Sunday, 9:40 PM
High-Level Journal Summary: Providing further information from the 5/24/08 online journal entry about Avastin. It is understood from the past 2 weeks about how harsh this IV-based chemotherapy is turning out to be. That information has not been lost. However, the reasons for many current actions are better explained in this recent clinical trial article on Avastin.
This excellent article reveals part of the reason why we are being so careful about having another brain bleed like on 1/8/08. The longer I go without a brain bleed, the more secure we could feel about an Avastin clinical trial in the future, such as if there were a GBM relapse because the current IV-based treatment did not work for some reason.
While Carboplatin + VP-16 is working so far, we must always plan for the worst. Having Avastin as an option is critical. Just reading this article helped fill in that picture even better for me.
Countdowns:
1.) Day 20 of 28 in Cycle 3 of Carboplatin + VP-16 chemotherapy. Healing continues from cycle 3 right now. My Decadron level was reduced today from 4 mg to just 2 mg, taken at 6 AM. This steroid level is still being slowly tapered from when leaving the Inova Hospital on 5/14/08. It is impacting my appetite, too. I am eating more, although I watch my meals wisely and continue to exercise every day (after a rare disruption earlier this month).
2008 Seizure Activity:
1.) Last Simple Partial Seizure, or SPS, was 8 days ago.
2.) In 2008, I have had 68 SPS's in 146 days. This is an average of 1 SPS every 2.1 days.
Website Updates:
Responses to Messages Page 187 were written throughout the day. Also, a new "Health Updates" section was provided on the Home Page of 38 Lemon.
Actual Journal: I addressed an important issue in my 5/24/08 online journal entry. This is an issue which projects a long way down the road, but as our entire medical team keeps our view open, this is an issue which warrants further explanation. It is yet another big part of why we are taking so many of our protective and immediate actions throughout this IV-based chemotherapy.
Avastin
This is what I wrote in my 5/24/08 online journal entry about the possible future use of Avastin. As a reminder, here is that brief text:
As a possible future treatment against brain cancer, Avastin cannot be used if I have a bleed in my brain (i.e., like "the bleed" on 1/8/08). That is why we must be so protective about any sort of future bleeding, which means having a solid Platelet count going into any new chemo cycle. We do not want to lose an option like Avastin which may have great future potential.
Here is a very recent article which tells much more about this Avastin treatment and why my neuro-oncologist Dr. Howard A. Fine at NIH knows this potential future treatment so well. This is shared verbatim from the Clinical Trials and Noteworthy Treatments for Brain Tumors website:
Avastin improves brain cancer survival
Friday May 16 2008
LOS ANGELES, May 15 (Reuters) - Results from a mid-stage trial showed treatment with Genentech Inc's Avastin improved survival for patients with recurring brain cancer, the company said on Thursday.
The Phase II trial compared Avastin, also known as bevicizumab, combined with irinotecan chemotherapy, to Avastin alone in patients with relapsed glioblastoma multiforme (GBM), the most common and aggressive type of brain cancer.
Genentech said results to be presented at a meeting of the American Society of Clinical Oncology show median survival was 9.2 months in the Avastin-only arm and 8.7 months in the Avastin and irinotecan arm.
As assessed by independent radiological review, 43 percent of GBM patients treated with Avastin alone and 50 percent of patients treated with Avastin in combination with chemotherapy lived without the disease advancing within six months.
"Avastin, both as a single agent and in combination with irinotecan chemotherapy, may improve survival compared to what would be normally expected for this devastating disease," Dr. Timothy Cloughesy, director of the neuro-oncology program at the University of California, Los Angeles, and a study investigator, said in a statement.
According to historical estimates, only 15 percent of patients with relapsed GBM would be expected to live without their cancer advancing within six months, he said.
Genentech said most side effects related to Avastin appeared to be similar to those reported in other studies, with the most common severe toxicities being high blood pressure and convulsion.
One patient in the Avastin and chemotherapy arm experienced a severe intracranial hemorrhage, the company said. There were two deaths associated with adverse events in the Avastin-only arm and one death associated with an adverse event in the Avastin-plus-chemotherapy arm.
Genentech said it plans to seek in the second half of this year U.S. Food and Drug Administration approval for Avastin as treatment for relapsed GBM. The company also said it expects to launch a Phase III study of Avastin in the first-line treatment of GBM this year.
The drug, designed to combat tumors by cutting off their blood supply, is already approved to treat colon, lung and breast cancer.
(Reporting by Deena Beasley; Editing by Braden Reddall)
We must protect for possible Avastin use
If I understand this language correctly, I am not in a situation where I have a "relapsed GBM" at this point. That is a huge part of what we are doing right now. We are killing, killing, killing -- so this tumor does not relapse, per se. We want this GBM stabilized for as long as humanly possible. That is our goal. That is why we are being so brutal in the toxicity of our treatments. We must be this harsh to fight such a tough opponent.
At the same time, we must plan for all worst possible situations. If we ever have a GBM relapse (or another warranted medical situation), then we want to have Avastin as a possible tool. In short, Avastin can potentially be more and more of a clinical trial option the longer we go without a brain bleed.
This helps my understanding
That put a bit more clear explanation on our overall motivations. For me, it is critical to understand things at this level. Strategically, it tells me "why we are doing what," both short-term and long-term. If Carboplatin + VP-16 ever failed, I would want to have Avastin lined up as a possible next treatment. We must take my current treatment and also maximize other options, both at the same time.
