DOPA results & treatment options

Went back to UCLA to get the results of the DOPA PET scan. Unfortunately, the area on the dopa scan is positive which does indicate tumor. It verified that it is the same area of contrast we saw on the earlier MRIs. The new tumor is in a crescent shape around the resection area and has infiltrated into more sensitive areas of the brain.

options
surgery – at this point, the tumor is not causing any symptoms, the risk with surgery is that it can possibly take away tumor, but can cause symptoms that would be undesirable; unfortunately though, without tumor we can’t do dendritic cell vaccine

radiation – is an effective therapy, however, since it was given only 5yrs ago, it probably is not long enough to repeat and increases the likelihood of radiation damage (tissue breakdown) which again can cause undesirable symptoms

chemo – there's alot more data that exists today that when temodar was used successfully before and recurrence occurs greater than a yearafterwards..patients typically do really well on temodar again. This is Plan A that Mark is choosing for the first fight. Mark has already taken round 1 and we're waiting for the bloodwork on day21 and day28 before doing round2. We also asked about the risk of leukemia? Typically the risk is higher when you do a continual dosage which is why we stopped after 2 years. If a patient had a durable response while on Temodar the first round, it is a reasonable initial treatment choice for recurrence.

Metronomic doses of Temodar? – instead of 5 out of 28, it can be done week on week off or 21 days straight, it tends to affect white counts more (concern for Mark since he had issues with low counts last time around). The studies haven’t seen data that supports that it is any better than the normal dosage for tests done on recurrent tumors.

combining chemos – we could do this, but so far there isn’t a lot of good data with the agents they typically combine with (ccnu, acutane, etc) that warrant this choice as an initial treatment

avastin (now FDA approved!) can be more effective than temodar alone; however studies show that it works better when clear VEGF (vasculin growth factor) is present in the tumor area which can be noticed by evidence of swelling/adema. At recurrence you could go to avastin, but they believe that it is better to save til later on. Better to see if you get a response out of temodar. Avastin use can also exclude you from several trials. At this point Mark's tumor area isn't displaying these VEGF characteristics so Avastin isn't yet being suggested as part of plan A.

dendritic cell vaccine - there is no longer any of Mark's original tumor available to create a vaccine, surgery would be the only way to get another piece, but risks are high so it is not yet suggested. We asked about a synthetic version of the vaccine. Apparently there is a group at Baylor that trials one. It has a set number of antigens they combine with dendritic cell. It is often used with radiation but when combined they can’t see if there is a benefit from the vaccine or from the radiation. It is not typically used in recurrent setting. So far there don't seem to be any side effects if this is used. This could be an option Mark may consider.

Novacure headpiece - Electric field therapy to stop GBM cells from dividing
there is a phase 3 trial going on at USC, UCSD where they send an electric field over two grids. In a petrie dish it looks good, tumor cells don’t grow, however it is not yet proven if it goes through the skin/brain and produces the same results? They've had patients at UCLA try it out, but they complain about the burdensome nature of the treatment. You have to wear the device all the time, shave your head for good connection and carry around a 10-15 lb battery a minimum of 20hrs a day. Men seem to tolarate better because the battery is heavy. There don't seem to be any real side effects

Carl Berg/molecule?
Dr. C did look at some documentation on this molecule. At this point, there isn't documentation given didn’t show any evidence of success in glios. Dr. C said that he would talk to the doctors involved with this trial if we want him to.

what's next:
bloodwork to be done 4/8 and 4/15
next MRI 4/27