition page 285), have adcc capablities and have ease of access to and into the tumor, they meet the necessary strategic requirements in reducing tumor size.

Futhermore, because helminth excretory and secretory (HES) antigens elicite such a pronounced Th2 immune response that they cause bystander (Eur. J. Immunol. 2000. 30: 1977-1987 J. Holland et. al.) antigens (tumor) responses to also be driven to a Th2 response.

This will result in the immunolgical response to the tumor as if it were a helminth.

Freeze/thaw killed helminth ova have a similar effect but not as pronounced.

It can be implemented by first inoculating the patient with helminth antigen (not HES or ova).

When the serum eosinophil level reaches at least 20%; the HES or freeze/thaw killed ova of the same species as the inoculation can now be injected into the tumor or tumors. 

Best wishes,

George

RE: Treatment Options for progressive GBM

by brownsugar45 on Thu Aug 27, 2009 12:00 AM

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My mom had GBM we found out in dec.16 and she had the surgery and the treatment but her body could not handle the treatmant she died june 27,09. so be there for him and pray.

RE: Treatment Options for progressive GBM

by Nickio on Thu Aug 27, 2009 12:00 AM

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Ive had a GBM for 9years  I hadradiatio tcenuu gliadel wafers  now vastin and more temodar because I never had th full coourse befoe thst procarbazine Ive had 7 surgeries

RE: Treatment Options for progressive GBM

by Nickio on Thu Aug 27, 2009 12:00 AM

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On 8/27/2009 Nickio wrote:

Ive had a GBM for 9years  I hadradiatiothengliadel wafers  now vastin and more temodar because I never had the full coourse before that procarbazine
Ive had 7 surgeries radiation   twice

 

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